Global inequalities in the burden of traumatic spinal cord injury from 1990 to 2021: findings from the global burden of disease study 2021.

Instruction: Traumatic spinal cord injury (TSCI) can cause severe health loss because of premature mortality and long-term disabilities. This study estimated the global, regional, and national incidence, prevalence and years lived with disability (YLDs) of TSCI using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021.

Methods: DisMod-MR2.1 was utilized to derive case number and age-standardized rate (ASR) with 95% uncertainty intervals (95% UIs) for the incidence (ASIR), prevalence (ASPR), and YLDs (ASYR) for SCI from 1990 to 2021 for the whole world, 21 GBD regions, and 204 countries. Estimated annual percentage change (EAPC) was determined using a linear regression mode. Spearman rank order correlation was performed to identify the correlations between sociodemographic index (SDI) and the burden of TSCI.

Results: Globally, there were 574,502 (95% UI 440,219 to 757,445) incident cases, 15,400,682 (95% UI, 17,075,106-14,009,114) prevalent cases and 1,305,142 (95% UI, 1,726,419-917,167) YLDs of total TSCI in 2021. From 1990, the number of incidences, prevalence, and YLDs cases showed an upward trend, while the ASIR, ASPR, and ASYR showed a downward trend. Males had higher ASIR, ASPR, and ASYR, and the ASIR, ASPR, and ASYR increased with age. Cervical SCI had higher ASIR and ASYR than SCI below neck level. It showed positive correlations between SDI and ASIR (rho = 0.4670, p < 0.01), ASPR (rho = 0.4035, p < 0.01), and ASYR (rho = 0.2727, p = 0.003) in 2021.

Conclusion: The absolute counts of incidence, prevalence, and burden of TSCI substantially increased from 1990 to 2021, despite the decrease in corresponding ASRs. TSCI happened in the most active periods of individuals globally, which were shifting towards older age groups over time. TSCI had larger effects on the elderly and males than younger populations and females.