Employment and productivity losses from cervical spinal cord injury: a 7-year nationwide cohort study in Taiwan, 2012-2018.

Abstract

Objective: To investigate the extent to which employment and productivity losses could be prevented by mitigating cervical spinal cord injury (SCI) and concurrent traumatic brain injury (TBI) in Taiwan.

Design: Using Taiwan's National Health Insurance Database, we identified individuals with cervical SCI and concurrent TBI, with the 7-year data collection period (2012-2018) and a general population cohort as the reference. Survival and employment status were extrapolated to lifetime and age using rolling extrapolation with restricted cubic spline regression and generalized linear models.

Results: This study included 2,852 patients with cervical SCI and 367 with concurrent TBI. In cervical SCI, loss-of-life expectancy, loss-of-lifetime employment duration (LED), and loss-of-lifetime insured salary (LIS; a proxy for productivity) were 19.3 years, 7.5 years, and $122,998, respectively. The relative loss-of-LED of motor-vehicle-related cervical SCI with concurrent TBI was significantly higher than that without TBI (72.7% vs. 64.2%). The relative loss-of-LED in middle-aged cervical SCI was significantly higher than loss-of-LIS (58.2% vs. 63.5%), suggesting that total productivity was more severely affected than working time.

Conclusion: This 7-year nationwide cohort provides the first lifetime employment and productivity loss estimates for cervical SCI, demonstrating that concurrent TBI and younger age amplify economic burden. The findings shift the policy focus from generic SCI prevention to specific, high-yield interventions: mandatory TBI screening, age-tailored vocational programs, and productivity-targeted workplace accommodations. These evidence-based figures enable precise cost-benefit analyses for preventive measures (e.g. enhanced helmet legislation, road safety) and rehabilitation investments, offering actionable data for Taiwan's health and labor policymakers.