Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov;22(11):1026-1047.
doi: 10.1016/S1474-4422(23)00287-9.

Global, regional, and national burden of spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

GBD Spinal Cord Injuries Collaborators
Collaborators

Global, regional, and national burden of spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

GBD Spinal Cord Injuries Collaborators. Lancet Neurol. 2023 Nov.

Erratum in

Abstract

Background: Spinal cord injury (SCI) is a major cause of health loss due to premature mortality and long-term disability. We aimed to report on the global, regional, and national incidence, prevalence, and years of life lived with disability (YLDs) for SCI from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.

Methods: Using GBD 2019 data pooled in DisMod-MR 2.1, a Bayesian meta-regression tool, we systematically derived numbers and age-standardised rate changes with 95% uncertainty intervals (95% UIs) for the incidence, prevalence, and YLDs for SCI from 1990 to 2019 for the whole world, 21 GBD regions, and 204 countries and territories. We report trends based on age, sex, year, cause of injury, and level of injury.

Findings: Globally, 20·6 million (95% UI 18·9 to 23·6) individuals were living with SCI in 2019. The incidence of SCI was 0·9 million (0·7 to 1·2) cases with an estimated 6·2 million (4·5 to 8·2) YLDs. SCI rates increased substantially from 1990 to 2019 for global prevalence (81·5%, 74·2 to 87·1), incidence (52·7%, 30·3 to 69·8), and YLDs (65·4%, 56·3 to 76·0). However, global age-standardised rates per 100 000 population showed small changes in prevalence (5·8%, 2·6 to 9·5), incidence (-6·1%, -17·2 to 1·5), and YLDs (-1·5%, -5·5 to 3·2). Data for 2019 shows that the incidence of SCI increases sharply until age 15-19 years, where it remains reasonably constant until 85 years of age and older. By contrast, prevalence and YLDs showed similar patterns to each other, with one peak at around age 45-54 years. The incidence, prevalence, and YLDs of SCI have consistently been higher in men than in women globally, with a slight and steady increase for both men and women from 1990 to 2019. Between 1990 and 2019, SCI at neck level was more common than SCI below neck level in terms of incidence (492 thousand [354 to 675] vs 417 thousand [290 to 585]), prevalence (10·8 million [9·5 to 13·9] vs 9·7 million [9·2 to 10·4]), and YLDs (4·2 million [3·0 to 5·8] vs 1·9 million [1·3 to 2·5]). Falls (477 thousand [327 to 683] cases) and road injuries (230 thousand [122 to 389] cases) were the two leading causes of SCI globally in 2019.

Interpretation: Although age-standardised rates of incidence, prevalence, and YLDs for SCI changed only slightly, absolute counts increased substantially from 1990 to 2019. Geographical heterogeneity in demographic, spatial, and temporal patterns of SCI, at both the national and regional levels, should be considered by policy makers aiming to reduce the burden of SCI.

Funding: Bill & Melinda Gates Foundation.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests R C Franklin reports grants or contracts from Heatwaves in Queensland—Queensland Government and Arc Flash–Human Factors–Queensland Government; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Honoraria–World Safety Conference 2022–Conference Convener; support for attending meetings or travel from the Australasian College of Tropical Medicine for the Tropical Medicine and Travel Medicine Conference 2022 and from the International Society of Travel Medicine for the Travel Medicine Conference, Basel 2023; and leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with Kidsafe as Director, Farmsafe as Director, Auschem as Director, the Public Health Association of Australia Injury Prevention Special Interest Group as Convenor, and the International Society for Agricultural Safety and Health as a member of the Governance Committee, all outside the submitted work. E Trinka reports grants or contracts from the Austrian Science Fund (FWF), Oesterreichische Nationalbank, the EU, GSK, Biogen, Eisai, Novartis, Red Bull, Bayer, and UCB; consulting fees from Angelini, Clexio, Argenx, Arvelle, Epilog, Ever Pharma, UCB, Biogen, GSK, Bial, Eisai, Takeda, Newbridge, GW Pharma, Sunovion, Liva Nova, Marinus, Medtronic, Novartis, Sandoz, and Sanofi; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from UCB, Eisai, Biogen, Novartis, Bial, Sunovion, Ever Pharma, Liva Nova, Sanofi, Hikma, Newbridge, Arvelle, GW Pharma, and Sandoz; and other support from Neuroconsult as CEO, all outside the submitted work. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Global numbers of incidence, prevalence, and YLDs for spinal cord injuries, 1990–2019 Shading indicates 95% UIs. YLDs=years of life lived with disability.
Figure 2
Figure 2
Global age-standardised incidence, prevalence, and YLDs rates per 100 000 population for spinal cord injuries, 2019 (A) Age-standardised incidence rate. (B) Age-standardised prevalence rate. (C) Age-standardised YLDs rate. Countries for which no data (and therefore no modelled results) are available are shown in black. YLDs=years of life lived with disability.
Figure 2
Figure 2
Global age-standardised incidence, prevalence, and YLDs rates per 100 000 population for spinal cord injuries, 2019 (A) Age-standardised incidence rate. (B) Age-standardised prevalence rate. (C) Age-standardised YLDs rate. Countries for which no data (and therefore no modelled results) are available are shown in black. YLDs=years of life lived with disability.
Figure 3
Figure 3
Global numbers of incidence, prevalence, and YLDs for spinal cord injuries from all causes according to age group, 1990–2019 Early neonatal corresponds to the first week after birth, late neonatal corresponds to 1–4 weeks after birth, and post-neonatal corresponds to 4 weeks to 12 months after birth.
See this image and copyright information in PMC

Comment in

References

    1. Qasheesh M, Shaphe MA, Iqbal A, Alghadir AH. Association of psychological variants with functional outcomes among people with spinal cord injury. Sci Rep. 2021;11 - PMC - PubMed
    1. Thietje R, Pouw MH, Schulz AP, Kienast B, Hirschfeld S. Mortality in patients with traumatic spinal cord injury: descriptive analysis of 62 deceased subjects. J Spinal Cord Med. 2011;34:482–487. - PMC - PubMed
    1. van den Berg ME, Castellote JM, de Pedro-Cuesta J, Mahillo-Fernandez I. Survival after spinal cord injury: a systematic review. J Neurotrauma. 2010;27:1517–1528. - PubMed
    1. Ackery A, Tator C, Krassioukov A. A global perspective on spinal cord injury epidemiology. J Neurotrauma. 2004;21:1355–1370. - PubMed
    1. French DD, Campbell RR, Sabharwal S, Nelson AL, Palacios PA, Gavin-Dreschnack D. Health care costs for patients with chronic spinal cord injury in the Veterans Health Administration. J Spinal Cord Med. 2007;30:477–481. - PMC - PubMed

Publication types