Trends and projections of cervical and subcervical spinal cord injury burden in China: An observational study analysis for the GBD 2021

Cervical spinal cord injury (CSCI) and subcervical spinal cord injury (SSCI) are severe central nervous system disorders with high disability and mortality rates, imposing a substantial burden on patients and society. To assess the incidence and prevalence and trends of spinal cord injury (SCI) in China, we analyzed data from the global burden of disease 2021 study. Variations in the age-standardized incidence rate (ASIR), prevalence rate (ASPR), and years lived with disability rate (ASYR) for CSCI and SSCI were evaluated using Joinpoint regression and age-period-cohort models, and long-term trends were projected with ARIMA models. From 1990 to 2021, CSCI's ASIR increased from 3.12 to 3.23 per 1,00,000 and ASPR from 68.95 to 72.16 per 1,00,000, while ASYR decreased from 29.84 to 27.65 per 1,00,000, with estimated annual percentage changes of -0.14, -0.17, and -0.63, respectively. For SSCI, ASIR increased slightly from 2.95 to 2.98 per 1,00,000, ASPR declined from 80.89 to 79.53 per 1,00,000, and ASYR decreased markedly from 22.25 to 13.96 per 1,00,000, with estimated annual percentage changes of -0.32, -0.48, and -2.14, respectively. Both prevalence and incidence were consistently higher in men. Joinpoint analysis revealed declining ASIR trends from 1990 to 2011, followed by increases between 2011 and 2021, with ASPR showing fluctuations and ASYR declining overall, while SSCI rebounded after 2010. Age-period-cohort analysis suggested that period and cohort effects decreased with age, whereas incidence rates increased. ARIMA projections indicated that by 2050, the ASIR and ASPR of CSCI will decline to 2.97 and 66.62 per 1,00,000, respectively, and those of SSCI to 2.93 and 76.66 per 1,00,000. These findings indicate a gradual downward trend in the burden of CSCI and SSCI in China; however, population size and aging continue to drive increases in absolute incidence, prevalence, and years lived with disability. The burden of CSCI remains higher than that of SSCI, particularly among men and older adults, underscoring the need for strengthened prevention and rehabilitation strategies in high-risk groups.