Comparison of Trends in the Incidence of Traumatic Spinal Cord Injury in Daily Life, Automobile Accidents, and Industrial Accidents: A National Multi-Insurance Study in Korea

Abstract

Background To examine the incidence of traumatic spinal cord injury (TSCI) from all etiologies, we measured and compared the incidence of TSCI from three national or quasi-national databases in South Korea, namely, the National Health Insurance Service (NHIS), automobile insurance (AUI), and Industrial Accident Compensation Insurance (IACI). Methods We reviewed patients with TSCI reported in the NHIS database between 2009 and 2018, and in the AUI and IACI databases between 2014 and 2018. TSCI patients were defined as those first admitted to the hospital with a diagnosis of TSCI according to the International Classification of Diseases (10th revision) criteria. Age-adjusted incidence was calculated using direct standardization using the 2005 South Korean population or the 2000 US population as the standard population. The annual percentage changes (APC) of TSCI incidence were calculated. The Cochrane–Armitage trend test was performed according to the injured body region. Results In the NHIS database, age-adjusted TSCI incidence using the Korean standard population increased significantly from 2009 to 2018 (from 33.73 per million in 2009 to 38.14 per million in 2018, APC = 1.2%, P = 0.014). Contrarily, age-adjusted incidence in the AUI database significantly decreased from 13.88 per million in 2014 to 11.57 per million in 2018 (APC = – 5.1%, P = 0.009). In the IACI database, the age-adjusted incidence showed no significant difference, while crude incidence showed a significant increase (from 22.02 per million in 2014 to 28.92 per million in 2018, APC = 6.1%, P = 0.038). According to the age group, all the three databases showed high incidences of TSCI in those in their 60s and 70s or older. Among those in their 70s or older, the incidence of TSCI increased dramatically in the NHIS and IACI databases, while no significant trend was found in AUI database. In 2018, the number of TSCI patients was the highest among those over 70 years of age in the NHIS, whereas among those in their 50s were the highest in both AUI and IACI. The proportion of patients with cervical spinal cord injury was the most common in all these databases. Conclusions The differences in trends in the incidence of TSCI may be due to the different etiologies and different characteristics of subjects depending on insurance type. These results imply the need for tailored medical strategies for the different injury mechanisms represented by three national insurance services in South Korea.

Spinal Cord Injury Fact Sheet in Korea

“…In the case of IACI and AUI, the incidence was high in the 50-59 years group; in the 30-39 years-the main working age group, but the occurrence of TSCI patients in AUI was higher than that in the IACI (Fig. 1) [10].…”

“…For the distribution of TSCI by insurance type in South Korea, in all three trauma-related insurance databases, the number of male with TSCI was higher than the number of female. In particular, in the case of IACI, male TSCI incidence was approximately 17 times higher than female TSCI incidence per year on average, showing the largest gap between sexs (Table 1) [10].…”

“…When the age-adjusted incidence of TSCI in South Korea's health insurance data was compared between 2009 and 2018, it increased from 33.73 in 2009 to 38.14 per 1 million population in 2018. Additionally, in the case of AUI, the number decreased from 13.88 in 2014 to 11.57 in 2018, and in IACI, from 22.02 in 2014 to 28.92 in 2018 [10]. Approximately 1,103 people are diagnosed with acute SCI on average yearly, and the average number of cases of SCI in male is 805 per year, higher than that in female (297 cases).…”

Trends in the Incidence and Etiology of Non-Traumatic Spinal Cord Injury in Korea: A Nationwide Population-Based Study From 2007 to 2020

“…This was possible because Korea is one of the few countries in the world that provide life-long coverage by national health insurance for the entire population. As NTSCI is not caused by traumatic accidents, such as automobile or industrial accidents, 8 34 the majority of patients with NTSCI in Korea would be included in the NHIS data. Second, this is the first study that reported the incidence of NTSCI on a national scale in Korea.…”

“… 2 6 7 In addition, the proportion of men was slightly higher than that of women among patients with NTSCI, while the men-to-women ratio was less prominent in patients with TSCI. 6 7 8 Previous studies have also demonstrated that the incidence of NTSCI was higher than that of TSCI in developed countries. 9 10 11 …”