Overall Rate of Traumatic Spinal Cord Injury Remains Stable in United States

Between 1993 and 2012, the incidence rate of acute traumatic spinal cord injury remained relatively stable in the United States, although there was an increase among older adults, mostly associated with an increase in falls, according to a study in the June 9, 2015 issue of JAMA, a theme issue timed with the forthcoming 25th anniversary of the Americans with Disabilities Act.

Traumatic spinal cord injury (SCI) leads to chronic impairment and disability. Despite the substantial effects of this injury on health-related quality of life and health care spending, contemporary data on trends in incidence,causes, and medical care are limited, according to background information in the article.

Nitin B. Jain, M.D., M.S.P.H., of the Vanderbilt University School of Medicine in Nashville, Tenn., and colleagues analyzed survey data from the U.S. Nationwide Inpatient Sample (NIS) databases for 1993-2012 to examine trends in incidence, causes, health care utilization and mortality for acute traumatic SCI.

The total study sample consisted of 63,109 patients with acute traumatic SCI. The actual number of cases in the NIS database increased from 2,659 in 1993 to 3,393 in 2012. The incidence rate for acute traumatic SCI remained relatively stable:  The estimated rate was 53 cases per 1 million persons in 1993 and 54 cases per 1 million persons in 2012.

Incidence rates among the younger male population declined. For both the male and female populations, a high rate of increase in SCI incidence from 1993 to 2012 was observed in elderly persons. Although overall in-hospital mortality increased from 6.6 percent in 1993-1996 to 7.5 percent in 2010-2012, mortality decreased significantly from 24 percent in 1993-1996 to 20 percent in 2010-2012 among persons 85 years or older.

The percentage of SCI associated with falls increased significantly from 28 percent in 1997-2000 to 66 percent in 2010-2012 in those 65 years or older. "This is a major public health issue, and it likely represents a more active 65- to 84-year-old U.S. population currently compared with the 1990s, which increases the risk of falls in this age group. This issue may be further compounded in the future because of the aging population in the United States," the authors write.

Lesley Hudson, MA, project director of the Spinal Cord Injury Model System at Shepherd Center, concurs with the authors' conclusions regarding the increase in SCI.

"As the large 'Baby Boom' generation moves into the various stages of aging, many traumatic indices have shown an increase in injuries in the over-55 age group," Hudson said. "Spinal cord injury has tracked with this trend, as observed by the Spinal Cord Injury Model System National Data Center.

"In addition to the increase in individuals in this age category, one other cause of the increase in spinal cord injuries among this group is a more active lifestyle. Being less sedentary than previous generations at the over-55 age mark has its benefits, but increased activity -- sometimes beyond what may be safe -- also carries risk. The result of those two facts has caused an observed increase in the incidence of spinal cord injury in the U.S. population over the age of 55 years."

Recognizing this trend, Shepherd Center's Injury Prevention Program is emphasizing prevention of falls. Read more about it in this previously published Shepherd Center article.