Trends and Projections of Spinal Cord Injury Burden in China: Insights from the Global Burden of Disease 2023 Study

Background: Traumatic spinal cord injury (TSCI) leads to substantial health loss through both premature mortality and long-term disability. In this study, we used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to estimate the global, regional, and national incidence, prevalence, and years lived with disability (YLDs) associated with TSCI. Methods: DisMod-MR 2.3 was applied to estimate case counts and age-standardized rates (ASRs), together with 95% uncertainty intervals (95% UIs), for the incidence (ASIR), prevalence (ASPR), and years lived with disability (ASYR) of spinal cord injury (SCI) from 1990 to 2021 at the global level, across 21 GBD regions, and in 204 countries and territories. Trends in ASRs were quantified using the estimated annual percentage change (EAPC) derived from a linear regression model, and Spearman rank-order correlation was used to explore the relationship between the sociodemographic index (SDI) and the burden of TSCI. Results: In 2023 there were an estimated 574,502 (95% UI 440,219-757,445) new cases, 15,400,682 (95% UI 14,009,114-17,075,106) existing cases, and 1,305,142 (95% UI 917,167-1,726,419) YLDs attributable to TSCI in global. Between 1990 and 2021, the absolute numbers of incident, prevalent, and YLD cases increased, whereas the age-standardized incidence (ASIR), prevalence (ASPR), and YLD (ASYR) rates declined. Men consistently exhibited higher ASIR, ASPR, and ASYR than women, and these ASRs rose with advancing age. Cervical SCI showed higher ASIR and ASYR compared with SCI below the neck. In 2021, the SDI was positively associated with ASIR (rho = 0.4670, p <0.01), ASPR (rho = 0.4035, p <0.01), and ASYR (rho = 0.2727, p =0.003). 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.