Incidence of SCI
Incidence is the proportion of a population initially free of the condition that develops it over a given period of time. In our review, incidence is standardized as the number of cases of traumatic SCI per million inhabitants a year.
Tables 2 to 5 present the incidence of traumatic SCI by geographic area: Table 2. Incidence in the Americas; Table 3. Incidence in Europe; Table 4. Incidence in Asia; Table 5. Incidence in Oceania.
North America – Canada
| Author
Year N |
Geographic Area |
Inclusion and exclusion criteria | Definition of cases
(nominator) and source population (denominator) used to calculate incidence |
Incidence (per million inhabitants / year) |
|---|---|---|---|---|
| Lenehan et al. 2012 N=930 |
British Columbia, Canada |
1995-2004 Hospital admissions to level 1 trauma center were prospectively collected using a locally designed spine database |
age-specific cases / Demographic structure for the population of Canada |
42.2 (1995) 43.4 (1996) 39.4 (1997) 38.4 (1998) 27.9 (1999) 40.3 (2000) 33.8 (2001) 30.4 (2002) 28.7 (2003) 32.5 (2004) |
| Noonan et al. 2012 N=1785 |
Canada | Incidence rates from Dryden et al. 2003 were used to estimate incidence in Canada |
Age-specific incidence rates from Dryden et al. / Demographic structure for population of Canada |
53.0 (2010) |
| McCammon & Ethans 2011 N=553 |
Manitoba, Canada |
1981-1985, 1998-2002, 2003-2007 Inclusion criteria: survival to hospital admission with TSCI, or outpatient referral to an SCI rehabilitation specialist. Exclusion criteria: congenital causes of paralysis such as spina bifida or cerebral palsy as well as acquired paralysis from multiple sclerosis or Guillan-Barre syndrome |
Winnipeg Rehabilitation Hospital at the Health Sciences Center and database at the Manitoba branch of the Canadian Paraplegic Association / Canadian Census Population results |
17.1 (1981-1985) 19.5 (1998-2002) 25.6 (2003-2007) |
| Couris et al. 2010 N=936 |
Ontario, Canada |
The study included all patients aged 18 years or older living in Ontario during the fiscal years 2003–2004 (through 2006–2007) who experienced TSCI. |
Standardized incidence rates using the age structure of the Ontario population (census data) and agespecific incidence rates were estimated by sex and by year, and over the four cumulated fiscal years |
24.2 (95% CI: 21.2- 27.6) in 2003 23.1 (95% CI: 20.2- 26.3) in 2006 |
| Pickett et al. 2006 N=151 |
London, Ontario, Canada |
1997-2006 Hospital admissions for SCI in Ontario Trauma Registry |
age specific cases / demographic structure general population from Statistics Canada data |
40.8 (1997-2000) 21.0 (1997) 26.0 (1998) 44.0 (1999) 49.0 (2000) |
| Dryden et al. 2003 N=450 |
Alberta, Canada |
1997-2000 Data from the Alberta Ministry of Health and Wellness, the Alberta Trauma Registry, and the Office of the Medical Examiner |
All identified cases / Mid-year population census for 1998 |
52.5 |
| Pickett et al. 2003 N=2385 |
Ontario, Canada |
1994-1999 Hospital admissions for SCI in Ontario Trauma Registry |
age specific cases / demographic structure general population from Statistics Canada data |
37.2 (1994/95) 46.2 (1995/96) |
| Hu et al. 1996 SCI=122 |
Manitoba, Canada |
1981-1984 Manitoba Health Services Insurance Plan database |
records of hospital databases and physician reimbursement claims / 1982 Manitoba population census |
40.0 |
North America – USA
| Author Year N |
Geographic Area |
Inclusion and exclusion criteria | Definition of cases (nominator) and source population (denominator) used to calculate incidence |
Incidence (per million inhabitants / year) |
|---|---|---|---|---|
| Schoenfeld et al. 2011 N=5928 |
US Military | Incident cases of SCI between 2000-2009 in US military taken from Defense Medical Epidemiology database |
Query of DMED to identify based on ICD-9-CM codes for SCI / Total population at-risk (military personnel) |
429 (2000-2009) |
| Burke et al. 2001 N=161 |
Kentucky and Indiana counties, USA |
1993-1998 University of Louisville Hospital SCI Trauma Registry and patient medical records |
hospital SCI trauma registry / US Census Bureau’s population estimates |
25.2 |
| Marshall 2000 N=106 |
County of San Diego, California, USA |
1992-1997 San Diego County Trauma Injury |
study of all trauma centers in San Diego County, including Children’s Hospital / 1992 and 1997 census data |
40.0 (1992) 40.0 (1997) |
| Surkin et al. 2000 N=395 |
Mississippi, USA |
1992-1994 All SCI cases that occurred in the state of Mississippi |
data from the SCI Surveillance System / Mississippi 1990 census data |
77.0 |
| Thurman et al. 1995 N=223 |
Utah, USA |
1989-1991 Statewide injury reporting system from all state hospital and inpatient rehabilitation units and state death certificates. |
age specific verified cases from 1989-1991 / 1990 U.S. census population |
47.0 (age adjusted to 1980) 43.0 (crude) |
| Warren et al. 1995 N=139 |
Alaska, USA |
1991-1993 SCI in Alaska Trauma Registry |
total cases from 1991-1993 / population estimates published by Alaska Department of Labor |
83.0 |
| Price et al. 1994 N=376 |
Oklahoma, USA |
1988-1990 Oklahoma residents with SCI in Oklahoma statewide multilevel surveillance system. Exclusion Criteria: People who died at scene of injury; Injuries to nerve roots or spinal plexus. |
estimated cases using sensitivity of surveillance system by year and strata / Oklahoma population from 1990 census |
51.0 |
| Woodruff and Baron 1994 N=150 |
West Virginia, USA |
1985-1988 West Virginia residents with SCI in Statewide reporting system Data collected during the West Virginia Spinal Cord Injury Registry, includes only injured patients surviving until hospitalization |
data from the SCI Surveillance System / estimated resident population by Regional Research Institute of West Virginia University in 1985 |
25.0 |
| Acton et al. 1993 N=644 |
Arkansas, USA |
1980-1989 Arkansas State Spinal Cord Commission registry. |
total cases by age group from 1980-1989 / age specific 1980-1989 Arkansas population,1980 and 1989 census data |
28.5 |
| Centers for Disease Control and Prevention 1991 N=5384 |
New York State, USA |
1982-1988 All hospital discharges from acutecare facilities in New York State from the New York State Department of Health’s Statewide Planning and Research Cooperative System |
New York state hospital discharge data / Residents of New York State |
43.0 |
| Starr-Bocian 1991 N=522 |
Colorado, USA |
1986-1991 SCI cases in Colorado and Wyoming Spinal Cord Injury Early Notification System (ENS) |
annual cases for 1986-1991 / annual population of Colorado from 1986-1991 using U.S. Census data |
26.5 (1986) 23.9 (1987) 24.7 (1988) 35.9 (1989) 38.8 (1990) |
| Griffin and Opitz 1985 N=154 |
Olmsted County, Minnesota, USA |
1935-1981 Medical records-linkage system of the Rochester Project at the Mayo Clinic, periodic multi-centre surveys |
Medical records / Population from census data |
54.8 (1935-1981) 22.2 (1935-1944) 70.8 (1975-1981) |
| Bracken et al. 1981 N=66,204 |
USA | 1970-1977 National Center for Health Statistics Hospital Discharge Survey |
Survey results / Current Population Reports Series |
40.1 |
| DeVivo et al. 1980 N=not given |
USA | National Model Spinal Cord Injury Data Base |
Life-expectancy tables of SCI patients 9-86 years at time of injury |
30.0 |
| Kalsbeek et al. 1980 N=1,236 SCI=31 |
USA | 1974 National Head and Spinal Cord Injury Survey |
Hospital admissions / Midyear estimates of population size in 1974 based on data from the United States Bureau of the Census |
50 (1974) |
South America
| Author Year N |
Geographic Area |
Inclusion and exclusion criteria | Methodology used to determine incidence |
Incidence (per million inhabitants / year) |
|---|---|---|---|---|
| Correa et al. 2011 N=173 |
Chile | Patients with traumatic SCI incurred in the workplace from 1986 to 2005 and were admitted to Hospital del Trabajador in Santiago, Chile. |
Number of workers who suffer from TSCI divided by the total work force affiliated to ACHS in the same year. Total work force calculated as the average between the total work force at the beginning and at the end of each year. |
7.8±3.6 (1986-2005) |
Europe
| Author
Year N |
Geographic Area |
Inclusion and exclusion criteria | Definition of cases
(nominator) and source population (denominator) used to calculate incidence |
Incidence (per million inhabitants / year) |
|---|---|---|---|---|
| Knutsdottir
2012 N=207 |
Iceland | 1975-2009
Patients admitted to Landspitali University Hospital. |
Total cases/year
/ Population of Iceland. |
30 (1975-1979)
12.5 (1995-1999) 33.5 (2005-2009) |
| Perez et al.
2012 N=10,274 |
Spain | Hospitalizations for traumatic SCI between 2000 and 2009 in Spain. | Incidence of cases between 2000 and 2009
/ Population of Spain during the study period. |
23.5 (2000-2009) |
| Sabre et al.
2012 N=595 |
Estonia | Retrospective review of all medical records of patients with tSCI from January 1997 to December 2007. | Incident cases of tSCI from hospitals
/ Estonian population during time period. |
39.4 (1997-2007) |
| Van Den Berg et al.
2011 N=540 |
Aragon, Spain | Hospitalized for traumatic SCI from January 1972 to December 2008, and received medical care in Aragon following the acute stabilization period, regardless of place of injury and acute care. | Not reported. | 8.2 (1972-1980)
13.8 (1981-1990) 12.9 (1991-2000) 13.4 (2001-2008) |
| Hagen et al.
2010 N=336 |
Norway (2 counties: Hardaland and Sogn og Fjordane | Patients who suffered a tSCI from 1952-2001 and lived in Hordaland or Sogn og Fjordane. | Number of new cases per 1 million inhabitants per year (grouped into 5-year intervals from 1952-2001). | 6.2 (1952-1956)
26.3 (1997-2001) 3.3 (1952-1961) 10.7 (1992-2001) |
| Pietraszkiewicz & Tysiewicz Dudek
2010 N=343 |
Lubuskie, Poland | Patients wh0 were admitted to Lubuskie hospitals from 2005-2008 with codes corresponding to SCIs for International Classification of Diseases (ICD-10). | Not reported. | 14.5 |
| Hagen et al.
2009 N=366 |
Western Norway | 1952-2001 discharges from 8 hospitals in region with SCI. | Total incident cases in each year
/ Population of two counties in region each year. |
6.2 (1952-1956)
26.3 (1997-2001) |
| Ahoniemi et al.
2008 N=1647 |
Finland | 1976-2005
Data from Käpylä Rehabilitation |
Register survey; Medical records from registers of Käpylä Rehabilitation Centre. | 13.8 (1976-2005) |
| Kannus et al.
2007 1970 N=29 2004 N=228 |
Finland | 1970-2004
All persons aged 50 or older admitted to Finnish hospitals for treatment of a fall-induced cervical SCI. |
Number of cases
/ Finnish statistics for that population. |
52.0 (1970)
120.0 (2004) |
| O’Connor and Murray
2006 N=46 |
Ireland | 2000
Patients admitted to National Rehabilitation Hospital. |
Total admissions in 2000
/ Population of Ireland in 1999. |
13.1 |
| Albert et al.
2005 N=934 |
France | 2000
Rehabilitation units; Patients Exclusion Criteria: |
Total estimated cases in 2000
/ Population of metropolitan France over age of 15 years in 1999. |
19.4 |
| Gur et al.
2005 N=539 |
South Eastern Anatolia, Turkey | 1990-1999
4 hospitals were major referral centers for trauma. |
New SCI cases
/ Not given. |
12.1 |
| Karacan et al.
2000 N=581 |
Turkey | 1992
Nation-wide survey of SCI admissions to medical institutions. Exclusion Criteria: |
(Total cases from 49 cities who returned questionnaires)/ (estimated population of the |
12.7 (1992) |
| Van Asbeck et al.2000 N=126 |
Netherlands | 1994
Defined SCI cases within national Exclusion Criteria: |
(Total identified cases/known group)*(total group)/ Netherlands population. |
12.1 |
| Caldana and Lucca
1998 N=577 |
Veneto, Italy | 1994-1995
New cases of traumatic spinal |
Traumatic injury and nontraumatic disease admitted to hospitals/ Veneto population. |
14.3 |
| Martins et al.
1998 N= 398 |
Central Region of Portugal | 1989-1992
2 hospitals that treat all SCI in the Including deaths due to SCI and |
SCI cases from university hospital, city hospital and Institute of Legal Medicine/ 1993 census data for the 6 districts that make up the central region of Portugal. |
57.8 |
| Karamehmetoglu et al.
1997 N=75 |
Southeast Turkey |
1994
Traumatic SCI in Southeast |
Data from records of SCI
/ 1994 Turkey census data. |
16.9 |
| Karamehmetaglu et al.
1995 N=152 |
Istanbul, Turkey | 1992
All new patients with SCI, |
SCI cases
/ 1992 Istanbul population. |
20.8 |
| Soopramanie
1994 N=412 (SCI=270) |
Bucharest, Romania | 1992-1993
SCI patients admitted to Dr Gh. Marinescu Hospital. |
Not reported. | 28.5 |
| Stavrev et al.
1994 N=980 |
Plovdiv Region, Bulgaria | 1983-1992
Treatment for SCI at 2 clinics in Plovdiv Region. |
1983-1992 total cases
/ Population of Plovdiv Region. |
130.6 |
| Knutsdottir
1993 N=79 |
Iceland | 1973-1989
Patients admitted to rehabilitation |
Average new cases/year
/ Population of Iceland. |
24.0 (1973 1982)
18.0 (1983-1989) |
| Garcia Reneses et al.
1991 N=1010 |
Spain | 1984-1985
Every traumatic and non |
505 acute SCI/year
/ 38.5 million people in Spain. |
13.1 |
| Biering Sorensen et al.1990 N=360 |
Kingdom of Denmark (Denmark, Greenland, Faroe Islands) |
1975-1984
Admission to national specialized |
Traumatic SCI for whole of Denmark/ Average population for 10 year period. |
9.2 |
| Koning and Frowein
1989 N=4431 |
Federal Republic of Germany | 1983
Hospital admissions, Hamburg’s |
Hamburg Central Office for Paraplegic Patients, General Local Health Insurance users/ Hospital admissions to 16 SCI Centers in FRG, German |
36.0 |
| Pederson et al.1989 N=29 |
Greenland | 1965-1986
Admissions to rehabilitation |
Total cases from 1965-1986
/ Average population of |
26 |
Asia
| Author Year N |
Geographic Area |
Inclusion and exclusion criteria | Methodology used to determine incidence |
Incidence (per million inhabitants / year) |
|---|---|---|---|---|
| Li et al. 2011 # of patients: N=1079 data collected: N=264 |
Beijing, China |
Patients with acute TSCI admitted to civilian or military hospitals during Jan 1- Dec 31 2002 |
Number of ATSCI patients admitted in all hospitals in Beijing/ total population of Beijing |
60.6 (2002) 6.7 (1982 to 1986) |
| Ning et al. 2011 N=869 |
Tianjin, China | All TSCI patients aged 15 or older admitted to tertiary hospitals in Tianjin from Jan 1, 2004- Dec 31, 2008 |
Average incidence rate calculated using population estimates from Tianjin Bureau of Statistics for 2006. |
23.7 |
| Yang et al. 2008 N=54,484 |
Taiwan | 2000-2003 Spinal trauma cases in National Health Insurance database. Spinal injury with neurological deficit: (spinal injury incidence)* (% of total spinal injuries with neurological deficit) Exclusion Criteria: Subsequent admission for chronic care or other medical disorders |
Spinal injuries: defined cases from 2000-2003 / Average # of insurance beneficiaries from 2000-2003 using National Health Insurance statistics |
614.2 (spinal trauma) 174.0 (spinal injury with neurological deficits) |
| Chen et al. 1997 SCI=1,586 |
Taiwan | 1992-1996 113 hospitals (11 medical centers, 50 regional general hospitals, 52 local general hospitals) |
Hospital admissions / midyear population of Taiwan area |
18.8 (1992-1996) 24.5 (1993) 19.6 (1994) 18.2 (1995) 17.2 (1996) |
| Otom et al. 1997 N=151 |
Jordan | 1988-1993 Patients admitted to spinal unit of hospital in Amman. Exclusion Criteria: Patients who died before hospitalization; nontraumatic SCI. |
total cases from 1998-1993 / hospital catchment population |
18.0 |
| Shingu et al. 1995 N=9752 |
Japan | 1990-1992 Survey of nationwide institutions assumed to accept. SCI patients. Exclusion criteria: Patients only receiving outpatient services in this period. |
sum of estimated cases in each prefecture / population of Japan from 1990-1992 |
40.2 (Frankel levels A-D) |
| Silberstein and Rabinovich 1995 N=196 |
Novosibirsk, Russia |
1989-1993 All in patients with SCI admitted to the Department of SCI. |
SCI patients over 5 years / 1994 Novosibirsk population |
29.7 |
| Shingu et al. 1994 N=3465 |
Japan | 1990 Survey of nationwide institutions assumed to accept SCI patients. Exclusion criteriaPatients only receiving outpatient services in this year |
Sum of estimated cases in each prefecture / population of Japan in 1990 |
39.4 (Frankel levels A-D) 50.5(Frankel levels A-E) |
| Ide et al. 1993 N=92 |
Okayama Prefecture, Japan |
1988-1989 Handicapped registration system “Law for the Welfare of the Physically Disabled” |
defined cases / 1985 National Census data |
49.0 (all SCI) 28.6 (only traumatic) |
| Lan et al. 1993 N=99 |
Hualien county, Taiwan |
1986-1990 Treatment of traumatic SCI in 4 hospitals in Hualien county. Exclusion Criteria: People who died before hospitalization; nontraumatic SCI; patients with transient paralysis; non residents of Hualien |
total cases from 1986-1990 / average population of Hualien from 1986-1990 |
56.1 |
| Chen et al. 1985 N=560 |
Taipei, Taiwan |
1978-1981 All record from general hospitals in Taipei. Included all spinal cord lesions. |
Taipei inhabitants with SCI / Taipei residences |
14.6 |
Oceania
| Author Year N |
Geographic Area |
Inclusion and exclusion criteria |
Methodology used to determine incidence |
Incidence (per million inhabitants / year) |
|---|---|---|---|---|
| Derrett et al. 2012 N= 230 |
New Zealand | 2007-2009 Admission to one of NZ’s two spinal units. |
All ages of tSCI and ntSCI admitted to NZ spinal units / Population of NZ from 2006 Census |
30.0 (95% CI, 26- 34) |
| O’Connor 2005 N=2959 (253 in 1997) |
Australia | 1986-1997 Australian Spinal Cord Injury Register; ages ≥ 15 years. |
1997 cases / 1997 Australian Bureau of Statistics population data |
17.3 (1997) |
| O’Conner 2002 N=265 |
Australia | 1998-1999 Australian Spinal Cord Injury Register; ages ≥ 15 years. Transient neural deficits were excluded. |
adult SCI cases / Denominator not given |
14.5 |
| Maharaj 1996 N=75 |
Fiji | 1985-1994 Medical Rehabilitation Unit at Tamavua Hospital |
Medical records of spinal cord paralysis patients admitted to the Medical Rehabilitation Unit at Tamavua Hospital / not given |
5.6 (1986) 17.9 (1991) 10.0 (1986-1991) |
| Dixon et al. 1993 N=164 (1988) |
New Zealand | 1979-1988 SCI cases in Health Statistics Services files. |
(total cases from 1988) + (Total cases from 1979-1988) / population of New Zealand Source and date not provided. |
49.1 (1988) 43.3 (1979-1988) |
| Yeo 1993 N=772 |
New South Wales, Australia |
1986-1992 Admission to 2 spinal units in Sydney with significant loss of motor power and sensation associated with SCI. |
1986-1992 admissions / 1986-1992 population of NSW |
19.2 (1986) 21.6 (1987) 20.3 (1988) 18.5 (1989) 18.8 (1990) 14.4 (1991) 15.6 (1992) |
Discussion
In North America, the incidence of traumatic SCI varied from 17 to 83 people per million inhabitants a year in the most recent studies; incident cases in the US military was considerably higher at 429 per million. The vast majority of the studies are based on Canadian (n=8) or American data (n=15).
In Europe, the estimated incidence varied from 3.3 to 130.6 individuals with traumatic SCI per million inhabitants a year. This reflects the experience of several countries including Bulgaria, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Norway, Portugal, Romania, Spain, The Netherlands, Estonia and Turkey.
In Asia, the incidence of traumatic SCI was reported between 6.7 and 246 persons per million inhabitants a year. There were 5 Taiwanese studies, 3 Japanese studies, 2 Chinese studies, 1 Russian and 1 Jordanian study.
In Oceania, the estimated incidence varied from 5.6 to 49.1 individuals with traumatic SCI per million inhabitants a year. There were 3 Australian studies, 12 from New Zealand and 1 from Fiji.
Our search did not capture any study focused on incidence or prevalence in an African country.
Time Trends in SCI Incidence
Of the 67 articles on incidence, 19 studies provided estimated incidence rates of traumatic SCI in at least 2 different periods of time. Most of those studies suggested an increasing incidence of traumatic SCI over the last decades, but three articles in Canada, Taiwan, and Australia reported a decreasing incidence. Interestingly, an updated analysis from Iceland found that while incidence appears to have dropped between the late 70’s and 90’s, it has returned to past levels in the late 00’s.
The most recent analysis from Canada found that in British Columbia, the incidence of SCI decreased from 42.2 to 32.5 per million between 1995 and 2004 (Lenehan et al. 2012). Pickett et al. (2006) found that the incidence of traumatic SCI in London (Ontario, Canada) increased from 21 to 49 people per million inhabitants a year between 1997 and 2000. Similarly, Starr-Bocian (1991) reported that the SCI incidence in Colorado (USA) increased from 26.5 to 38.8 individuals per million inhabitants a year between 1986 and 1990. Based on a broader time series from Olmsted County (Minnesota, USA), Griffin et al. (1985a) also found considerable increase in the SCI incidence from 22.2 people per million inhabitants a year between 1935 and 1944 to 70.8 people per million inhabitants a year between 1975 and 1981. In a Finnish study (Kannus et al. 2007), the incidence of traumatic SCI more than doubled from 52 individuals per million inhabitants in 1970 to 120 in 2004. Similarly, Maharaj (1996) documented a significant increase in the SCI incidence in Fiji from 5.6 to 17.9 people per million inhabitants a year between 1986 and 1991. In the most recent study, Hagen et al. (2009) documented an increase in the incidence of traumatic SCI from 6.2 to 26.3 individuals per million a year from the 1950s to the 1990s in Western Norway.
Differently, Chen et al. (1997) reported a reduction in the SCI incidence in Taiwan from 24.5 to 17.2 individuals per million a year between 1993 and 1996. Yeo (1993) also found a decreasing incidence of traumatic SCI in New South Wales (Australia) from 21.6 people per million inhabitants a year in 1987 to 15.6 individuals per million inhabitants a year in 1992. Similarly, Knutsdottir (1993) reported a decrease in the incidence of traumatic SCI in Iceland from 24 in the 1970s to 18 people per million a year in the 1980s.
