Epidemiology of Traumatic Spinal Cord Injury in China

Background: China accounts for nearly one-fifth of the world's population. However, the national epidemiology of traumatic spinal cord injury (TSCI) is still unknown. Therefore, this study aimed to clarify the incidence and epidemiological characteristics of TSCI in China. Methods: We retrospectively reviewed the medical records of patients with spinal cord injury in hospitals and the ability to treat TSCI. TSCI was defined as the clinical manifestation of paraplegia or quadriplegia after trauma. We collected general data, causes of injury, level of injury, severity of injury, multiple injuries, complications and other data through the designed medical record questionnaire, and then performed an analysis according to geographical region, age and gender, and calculated the overall incidence of the whole country and each region. Findings: The study included medical records of 4,134 patients with a male to female ratio of 2·99:1. In 2018, the overall TSCI rate in China was 50·484 cases (95% CI: 50·122, 50·846) per one million persons, and the expected number of cases was 74,890. The highest incidence rate in the East was 53·791 (95% CI: 53·217, 54·365) cases per one million persons, and the expected number of cases was 33,724. The leading cause of injury was high falls (29·58%), the most common level of injury was cervical injury (64·49%). Regarding the severity of injury, the highest percentages of incomplete quadriplegia (55·20%). Interpretation: The estimated overall incidence of TSCI in China is similar to that of the United States. The leading cause of injury in different regions of China was determined. Preventive work should be carried out in a targeted manner. With the ageing population, there are more TSCIs in the elderly population due to low falls. Future public health policies need more strategies to prevent low falls and to widely publicize them. Funding Statement: This study was supported by the Key Program from the National Natural Science Funds (81830077); the General Program from the National Natural Science Funds (81772357);the National Natural Science Foundation of China; the Key Project from the Science and Technology Commission of Shaanxi (2017ZDXM-SF-054); the Department of Health, Shaanxi Province (2018E002); the Major Research from the Xi'an Science and Technology Department (2017123SF/YX017). Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: The Ethics Committee of Xi'an Honghui Hospital and the ethics committee of each participating centre approved the current study.