20-year Rise in Spinal Cord Injury Mortality (1999-2020): Trends and Disparities Across Demography and Geography
Julieta Serobyan1, Robert del Carlo1, Eshita Sharma1, Ansh Sharma2, Neha Tahir3, Fatima Babi4, Aisha Rizwan Ahmed5, Yasmin Silva6, Yan Gabriel Morais David Silva7, Walter Fagundes8
1David Geffen School of Medicine at UCLA, 2Mountain House High School, 3King Edward Medical University, 4Quetta institute of medical sciences, 5Jinnah Medical and Dental College, 6Healthcare Institution of South Iceland, 7Hospital Ortopédico do Estado (Soc. Ben. Israelita Albert Einstein), 8Federal University of Espirito Santo. (UFES)
Objective:
The objective is to evaluate national mortality trends and identify sociodemographic and geographic disparities critical to guiding public health interventions.
Background:
Spinal cord injury (SCI) is associated with significant morbidity, long-term disability, and rising healthcare costs. Despite advances in trauma care and rehabilitation, SCI-related mortality increased over the past decade, disproportionately impacting older adults, racial minorities, and underserved geographic regions.
Design/Methods:
The CDC WONDER database was analyzed retrospectively for SCI mortality in individuals ≥25 years from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated using the 2000 U.S. Standard Population. Jointpoint regression assessed temporal trends to estimate Annual Percent Changes (APCs). Analyses were stratified by age group, sex, race/ethnicity, geographic region, and urbanization status.
Results:
Between 1999 and 2020, 106,824 SCI-related deaths occurred. AAMRs increased from 2.06 in 1999 to 2.14 in 2010, and further to 2.45 in 2020, with mortality rising exponentially with age, especially amongst men. Substantial racial disparities were observed. American Indian or Alaska Native adults had the highest AAMR (2.60), followed by White adults (2.34) and Black (2.00). Mortality among Black adults increased significantly after 2011 (APC +1.54%), indicating worsening disparities. Regionally, the Midwest exhibited the sharpest post-2010 increase (APC +1.82%), and non-metropolitan areas consistently demonstrated higher mortality compared to urban centers. Notably, large fringe metropolitan areas showed a concerning rise in SCI mortality (AAMR 2.37, APC +1.23%), revealing an emerging suburban public health vulnerability.
Conclusions:
SCI-related mortality has risen since 1999, with a more pronounced increase after 2010, driven by an aging population and persistent sociodemographic inequities. These findings underscore the urgent need for nationwide initiatives targeting older adults, expanded access to specialized SCI care for racial minorities, and investment in rehabilitation services for suburban and rural populations.
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