The incidence and trends of diving-related spine injuries in the United States and risk factors associated with spinal cord injury

Abstract

Study design: Retrospective longitudinal cohort study.

Objectives: To characterize: (1) incidence and trends of diving-related spine injuries (DRSI) and diving-related spinal cord injury (DRSCI) in the United States and (2) risk-factors associated with DRSCI.

Setting: Using a large, national, multi-insurance administrative dataset of over 161 million patients, those who suffered a DRSIs were identified and characterized.

Methods: Persons who suffered a DRSIs were analyzed from 2010-2021. Estimated annual percentage change (EAPC) was calculated by log-linear regression. For those with DRSCI, risk-factors were assessed by multivariable logistic regression.

Results: Of 3829 persons who suffered DRSIs, the cervical spine was most frequently involved (53.0%). EAPCs of DRSIs at the cervical, thoracic, and lumbar spine significantly decreased over the studied years (-4.69, -6.81, and -4.88%, respectively; p < 0.05 for all), while DRSCI demonstrated a nonsignificant trend (p = 0.081). Among the 629 (16.4%) with DRSCI, risk-factors included: prior cervical spine surgery (OR 13.31, p < 0.001), history of cervical spondylolisthesis (OR 5.36, p < 0.001), male sex (OR 2.69, p < 0.001), history of cervical stenosis (OR 2.26, p < 0.001), coastal states (OR 1.38, p = 0.012), higher Elixhauser Comorbidity Index (OR 1.15, p < 0.001), and older age (OR 1.01, p = 0.029).

Conclusions: The rate of DRSIs of the cervical, thoracic, and lumbar spine has significantly decreased in recent years in the United States. However, the nonsignificant trend in DRSCI highlights the importance of continued public health initiatives. Among those with DRSCI, several unique risk-factors were identified, laying the foundation for the refinement of current diving injury prevention programs.