The Global Macroeconomic Burden of Spinal Cord Injury: A Dynamic Modeling Study from 2020 to 2050

Spinal cord injury (SCI) is a debilitating condition that imposes profound and persistent socioeconomic burdens. Despite its relatively low prevalence, SCI results in lifelong disability, reduced productivity, and sustained healthcare costs, particularly among working-age populations. While clinical aspects of SCI have been extensively studied, its broader macroeconomic burden remains underexplored.

We developed a dynamic macroeconomic model to estimate the long-term economic burden of SCI across 191 countries and territories from 2020 to 2050. The model integrated epidemiological data from the Global Burden of Disease (GBD) 2021 study with macroeconomic indicators to assess the impact of SCI on labor supply and physical capital accumulation. A counterfactual scenario, assuming the absence of SCI-related disability and healthcare costs, was used to estimate the economic burden. Sensitivity analyses were performed using Monte Carlo simulations and varying social discount rates.

Globally, the cumulative macroeconomic burden of SCI between 2020 and 2050 was estimated at international dollars (INT$) 5.58 trillion (PPP-adjusted, 2024 INT$), with the highest absolute burdens in China (INT$ 1.04 trillion), the USA (INT$ 882 billion), and India (INT$ 385 billion). Per capita burden ranged from below INT$ 1,000 to over INT$ 350,000, highest in Ireland, Guyana, and Andorra, while China and the USA remained in the middle-to-upper range. The highest relative burdens as a share of gross domestic product occurred in Iraq (0.25%), Burundi (0.19%), and Sri Lanka (0.17%), highlighting the vulnerability of lower income economies. High-income countries (HICs) bore the greatest total cost (INT$ 2.84 trillion), and highest per capita costs (INT$ 65,589), driven by intensive care utilization and prolonged survival. However, low-income countries experienced the highest burden relative to income per capita, highlighting fiscal vulnerability. Regionally, East Asia and the Pacific, Europe and Central Asia, and North America had the largest total burdens, while per capita burden was highest in North America and Europe. The burden of SCI was primarily driven by reduced labor-force participation and long-term healthcare expenditures, significantly constraining national savings and investment.

SCI imposes a substantial and uneven macroeconomic burden, with profound implications for national productivity and fiscal resilience. Economic consequences are shaped not only by disease prevalence but also by institutional capacity and health system responsiveness. Investments in SCI prevention, rehabilitation, and social protection are urgently needed, particularly in LMICs, to mitigate long-term economic burden. Our findings offer empirical evidence to inform global health financing and disability policy.