See All Evidence Sections
Epidemiology of Traumatic SCI

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
Centre database.

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
admitted for first stay. Ages ≥15
years.

Exclusion Criteria:
Non-traumatic etiology; Neurological impairment due to peripheral nervous lesion; paraplegia due to brain injury; Follow-up or readmissions to rehab unit.

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:
Patients who died before hospitalization.

(Total cases from 49 cities who
returned questionnaires)/

(estimated population of the
49 cities in 1992 from State
Institute of Statistics and
General Directorate of
Security of Ministry Interior).

12.7 (1992)
Van Asbeck et
al.2000

N=126

Netherlands 1994

Defined SCI cases within national
registration system.

Exclusion Criteria:
Spinal contusions with no or
temporary neurological
symptoms.

(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
cord injury and non-traumatic
spinal cord disease treated in
regional hospitals.

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
central region of Portugal.

Including deaths due to SCI and
pediatric cases. Cases without
neurological lesion, rehospitalization, and vertebral lesions were excluded.

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
Turkey. SCI cases identified from
emergency services, ICU,
orthopedic and neurosurgery and
rehabilitation medicine.

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,
including pediatrics.

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
unit in Reykjavik.

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
traumatic SCI patient in
specialized Spanish hospitals.

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
rehabilitation hospitals.

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
Central Office for Paraplegic
Patients, German Workmen’s
compensation, and General Local
Health Insurance company.

Hamburg Central Office for
Paraplegic Patients, General
Local Health Insurance users/

Hospital admissions to 16 SCI Centers in FRG, German
Workmen’s Compensation
new cases.

36.0
Pederson et
al.1989

N=29

Greenland 1965-1986

Admissions to rehabilitation
hospital in Hornback with
traumatic SCI.

Total cases from 1965-1986

/

Average population of
Greenland from 1968, 1977,
1986.

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.

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