Trends in traumatic spinal cord injuries in Estonia from 1997 to 2018

Abstract

Objective:

To analyze time trends in incidence, causes and risk factors for traumatic spinal cord injuries (TSCI) in Estonia between 1997–2007 and 2008–2018.

Design:

Retrospective, population-based cohort study.

Setting:

Specialized trauma centres in Estonia.

Participants:

Medical records of patients with TSCI from 1997 to 2018.

Intervention:

None.

Outcome measures:

Demographical data, crude and age- and sex-adjusted incidence rates, causes of TSCI, level and extent of injury, associated injuries.

Results:

A total of 940 new patients with TSCI were identified for the period of 1997–2018. The average annual incidence rate (standardized to the Estonian population by age and sex in 2011) decreased significantly from 37.8 (95% confidence interval (CI) 34.6–41.1) in the first period (1997–2008) to 28.2 per million population (95% CI 25.3–31.0) during the second period (2008–2018) (incidence rate ratio 0.74 (95% CI 0.65–0.85), P < 0.0001). The decrease in incidence was most significant among young men. The mean age at injury increased from 38.7 (±16.7) years to 46.6 (±19.9) years, P < 0.0001. Falls were the leading cause of injury during both periods followed by traffic accidents and sports injuries. Still, traffic accidents as a cause of TSCI decreased significantly (from 30.5% to 20.6%, P = 0.001) and falls increased (from 39.9% to 59.5%, P < 0.0001) during the second period. Alcohol consumption prior to injury also decreased significantly from 66.0% to 55.1% (P = 0.006).

Conclusion:

Estonia has become closer to other European countries regarding TSCI during the last decade; TSCI incidence has significantly decreased, the mean age at injury and the percentage of falls have increased.

Keywords:

• Traumatic spinal cord injury
• Epidemiology
• Trends

Acknowledgements

The authors thank Heti Pisarev for statistical assistance.

Data archiving

There were no data to deposit.

Statement of ethics

The study protocol was approved by the Research Ethics Committee of the University of Tartu, Estonia (289/T-31). As the study was a retrospective cohort study based on medical records, written informed consent from every participant was not obtained as all requirements from Personal Data Protection Act were fulfilled and approved by the ethics committee.

Disclaimer statements

Contributors L. S. designed and conceptualized the study, collected, reviewed, and analyzed medical records, performed statistical analysis, analyzed and interpreted the data, and drafted and revised the article. M. N. reviewed and analyzed medical records and wrote the manuscript. A. A. collected medical records and revised the article. T. A. conceptualized the study and revised the article. J. K. designed and conceptualized the study, interpreted the data, and drafted and revised the article.

Conflict of interest The authors declare no financial or other conflicts of interest.

Additional information

Funding

This study was supported by the Grant PRG957 of the Estonian Research Council.