Trends and disparities in spinal cord injury: incidence, prevalence, and disability across the United States from 1990 to 2023.

Abstract

Spinal cord injury (SCI) is associated with significant disability and mortality across the United States. Updated epidemiological data is necessary to direct public health efforts and policy development. The aim of this study was to characterize SCI burden in the US from 1990 to 2023 and to evaluate the incidence, prevalence, and years lived with disability (YLDs) across multiple strata, including age, sex, geography, and injury subtype. Epidemiological data were extracted from the Global Burden of Disease (GBD) database, including rates per 100,000 population of SCI incidence, prevalence, and YLDs. The US was divided into the four Census Bureau regions. State-level 2023 Human Development Index (HDI) values were obtained from the Global Data Lab. The Quality of Care Index, a composite measure derived from GBD outcome ratios, was calculated to assess health system performance by quantifying the discrepancy between SCI burden and disability outcomes. State-level differences in SCI metrics and their correlations with state HDI values were evaluated. In 2023, the national mean incidence of SCI was 26.88 per 100,000, with prevalence of 662.15 and YLDs of 174.93. From 1990 to 2023, incidence increased by 3.43%, while prevalence and YLD decreased by 18.84% and 23.64%, respectively. Cervical injuries consistently demonstrated higher incidence, prevalence, and YLDs than thoracic or lumbar injuries. Adults aged 65-79 years had the greatest prevalence, incidence, and YLDs. Regionally, the West had the highest 2023 incidence (28.89), prevalence (714.16), and YLDs (188.10). Across all regions, males had significantly higher SCI metrics than that of females (all p < 0.001). No significant associations were identified between state-level SCI metrics in 2023 and HDI values. The national Quality of Care Index was 90.3, and showed a moderately positive correlation with state HDI values (R2 = 0.48, p < 0.001). While the US burden of SCI has decreased over the past 34 years, unequal distribution across regions and sexes necessitates targeted prevention and policies to further reduce the SCI burden and improve patient outcomes and quality of life.