Secular Trends, Decomposition and Projections of Spinal Cord Injury Burden in China, 1990-2050

To characterize the burden of spinal cord injury (SCI) in China from 1990 to 2023 and project it to 2050, integrating temporal trends, demographic drivers, and anatomical-level patterns.

In this secondary analysis of the Global Burden of Disease (GBD) 2023 study, incidence, prevalence, and years lived with disability (YLDs) for SCI in China were analysed by sex, age, anatomical level (cervical and below-neck), and external cause using Joinpoint regression, age-period-cohort modelling, Das Gupta decomposition, and Bayesian age-period-cohort projection.

From 1990 to 2023, incident SCI cases increased by 43.56%, prevalent cases by 84.83%, and YLDs by 46.22%, while the age-standardised YLD rate remained essentially stable (average annual percent change -0.03%, P = 0.743). Cervical SCI showed a rising age-standardised YLD rate, whereas below-neck SCI declined - a divergence corroborated by decomposition analyses showing opposite rate-change contributions for the two anatomical levels. Falls were the leading external cause, accounting for nearly 80% of incident cases in 2023; falls-attributable rates rose sharply during 2005-2015 and then declined after 2015, a temporal pattern inconsistent with gradual population ageing alone. Projections indicated declining age-standardised rates through 2050 but a persistently high prevalent burden of approximately 8.5 million cases at mid-century.

The burden of SCI in China has shifted toward older adults, cervical injuries, and falls. We propose that the falls burden reflects two overlapping ageing transitions: community-dwelling population ageing superimposed on degenerative cervical spine disease, and occupational ageing of China's construction workforce during a period of rapid sector expansion. Although age-standardised rates are projected to decline, the absolute burden will remain substantial. Planning should prioritise fall prevention, occupational safety regulation in high-risk construction settings, geriatric cervical-spine care, and equitable rehabilitation capacity.