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

Abstract

Background Although patients with non-traumatic spinal cord injury (NTSCI) have distinct epidemiological characteristics compared to those with traumatic spinal cord injury, no previous study has reported the incidence of NTSCI on a national scale in Korea. In this study, we examined the trend in incidence of NTSCI in Korea and described the epidemiological characteristics of patients with NTSCI using nationwide insurance data. Methods National Health Insurance Service data were reviewed for the period from 2007 to 2020. The International Classification of Diseases, 10th revision, was used to identify patients with NTSCI. Inpatients with newly diagnosed NTSCI on their first admission during the study period were included. Crude incidence was calculated using the annual number of NTSCI cases divided by the mid-year population estimates. Age-specific incidence was calculated by dividing the number of cases in 10-year age groups by the total number of individuals in that age group. Age-adjusted incidence was calculated using direct standardization. Annual percentage changes were calculated using Joinpoint regression analysis. The Cochrane-Armitage trend test was conducted to examine the trends of NTSCI incidence according to the types or etiologies of NTSCI. Results The age-adjusted incidence of NTSCI increased continuously from 24.11 per million in 2007 to 39.83 per million in 2020, with a significant annual percentage change (4.93%, P < 0.05). The age-specific incidence for those in their 70s and 80s or older was the highest and rapidly increased from 2007 to 2020. According to the types of paralysis in NTSCI, the proportion of tetraplegia decreased, whereas those of paraplegia and cauda equina increased significantly from 2007 to 2020. The proportion of degenerative diseases was the largest among all etiologies and increased significantly during the study period. Conclusion The annual incidence of NTSCI in Korea is increasing significantly, particularly among older adults. As Korea is one of the countries with most rapidly aging population in the world, these results have significant implications, indicating that preventive strategies and sufficient rehabilitation medical services are warranted for the population of older adults.

Epidemiology of Traumatic and Non-Traumatic Spinal Cord Injury in Korea: A Narrative Review

“…A hospital-based study by Lee et al 27) published in 2022 evaluated the 10-year incidence of NTSCI over the past 30 years and reported 87 patients between 1990−1999, 318 between 2000−2009, and 543 between 2010−2019. In our population-based study published in 2023, 7) the incidence of NTSCI in 2020 was 39.83 per 1 million people based on the NHIS data.…”

“…The incidence of NTSCI increased more rapidly than that of TSCI in South Korea from 2007 to 2020 ( TABLE 1 ). 6 7) The incidence of TSCI increased by 0.87% per year, from 32.27 per million in 2007 to 34.00 per million in 2020, while the incidence of NTSCI increased by 4.93% per year, from 24.11 per million to 39.83 per million during the same period. Notably, in 2007, the number of TSCI cases was higher than the number of NTSCI cases, but by 2020, the number of NTSCI cases exceeded the number of TSCI cases due to a dramatic increase in the incidence of NTSCI.…”

“…Previous meta-studies have also shown that the incidence of paraplegia was higher in all WHO regions, except for the Asia-Pacific region represented by Japan. 7 33) However, since the Japanese study used in the meta-analysis was based on data from 1988, 18) it is necessary to update the statistics for the Asia-Pacific region using more recent data. 7) …”

“… 7 33) However, since the Japanese study used in the meta-analysis was based on data from 1988, 18) it is necessary to update the statistics for the Asia-Pacific region using more recent data. 7) …”

“…In Korea, national-level analyses for the incidence of SCIs have been performed relatively recently; however, a comprehensive review encompassing both traumatic and non-traumatic SCIs has not yet been conducted. 6 7) This review aimed to summarize the published incidence rates and trends of traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI) within Korea, and to compare the differences in the incidence rates between the two conditions, in order to gain an overarching understanding of the trends in SCIs across the country.…”