Global trends and cross-country inequalities in spinal cord injury attributable to falls: a systematic analysis of the Global Burden of Disease Study 2021.

Abstract

Background context: Falls are the leading cause of spinal cord injury (SCI), imposing profound disability, mortality, and socioeconomic burden. However, the global trends, regional patterns, and health disparities in SCI attributable to falls remain inadequately explored.

Purpose: To provide a comprehensive analysis of the global, regional, and national burden of SCI attributable to falls from 1990 to 2021 using the Global Burden of Disease (GBD) 2021 database. This study identifies epidemiologic trends, quantifies cross-country inequalities, and forecasts future challenges.

Study design/setting: A cross-sectional study utilizing data from the GBD 2021.

Patient sample: Patients from 204 countries and territories who sustained SCI due to falls.

Outcome measures: Age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized years lived with disability (YLDs).

Methods: Data were extracted from the GBD 2021. Descriptive analyses were conducted to evaluate ASIR, ASPR, and ASYR globally and across socio-demographic index (SDI) quintiles. Temporal trends were evaluated using joinpoint regression and age-period-cohort models. Decomposition analysis quantified the impact of aging, population growth, and epidemiologic shifts on the burden. Frontier analysis and inequality assessments assessed disparities, while Bayesian modeling forecasted the burden through 2035.

Results: Between 1990 and 2021, global age-standardized rates of SCI attributable to falls declined in high-SDI regions but increased in middle- and low-SDI regions. Australasia and Western Europe had the highest burden in 2021, while East Asia and Oceania exhibited the fastest-growing trends. Population growth was the primary driver of the global burden increase, as revealed by decomposition analysis. Inequality assessments uncovered widening SDI-related disparities, with both absolute and relative inequalities. Projections through 2035 indicate a continued rise in the burden in the coming decades.

Conclusions: SCI attributable to falls poses a significant and growing global health challenge, with stark regional and socioeconomic disparities. While high-SDI regions have seen progress, rising burdens in low- and middle-SDI areas demand urgent, region-specific preventive measures and equitable healthcare interventions. Policymakers must act decisively to address demographic transitions, reduce disparities, and prioritize fall prevention strategies to mitigate the growing burden.