Spinal Cord Injury
Facts & Statistics

Think you know the facts about spinal cord injuries? Here is some information that may surprise you.

Spinal Cord Injuries

According to the National Spinal Cord Injury Statistical Center at UAB, the distribution of the causes of SCI have changed drastically from 2015-2018/19.

  • Vehicular 39.3%
  • Falls 31.8%
  • Violence (primarily gunshot wounds) 13.5%
  • Sports/Recreation Activities 8.0%
  • Medical/Surgical 4.1%
  • Other 3.1%

Researchers have estimated that, as of 2019, 17,730 new SCI cases occur each year and between 249,000 and 363,000 people are currently living with SCI in the United States.

The average age at injury has moved from 29 years in the 1970’s to 43 years in 2018.

The length of hospital stays is declining with the average stay in hospital acute care at 11 days – down from 24 in the 1970’s – and rehabilitation stays at 31 days – down from 98 days in the 1970’s.

Who Do Spinal Cord Injuries Affect in the United States?

  • Approximately 291,000 Americans are spinal cord injured
  • 39.5% of spinal cord injured individuals are considered paraplegic and 59.9% quadriplegic
  • Approximately 17,730 new injuries occur each year
  • 78% of new cases are male
  • Nearly half (47.6%) of all injuries occur between the ages of 16 and 30
  • The average age of spinal cord injured person is 43
  • 87.4% of all SCI individuals are discharged from hospitals to a private home, 6.7% are discharged to nursing homes

What Do Spinal Cord Injuries Really Cost?

  • Length of initial hospitalization following injury in acute care units: 11 days
  • Average stay in rehabilitation unit: 31 days
  • First year expenses for paraplegics: $550,381
  • First year expenses for quadriplegics C1-C4: $1,129,302
  • First year expenses for quadriplegics C5-C8: $816,019
  • Average lifetime costs for paraplegics, age of injury 25: $2,450,234
  • Avg. lifetime costs for quadriplegics C1-C4, age of injury 25: $5 million
  • Avg. lifetime costs for quadriplegics C5-C8, age of injury 25: $3.6 million
  • Percentage of SCI individuals who are covered by private health insurance at time of injury 49.7%
  • Percentage of SCI individuals unemployed ten years after injury 77%

Number of New Injuries Per Year

54 injuries per million population or 17,730 injuries in the US each year

Most researchers feel that these numbers represent significant under- reporting. Injuries not recorded include cases where the patient died instantaneously or soon after the injury, cases with little or no remaining neurological deficit, and people who have neurologic problems secondary to trauma, but are not classified as SCI.

Statistics of People with SCI

  • About of new SCI cases are 78% male, 22% female
  • Highest per capita rate of injury occurs between ages 16-30
  • Average age at injury – 43
  • Median age at injury – 35.4
  • Mode (most frequent) age at injury 19
  • Motor vehicle accidents are the leading cause of SCI (39.3%), followed by falls (31.8%), acts of violence (13.5%), sports (8%), medical/surgical (4.3%), and other (3.1%)
  • About 2/3 of sports injuries are from diving
  • Falls overtake motor vehicles as leading cause after age 45
  • Acts of violence and sports cause less injuries as age increases
  • Marital status at injury:
    • Single 50.7%
    • Married 32.9%
    • Divorced 9.4%
    • Other 7%
  • 10 years post-injury:
    • 84.3 % reported ‘No Change’ in marital status
  • Employment status at injury:
    • Employed 58.1%
    • Unemployed 39.3% (includes: students, retired, and homemakers)
    • Other/Unknown: 2.6%
  • Employed 10 years post-injury:
    • 26.6%

People who return to work in the first year post-injury usually return to the same job for the same employer. People who return to work after the first year post-injury either worked for different employers or were students who found work.

How are Spinal Injuries Caused?

  • Vehicular 39.3%
  • Falls 31.8%
  • Violence (primarily gunshot wounds) 13.5%
  • Sports/Recreation Activities 8.0%
  • Medical/Surgical 4.1%
  • Other 3.1%

Most Frequent Neurological Category

  • Quadriplegia, incomplete 47.6%
  • Paraplegia, complete 19.9%
  • Paraplegia, incomplete 19.6%
  • Quadriplegia, complete 12.3%

Hospitalization

Lengths of stay in the hospital acute care unit have declined from 24 days in the 1970s to 11 days recently. Rehabilitation lengths of stay have also declined from 98 days in the 1970s to 31 days recently.

  • Acute Care Unit – Quadriplegics, complete 21 days
  • Acute Care Unit – Quadriplegics, complete 10 days
  • Acute Care Unit – Paraplegics, complete 13 days
  • Acute Care Unit – Paraplegics, incomplete 10 days
  • Rehab Unit – Quadriplegics, complete 56 days
  • Rehab Unit – Quadriplegics, incomplete 35 days
  • Rehab Unit – Paraplegics, complete 35 days
  • Rehab Unit – Paraplegics, incomplete 26 days

Average charges (2018 dollars) Note: Specific cases are considerably higher.

  • First year expenses for paraplegics: $550,381
  • First year expenses for quadriplegics C1-C4: $1,129,302
  • First year expenses for quadriplegics C5-C8: $816,019
  • Average lifetime costs for paraplegics, age of injury 25: $2,450,234
  • Avg. lifetime costs for quadriplegics C1-C4, age of injury 25: $5 million
  • Avg. lifetime costs for quadriplegics C5-C8, age of injury 25: $3.6 million

Primary Payer of Medical Costs at Time of Injury:

  • Private Insurance 49.8%
  • Medicaid 27.2%
  • Medicare 8.0%
  • Worker’s Comp 6.9%
  • Self-Pay 1.7%
  • Other 6.4%

Primary Payer of Medical Costs 10 years Post Injury: (Many people have more than one source of payment.)

  • Private Insurance 30.3%
  • Medicare 37.3%
  • Medicaid 20.9%
  • Worker’s Compensation 6.7%
  • Self-Pay 1.8%
  • Other 3.0%

After the Hospital

Residence at discharge

  • Private Residence 87.4%
  • Nursing Home 6.7%
  • Other Hospital 1.6%
  • Group Home 1.2%
  • Other/Unknown 3.1%

There is no apparent relationship between severity of injury and nursing home admission, indicating that admission is caused by other factors (i.e. family can’t take care of person, medical complications, etc.) Nursing home admission is more common among elderly persons.

Since 2015, about 30% of persons with SCI are re-hospitalized one or more times during any given year following injury. Among those re-hospitalized, the length of hospital stay averages about 19 days. Diseases of the genitourinary system are the leading cause of re-hospitalization, followed by disease of the skin. Respiratory, digestive, circulatory, and musculoskeletal diseases are also common causes.

Survival

Overall, 81% of SCI patients who survive the first 24 hours are still alive 10 years later, compared with 98% of the non-SCI population given similar age and sex.

Causes of Death

The most common cause of death is respiratory ailment, whereas, in the past it was renal failure. An increasing number of people with SCI are dying of unrelated causes such as cancer or cardiovascular disease, similar to that of the general population. Mortality rates are significantly higher during the first year after injury than during subsequent years.

Majority of above content: National Spinal Cord Injury Statistical Center at UAB


Global Key Facts

The following global facts are from World Health Organization Fact Sheet, Nov. 2013.

  • Every year, around the world, between 250 000 and 500 000 people suffer a spinal cord injury (SCI).
  • The majority of spinal cord injuries are due to preventable causes such as road traffic crashes, falls or violence.
  • People with a spinal cord injury are two to five times more likely to die prematurely than people without a spinal cord injury, with worse survival rates in low- and middle-income countries.
  • Spinal cord injury is associated with lower rates of school enrollment and economic participation, and it carries substantial individual and societal costs.
  • Most people with spinal cord injury experience chronic pain.
  • Estimated annual global incidence is 40 to 80 cases per million population.
  • Up to 90% of cases are due to traumatic causes, though the proportion of non-traumatic spinal cord injury appears to be growing.

Demographic Trends

  • Males are most at risk in young adulthood (20-29 years) and older age (70+).
  • Females are most at risk in adolescence (15-19) and older age (60+).
  • Studies report male-to-female ratios of at least 2:1 among adults, sometimes much higher.

Mortality

  • Mortality risk is highest in the first year after injury and remains high compared to the general population.
  • People with spinal cord injury are 2 to 5 times more likely to die prematurely than people without SCI.
  • Mortality risk increases with injury level and severity and is strongly influenced by availability of timely, quality medical care.
  • Transfer method to hospital after injury and time to hospital admission are important factors.
  • Preventable secondary conditions (e.g. infections from untreated pressure ulcers) are the main causes of death of people with spinal cord injury in low-income countries.

Health, Economic and Social Consequences

  • An estimated 20-30% of people with spinal cord injury show clinically significant signs of depression.
  • Children with spinal cord injury are less likely than their peers to start school, and once enrolled, less likely to advance.
  • Adults with spinal cord injury face barriers to economic participation, with a global unemployment rate of more than 60%.
  • The level and severity of the injury influence costs — higher injuries (e.g. tetraplegia vs. paraplegia) incur higher costs.
  • Direct costs are highest in the first year after spinal cord injury onset and then decrease significantly over time.
  • Indirect costs, in particular lost earnings, often exceed direct costs.
  • Much of the cost is borne by people with spinal cord injury.
  • Costs of spinal cord injury are higher than those of comparable conditions such as dementia, multiple sclerosis and cerebral palsy.

Causes

  • The leading causes of spinal cord injury are road traffic crashes, falls and violence (including attempted suicide).
  • A significant proportion of traumatic spinal cord injury is due to work or sports-related injuries.
  • physically accessible homes, schools, workplaces, hospitals and transportation;
  • inclusive education;
  • elimination of discrimination in employment and educational settings;
  • Vocational rehabilitation to optimize the chance of employment;
  • micro-finance and other forms of self-employment benefits to support alternative forms of economic self-sufficiency;
  • access to social support payments that do not act as disincentive to return to work; and
  • correct understanding of spinal cord injury and positive attitudes towards people living with it.