Global, regional and national burden of traumatic brain injury and spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Bin Guan; David B Anderson; Lingxiao Chen; Shiqing Feng; Hengxing Zhou

doi:10.1136/bmjopen-2023-075049

Global, regional and national burden of traumatic brain injury and spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

BMJ Open. 2023 Oct 6;13(10):e075049. doi: 10.1136/bmjopen-2023-075049.

Authors

Bin Guan^#¹, David B Anderson^#², Lingxiao Chen^{3

4}, Shiqing Feng^{3

5}, Hengxing Zhou^{3

6}

Affiliations

¹ Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China.
² School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
³ Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China zhouhengxing@sdu.edu.cn shiqingfeng@sdu.edu.cn lche4036@uni.sydney.edu.au.
⁴ Sydney Musculoskeletal Health, The Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁵ The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P.R. China.
⁶ Center for Reproductive Medicine, Shandong University, Jinan, Shandong, P.R. China.

^# Contributed equally.

Abstract

Objectives: To evaluate the most up-to-date burden of traumatic brain injury (TBI) and spinal cord injury (SCI) and analyse their leading causes in different countries/territories.

Design: An analysis of Global Burden of Disease (GBD) data.

Setting: The epidemiological data were gathered from GBD Results Tool (1 January, 1990─31 December 2019) covering 21 GBD regions and 204 countries/ territories.

Participants: Patients with TBI/SCI.

Main outcomes and measures: Absolute numbers and age-standardised rates/estimates of incidence, prevalence and years lived with disability (YLDs) of TBI/SCI by location in 2019, with their percentage changes from 1990 to 2019. The leading causes (eg, falls) of TBI/SCI in 204 countries/territories.

Results: Globally, in 2019, TBI had 27.16 million new cases, 48.99 million prevalent cases and 7.08 million YLDs. SCI had 0.91 million new cases, 20.64 million prevalent cases and 6.20 million YLDs. Global age-standardised incidence rates of TBI decreased significantly by -5.5% (95% uncertainty interval -8.9% to -3.0%) from 1990 to 2019, whereas SCI had no significant change (-6.1% (-17.3% to 1.5%)). Regionally, in 2019, Eastern Europe and High-income North America had the highest burden of TBI and SCI, respectively. Nationally, in 2019, Slovenia and Afghanistan had the highest age-standardised incidence rates of TBI and SCI, respectively. For TBI, falls were the leading cause in 74% (150/204) of countries/territories, followed by pedestrian road injuries (14%, 29/204), motor vehicle road injuries (5%, 11/204), and conflict and terrorism (2%, 4/204). For SCI, falls were the leading cause in 97% (198/204) of countries/territories, followed by conflict and terrorism (3%, 6/204).

Conclusions: Global age-standardised incidence rates of TBI have decreased significantly since 1990, whereas SCI had no significant change. The leading causes of TBI/SCI globally were falls, but variations did exist between countries/territories. Policy-makers should continue to prioritise interventions to reduce falls, but priorities may vary between countries/territories.

Keywords: epidemiology; neurology; orthopaedic & trauma surgery; public health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Accidental Injuries*
Brain Injuries, Traumatic* / epidemiology
Global Burden of Disease
Global Health
Humans
Incidence
Prevalence
Quality-Adjusted Life Years
Spinal Cord Injuries* / epidemiology
Spinal Cord Injuries* / etiology