Rates rising fastest among those over 65, and most injuries now due to falls, not car crashes
The number of serious traumatic spinal cord injuries is on the rise in the United States, and the leading cause no longer appears to be motor vehicle crashes, but falls, new Johns Hopkins research suggests.
The same research shows, moreover, that rates of these injuries — whose symptoms range from temporary numbness to full-blown paralysis — are rising fastest among older people, suggesting that efforts to prevent falls in the elderly could significantly curb the number of spinal injuries.
“We have demonstrated how costly traumatic spinal cord injury is and how lethal and disabling it can be among older people,” says Shalini Selvarajah, M.D., M.P.H., a postdoctoral surgical research fellow at the Johns Hopkins University School of Medicine and leader of the study published online in the Journal of Neurotrauma. “It’s an area that is ripe for prevention.”
For their study, the Johns Hopkins researchers analyzed a nationally representative sample of 43,137 adults treated in hospital emergency rooms for spinal cord injury in the United States between 2007 and 2009. While the incidence among those aged 18 to 64 ranged from 52.3 per million in 2007 to 49.9 per million in 2009, the incidence per million in those 65 and older increased from 79.4 in 2007 to 87.7 in 2009. Falls were the leading cause of traumatic spinal cord injury over the three-year study period (41.5 percent), followed by motor vehicle crashes (35.5 percent). Fall-related spinal cord injuries increased during the study period overall. Among the elderly, they increased from 23.6 percent to 30 percent of injuries.
The average age of adults with a traumatic spinal cord injury in a previous study that covered the years 2000 to 2005 was 41; the new study suggests it is now 51.
The investigators say that even when taking into account injury severity and other illnesses experienced by the patients, older adults with traumatic spinal cord injury are four times more likely to die in the emergency room from such an injury compared to younger adults. If they survive and are admitted, they are six times more likely to die during their inpatient stay.
While the researchers say they can’t pinpoint the exact reason that falls have surpassed car crashes as a cause of traumatic spinal injuries, they believe it may be a combination of the general aging of the population, the more active lifestyles of many Americans over 65, and airbags and seatbelt laws that allow drivers and passengers to survive crashes.
“We are seeing a changing face in the epidemiology of spinal cord injury,” says Edward R. Hammond, M.D., Ph.D., a research associate at the International Center for Spinal Cord Injury at Kennedy Krieger Institute and another of the study’s leaders.