Relationship Between Level of Economic Development, Age, and Etiology of Spinal Cord Injury: A Cross-Sectional Survey From 22 Countries

Abstract

Objective: To examine relationships between age and spinal cord injury (SCI) and cause of SCI and how this depends on economic development.

Design: Cross-sectional survey.

Setting: Community, 22 countries representing all stages of economic development.

Participants: A total of 12,591 adults with SCI (N=12,591).

Interventions: Not applicable.

Main outcome measures: Interactions between age at injury and gross domestic product per capita based on purchasing power parity (GDP PPP) quartiles calculated with the application of logistic regression with the Maximum Likelihood estimator. Independence between SCI cause and age was assessed with the Wald test.

Results: In persons with traumatic SCI, younger age was associated with a higher likelihood of injury in motor vehicle collisions, whereas older individuals had a greater chance of SCI due to falls. Associations between increased likelihood of high-energy traumatic SCI and younger age, low-energy traumatic SCI with older age, nontraumatic SCI with older age in persons injured in adulthood, and a higher prevalence of incomplete SCI lesions in individuals injured at an older age were revealed. Higher GDP PPP influenced positively the likelihood of low-energy SCI in older individuals and was negatively associated with the chance of sustaining SCI in motor vehicle collisions and the likelihood of having nontraumatic SCI at an older age.

Conclusions: SCI in older age is predominantly because of falls and nontraumatic injuries. Higher country income is associated with an increased proportion of SCI sustained later in life because of low-energy trauma involving cervical injury and a lower chance of being because of motor vehicle collisions. An increased prevalence of nontraumatic SCI in older individuals associated with lower country income may reflect a higher exposure to socially preventable conditions and lower access to or efficacy of health care. Future studies on etiology of SCI should make the distinction between low and high falls and overcome underrepresentation of older persons.

Keywords: Causality; Gross domestic product; Odds ratio; Rehabilitation; Spinal cord injuries.