Wang Yikang
Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China.
Front Public Health. 2025 Aug 20;13:1622693. doi: 10.3389/fpubh.2025.1622693. eCollection 2025.
Traumatic central nervous system (CNS) injuries-particularly traumatic brain injury (TBI), spinal cord injury (SCI), and skull fractures-represent a significant global health challenge. Previous estimates have lacked a comprehensive global analysis of these injuries and their associated risk factors. Herein, we aimed to examine the epidemiological patterns, temporal trends and risk factors of TBI, SCI, and skull fractures globally from 1990 to 2021.
We extracted data from the Global Burden of Disease Study (GBD) 2021, including the prevalence, incidence, and years lived with disability (YLDs) of TBI, SCI, and skull fractures across 204 countries and territories from 1990 to 2021. Data were presented as both numerical counts and age-standardized rates (ASRs) per 100,000 population, with corresponding uncertainty intervals. To assess temporal trends in disease burden, we calculated the estimated annual percentage change (EAPC) with associated 95% confidence intervals.
Compared with 1990, the number of global incident cases in 2019 changed by 122.56, 121.29, and 97.49% for TBI, SCI, and skull fracture, respectively. During the 30-year study period, there was a downward trend in the ASR of prevalence, incidence and YLDs for TBI (EAPC = -0.68, -0.8 and -0.66, respectively), SCI (EAPC = -0.73, -0.81 and -1.01, respectively) and skull fracture (EAPC = -1.37, -1.15 and -1.38, respectively). Regions with higher sociodemographic indices had higher incidences, incidence rates, and YLDs for all three types of CNS injury. The burden of CNS injury varies notably among regions and nations. Eastern Europe, Central Europe, southern Latin America, Australasia, and high-income North America were the GBD regions with the highest burden of CNS injury, and the burdens of TBI, SCI, and skull fracture showed the most significant increasing trends in the Caribbean. Young-to-middle-aged men (15-39 years) bore the primary burden of TBI, SCI, and skull fractures. Falls were the leading specific risk factor for all three types of CNS injury, followed by motor vehicle road injuries. The global burden of TBI, SCI, and skull fractures is projected to decline through 2040, both in terms of absolute case counts and age-standardized incidence rates.
The global, regional, and national burdens of TBI, SCI, and skull fractures-reflected by their prevalence, incidence, and YLDs-exhibit significant disparities. Our findings can inform policymakers in formulating future strategies for managing traumatic CNS injuries, with priority given to targeted preventive measures against risk factors to mitigate the burden of these life-threatening and disabling CNS conditions.
创伤性中枢神经系统（CNS）损伤，特别是创伤性脑损伤（TBI）、脊髓损伤（SCI）和颅骨骨折，是一项重大的全球健康挑战。以往的估计缺乏对这些损伤及其相关危险因素的全面全球分析。在此，我们旨在研究1990年至2021年全球范围内TBI、SCI和颅骨骨折的流行病学模式、时间趋势及危险因素。
我们从《2021年全球疾病负担研究》（GBD 2021）中提取数据，包括1990年至2021年204个国家和地区的TBI、SCI和颅骨骨折的患病率、发病率和伤残调整生命年（YLDs）。数据以数值计数和每10万人的年龄标准化率（ASRs）呈现，并伴有相应的不确定性区间。为评估疾病负担的时间趋势，我们计算了估计年变化百分比（EAPC）及其相关的95%置信区间。
与1990年相比，2019年全球TBI、SCI和颅骨骨折的新发病例数分别增加了122.56%、121.29%和97.49%。在30年的研究期内，TBI（EAPC分别为-0.68、-0.8和-0.66）、SCI（EAPC分别为-0.73、-0.81和-1.01）和颅骨骨折（EAPC分别为-1.37、-1.15和-1.38）的患病率、发病率和YLDs的年龄标准化率呈下降趋势。社会人口学指数较高的地区，这三种类型的中枢神经系统损伤的发病率、发病率和YLDs也较高。中枢神经系统损伤的负担在不同地区和国家之间存在显著差异。东欧、中欧、拉丁美洲南部、澳大拉西亚和高收入的北美是中枢神经系统损伤负担最高的GBD地区，而TBI、SCI和颅骨骨折的负担在加勒比地区呈现出最显著的上升趋势。中青年男性（15 - 39岁）承担了TBI、SCI和颅骨骨折的主要负担。跌倒是所有三种类型中枢神经系统损伤的主要特定危险因素，其次是机动车道路伤害。预计到2040年，TBI、SCI和颅骨骨折的全球负担将在绝对病例数和年龄标准化发病率方面下降。
TBI、SCI和颅骨骨折的全球、区域和国家负担，通过其患病率、发病率和YLDs反映出来，存在显著差异。我们的研究结果可为政策制定者制定未来管理创伤性中枢神经系统损伤的策略提供参考，优先采取针对危险因素的有针对性预防措施，以减轻这些危及生命和导致残疾的中枢神经系统疾病的负担。
