Lancet Neurol. 2023 Nov;22(11):1026-1047. doi: 10.1016/S1474-4422(23)00287-9.
Spinal cord injury (SCI) is a major cause of health loss due to premature mortality and long-term disability. We aimed to report on the global, regional, and national incidence, prevalence, and years of life lived with disability (YLDs) for SCI from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.
Using GBD 2019 data pooled in DisMod-MR 2.1, a Bayesian meta-regression tool, we systematically derived numbers and age-standardised rate changes with 95% uncertainty intervals (95% UIs) for the incidence, prevalence, and YLDs for SCI from 1990 to 2019 for the whole world, 21 GBD regions, and 204 countries and territories. We report trends based on age, sex, year, cause of injury, and level of injury.
Globally, 20·6 million (95% UI 18·9 to 23·6) individuals were living with SCI in 2019. The incidence of SCI was 0·9 million (0·7 to 1·2) cases with an estimated 6·2 million (4·5 to 8·2) YLDs. SCI rates increased substantially from 1990 to 2019 for global prevalence (81·5%, 74·2 to 87·1), incidence (52·7%, 30·3 to 69·8), and YLDs (65·4%, 56·3 to 76·0). However, global age-standardised rates per 100 000 population showed small changes in prevalence (5·8%, 2·6 to 9·5), incidence (-6·1%, -17·2 to 1·5), and YLDs (-1·5%, -5·5 to 3·2). Data for 2019 shows that the incidence of SCI increases sharply until age 15-19 years, where it remains reasonably constant until 85 years of age and older. By contrast, prevalence and YLDs showed similar patterns to each other, with one peak at around age 45-54 years. The incidence, prevalence, and YLDs of SCI have consistently been higher in men than in women globally, with a slight and steady increase for both men and women from 1990 to 2019. Between 1990 and 2019, SCI at neck level was more common than SCI below neck level in terms of incidence (492 thousand [354 to 675] vs 417 thousand [290 to 585]), prevalence (10·8 million [9·5 to 13·9] vs 9·7 million [9·2 to 10·4]), and YLDs (4·2 million [3·0 to 5·8] vs 1·9 million [1·3 to 2·5]). Falls (477 thousand [327 to 683] cases) and road injuries (230 thousand [122 to 389] cases) were the two leading causes of SCI globally in 2019.
Although age-standardised rates of incidence, prevalence, and YLDs for SCI changed only slightly, absolute counts increased substantially from 1990 to 2019. Geographical heterogeneity in demographic, spatial, and temporal patterns of SCI, at both the national and regional levels, should be considered by policy makers aiming to reduce the burden of SCI.
Bill & Melinda Gates Foundation.
脊髓损伤 (SCI) 是导致过早死亡和长期残疾的主要健康损失原因之一。我们旨在报告全球、区域和国家的发病率、患病率以及 1990 年至 2019 年残疾生命年（YLDs）的发生率、患病率和残疾生命年（YLDs），使用来自全球疾病、伤害和危险因素研究（GBD）2019 年的数据。
使用 GBD 2019 年汇总的数据，我们通过贝叶斯荟萃回归工具 DisMod-MR 2.1 系统地推导出 1990 年至 2019 年全球、21 个 GBD 地区和 204 个国家和地区的 SCI 发病率、患病率和 YLDs 的发生率、患病率和 YLDs 数据，并带有 95%不确定性区间（95%UI）。我们根据年龄、性别、年份、损伤原因和损伤程度报告趋势。
全球范围内，2019 年有 2060 万人（95%UI 1890 万至 2360 万）患有 SCI。SCI 的发病率为 0.9 百万（0.7 至 1.2）例，估计有 620 万（450 万至 820 万）残疾生命年（YLDs）。1990 年至 2019 年，全球患病率（81.5%，74.2%至 87.1%）、发病率（52.7%，30.3%至 69.8%）和 YLDs（65.4%，56.3%至 76.0%）的 SCI 发生率均显著增加。然而，全球标准化每 100000 人口发病率的标准率变化较小（5.8%，2.6%至 9.5%）、发病率（-6.1%，-17.2%至 1.5%）和 YLDs（-1.5%，-5.5%至 3.2%）。2019 年的数据显示，SCI 的发病率在 15-19 岁之间急剧增加，此后在 85 岁及以上年龄保持相对稳定。相比之下，患病率和 YLDs 表现出相似的模式，大约在 45-54 岁时出现一个高峰。全球范围内，SCI 的发病率、患病率和 YLDs 一直高于女性，男性和女性的发病率、患病率和 YLDs 从 1990 年到 2019 年都呈持续上升趋势。1990 年至 2019 年，颈部水平的 SCI 比颈部以下水平的 SCI 更为常见，在发病率（492 千[354 至 675]比 417 千[290 至 585]）、患病率（1080 万[950 至 1390 万]比 970 万[920 至 1040 万]）和 YLDs（420 万[300 至 580 万]比 190 万[130 万至 250 万]）方面。1990 年至 2019 年，全球 SCI 的两个主要原因是跌倒（477000 例）和道路伤害（230000 例）。
尽管 SCI 的发病率、患病率和 YLDs 的年龄标准化率变化不大，但绝对人数从 1990 年到 2019 年大幅增加。政策制定者应考虑国家和地区两级 SCI 的人口统计学、空间和时间模式的地域差异，以减少 SCI 的负担。
比尔及梅琳达·盖茨基金会。
