Burden of vertebral fractures attributable to motor vehicle collisions in China, India, and globally, 1990–2021: findings from the Global Burden of Disease Study 2021

Background This research examines changes over time (1990–2021) in the health impact of vertebral fractures (VFs) linked to road traffic injuries with a specific focus on variations in age and sex across China and India. These trends are compared with global patterns. This investigation seeks to examine the mechanisms of injury and population distribution patterns underpinning this public health challenge. Methods Data, including crude and age-standardized rates (ASRs) of incidence, prevalence, and years lived with disability (YLDs) for MVRI-related VFs, were extracted from the 2021 Global Burden of Disease (GBD) study. To evaluate changes over time in the impact of the disease on MVRI-related VFs, we employed joinpoint regression analyses and age-period-cohort (APC) modeling. These methodologies were applied to characterize shifts in incidence, prevalence, and YLDs rates across the study timeline. They offer a dynamic perspective on how the burden of MVRI-induced VFs changed between 1990 and 2021. Results From 1990 to 2021, the global age-standardized incidence rate (ASIR) of MVRI-related VFs declined by 42.8% (annual average percentage change [AAPC] = -1.839%, 95% CI: -1.869 -1.808). However, China exhibited no significant reduction in the ASIR (AAPC = -0.478%, 95% CI: -0.531 -0.426), whereas India demonstrated negligible variation (AAPC = -0.013%, 95% CI: -0.054 to 0.028). Regional analysis revealed divergent drivers: period effects (2000–2021) associated with hazardous driving behaviors in Chinese males aged 20–40 years and cohort effects for individuals born in 1980–1990 emerged as central factors. Conversely, individuals aged > 60 years presented an increasing disease burden due to osteoporosis and accelerated motorization. Gender-based disparities were evident worldwide, with males displaying elevated age-standardized incidence (ASIR), prevalence (ASPR), and YLDs rates relative to females. These disparities peaked in magnitude in China’s younger male demographic. Conclusion China’s persistently high burden of MVRI-related VFs, which diverges from global downward trajectories, underscores the urgent need for demographically tailored interventions that prioritize behavioral risks in younger males and age-related biomechanical factors in older populations. Enhanced enforcement of road safety legislation and trauma care infrastructure is needed in India. This study identifies the heterogeneous demands for road injury mitigation in China and India and offers evidence-based insights to optimize the allocation of public health resources.