Prevalence:
The number of people in the United States who are alive in July 2004 who have SCI has been
estimated to be approximately 247,000 persons, with a range of 222,000 to 285,000 persons.
(Note: Incidence and prevalence statistics are estimates obtained from several studies.
These statistics are not derived from the National SCI Database.)
Age at injury:
SCI primarily affects young adults. From 1973 to 1979, the average age at injury was 28.6
years, and most injuries occurred between the ages of 16 and 30. However, as the median
age of the general population of the United States has increased by approximately 8 years
since the mid-1970’s, the average age at injury has also steadily increased over
time. Since 2000, the average age at injury is 38.0 years. Moreover, the percentage of
persons older than 60 years of age at injury has increased from 4.7% prior to 1980 to
10.9% among injuries occurring since 2000. Other possible reasons for the observed trend
toward older age at injury might include changes in either referral patterns to model
systems, the locations of model systems, survival rates of older persons at the scene of
the accident, or age-specific incidence rates.
Gender:
Since 2000, 78.2% of spinal cord injuries reported to the national database have occurred
among males. Over the history of the database, there has been a slight trend toward a
decreasing percentage of males. Prior to 1980, 81.8% of new spinal cord injuries occurred
among males.
Ethnic groups:
A significant trend over time has been observed in the racial distribution of persons in
the database. Among persons injured between 1973 and 1979, 76.9% were Caucasian, 14.1%
were African American, 6% were Hispanic, and 3% were from other racial/ethnic groups.
However, among those injured since 2000, 67.5% are Caucasian, 19% are African American,
10.4% are Hispanic, and 3.1% are from other racial/ethnic groups. It is unknown whether
changing locations of model systems, referral patterns to model systems, or race-specific
incidence rates may be responsible for this trend.
Etiology:
Since 2000, motor vehicle crashes account for 50.4% of reported SCI cases. The next most
common cause of SCI is falls, followed by acts of violence (primarily gunshot wounds), and
recreational sporting activities. The proportion of injuries that are due to sports has
decreased over time while the proportion of injuries due to falls has increased. Acts of
violence caused 13.3% of spinal cord injuries prior to 1980, and peaked between 1990 and
1999 at 21.8% before declining to only 11.2% since 2000.
Neurologic level and extent of lesion:
Persons with tetraplegia have sustained injuries to one of the eight cervical segments of
the spinal cord; those with paraplegia have lesions in the thoracic, lumbar, or sacral
regions of the spinal cord. Since 2000, the most frequent neurologic category at discharge
of persons reported to the database is incomplete tetraplegia (34.3%), followed by
complete paraplegia (25.1%), complete tetraplegia (22.1%), and incomplete paraplegia
(17.5%). One percent of persons experienced complete neurologic recovery by hospital
discharge. Over time, the percentage of persons with incomplete tetraplegia has increased
slightly while both complete paraplegia and complete tetraplegia have decreased slightly.
Occupational status:
More than half (63.0%) of those persons with SCI admitted to a Model System reported being
employed at the time of their injury. The post-injury employment picture is better among
persons with paraplegia than among their tetraplegic counterparts. By post-injury year 10,
31.7% of persons with paraplegia are employed, while 26.4% of those with tetraplegia are
employed during the same year.
Residence:
Today 88.3% of all persons with SCI who are discharged alive from the system are sent to a
private, noninstitutional residence (in most cases their homes before injury.) Only 5.1%
are discharged to nursing homes. The remaining are discharged to hospitals, group living
situations or other destinations.
Marital status:
Considering the youthful age of most persons with SCI, it is not surprising that most
(53%) are single when injured. Among those who were married at the time of injury, as well
as those who marry after injury, the likelihood of their marriage remaining intact is
slightly lower when compared to the uninjured population. The likelihood of getting
married after injury is also reduced.
Length of stay:
Overall, average days hospitalized in the acute care unit for those who enter a Model
System immediately following injury has declined from 25 days in 1974 to 15 days in 2002.
Similar downward trends are noted for days in the rehab unit (from 115 to 40 days).
Overall, mean days hospitalized (during acute care and rehab) were greater for persons
with neurologically complete injuries.
Lifetime costs:
The average yearly health care and living expenses and the estimated lifetime costs that
are directly attributable to SCI vary greatly according to severity of injury.
Average Yearly Expenses
(in 2004 dollars)
| Severity of Injury |
First Year |
Each Subsequent Year |
| High Tetraplegia (C1-C4) |
$682,957 |
$122,334 |
| Low Tetraplegia (C5-C8) |
$441,025 |
$50,110 |
| Paraplegia |
$249,549 |
$25,394 |
| Incomplete Motor Functional at any Level |
$201,273 |
$14,106 |
Estimated lifetime costs by Age at Injury
(discounted at 2%)
| Severity of Injury |
25 years old |
50 years old |
| High Tetraplegia (C1-C4) |
$2,693,887 |
$1,585,906 |
| Low Tetraplegia (C5-C8) |
$1,523,204 |
$964,608 |
| Paraplegia |
$900,085 |
$613,915 |
| Incomplete Motor Functional at any Level |
$600,424 |
$435,139 |
These figures do not include any indirect costs such as losses in wages, fringe benefits
and productivity which average $56,964 per year but vary substantially based on
education, severity of injury and pre-injury employment history.
Life expectancy
Life expectancy is the average remaining years of life for an individual. Life
expectancies for persons with SCI continue to increase, but are still somewhat below life
expectancies for those with no spinal cord injury. Mortality rates are significantly
higher during the first year after injury than during subsequent years, particularly for
severely injured persons.
Life Expectancy for Persons who survive the first 24 hours
| Age at Injury |
No SCI |
Motor Functional at any Level |
Para |
Low Tetra (C5-C8) |
High Tetra (C1-C4) |
Ventilator Dependent
at any Level |
| 20 yrs |
58.1 |
53.1 |
45.7 |
40.8 |
36.4 |
16.6 |
| 40 yrs |
39.2 |
34.6 |
28.1 |
23.9 |
20.5 |
7.1 |
| 60 yrs |
21.9 |
18.0 |
13.0 |
10.2 |
8.0 |
1.4 |
Life Expectancy for Persons who survive at least 1 year
post-injury
| Age at Injury |
No SCl |
Motor Functional at any Level |
Para |
Low Tetra (C5-C8) |
High Tetra (C1-C4) |
Ventilator Dependent
at any Level |
| 20 yrs |
58.1 |
53.6 |
46.4 |
42.0 |
38.5 |
23.8 |
| 40 yrs |
39.2 |
35.1 |
28.7 |
25.0 |
22.1 |
11.4 |
| 60 yrs |
21.9 |
18.4 |
13.5 |
10.9 |
9.0 |
3.1 |
Cause of death:
years past, the leading cause of death among persons with SCI was renal failure. Today,
however, significant advances in urologic management have resulted in dramatic shifts in
the leading causes of death. Persons enrolled in the National SCI Database since its
inception in 1973 have now been followed for 30 years after injury. During that time, the
causes of death that appear to have the greatest impact on reduced life expectancy for
this population are pneumonia, pulmonary emboli and septicemia.
