Original research
Changing Demographics and Injury Profile of New Traumatic Spinal Cord Injuries in the United States, 1972–2014

https://doi.org/10.1016/j.apmr.2016.03.017Get rights and content

Abstract

Objective

To document trends in the demographic and injury profile of new spinal cord injury (SCI) over time.

Design

Cross-sectional analysis of longitudinal data by injury years (1972–1979, 1980–1989, 1990–1999, 2000–2009, 2010–2014).

Setting

Twenty-eight Spinal Cord Injury Model Systems centers throughout the United States.

Participants

Persons with traumatic SCI (N=30,881) enrolled in the National Spinal Cord Injury Database.

Interventions

Not applicable.

Main Outcome Measures

Age, sex, race, education level, employment, marital status, etiology, and severity of injury.

Results

Age at injury has increased from 28.7 years in the 1970s to 42.2 years during 2010 to 2014. This aging phenomenon was noted for both sexes, all races, and all etiologies except acts of violence. The percentage of racial minorities expanded continuously over the last 5 decades. Virtually among all age groups, the average education levels and percentage of single/never married status have increased, which is similar to the trends noted in the general population. Although vehicular crashes continue to be the leading cause of SCI overall, the percentage has declined from 47.0% in the 1970s to 38.1% during 2010 to 2014. Injuries caused by falls have increased over time, particularly among those aged ≥46 years. Progressive increases in the percentages of high cervical and motor incomplete injuries were noted for various age, sex, race, and etiology groups.

Conclusions

Study findings call for geriatrics expertise and intercultural competency of the clinical team in the acute and rehabilitation care for SCI. This study also highlights the need for a multidimensional risk assessment and multifactorial intervention, especially to reduce falls and SCI in older adults.

Section snippets

Participants

The NSCID contains baseline and follow-up information on persons with traumatic SCI who received initial hospital care from 1 of the 28 SCIMS centers since the early 1970s; it historically captures data from approximately 13% of new SCIs in the United States.11 To be qualified for the NSCID, individuals must (1) have sustained an SCI due to a traumatic event; (2) reside in the geographic catchment area of the SCIMS center at injury; (3) be admitted to the SCIMS center within 1 year of injury;

Demographic profile

The average age at injury increased from 28.7 years in the 1970s to 42.2 years during 2010 to 2014 (table 1). The trend toward increasing age at injury was noted for both sexes and all races, with the greatest increase in white females, followed by white males, Hispanic females, black females, Hispanic males, and black males (table 2). The gradual increase in age at injury was observed within all etiology groups except acts of violence.

The percentage of new SCI cases who were members of a

Discussion

Analysis of the demographic and injury profile of traumatic SCI enrolled in the NSCID over the last 5 decades reveals new findings, including progressive increases in motor incomplete injuries, age-specific single/never married status, and education level. Previously reported trends, including increasing age at injury and proportions of racial minorities, fall etiology, and higher cervical injuries across decades, were continued to 2014 among various age, sex, race, and etiology groups. Below

Conclusions

Demographic and injury trends in new SCIs call for greater involvement of experts in gerontology and geriatrics and intercultural competency of clinical teams during acute and rehabilitation care for SCI. Educational materials that portray SCI cases as men in their teens and early 20s need to be updated. Prevention efforts should incorporate multidimensional risk assessments, especially to reduce falls and associated SCI in older adults.

Supplier

  • a.

    SAS v9.3; SAS Institute Inc.

References (33)

  • D.J. Strauss et al.

    Trends in life expectancy after spinal cord injury

    Arch Phys Med Rehabil

    (2006)
  • Y. Cao et al.

    Lifetime direct cost after spinal cord injury

    Top Spinal Cord Inj Rehabil

    (2011)
  • S. Kirshblum et al.

    Spinal cord medicine

    (2011)
  • C.H. Tator et al.

    Translational potential of preclinical trials of neuroprotection through pharmacotherapy for spinal cord injury

    J Neurosurg Spine

    (2012)
  • M.J. DeVivo

    Epidemiology of traumatic spinal cord injury: trends and future implications

    Spinal Cord

    (2012)
  • B.K. Go et al.

    The epidemiology of spinal cord injury

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    Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (grant no. 90DP0011). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

    Disclosures: none.

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