Epidemiology and impact of spinal cord injury in the elderly: results of a fifteen-year population-based cohort study

Although experience suggests a shift in the epidemiology of spinal cord injury (SCI) toward an older demographic, population studies are lacking. We aimed to evaluate: 1) how the epidemiology and age profile of SCI have changed over time, and; 2) how increased age impacts health outcomes up to 15 years post injury. A population-based cohort study was performed in Ontario including adults diagnosed with traumatic SCI between 2002-2017. Older and younger SCI cohorts were created based on an age cut-off of 65 years. An older cohort of non-injured persons was matched to the older SCI cohort based on age, gender and comorbidity status. Changes in crude incidence were reported as average annual percentage change (AAPC). Survival, readmissions and costs were compared between the older and younger SCI cohorts as well as the older SCI and older matched non-injured cohorts. The incidence of SCI increased among females (AAPC:2.2;95%CI:0.1,4.3), driven by a marked rise (4%/year) among elderly females (AAPC:4.3;95%CI:0.1,4.3). While no change in incidence was detected for males, there was a trend towards increased incidence among older males (AAPC:1.2;95%CI:-1.3,3.8). There were a higher proportion of cervical, incomplete and fall-related injuries in the older vs. younger SCI cohorts. Age over 65 was associated with a 6-fold increased risk of death (HR:5.75;95%CI:4.72,7.00). In comparison to the older non-injured cohort, the older SCI cohort had double the risk of death (HR:2.23;95%CI:2.00,2.50). Older persons with SCI had higher odds of readmission and higher costs. The incidence of SCI among elderly is increasing, particularly among women. Prevention through fall reduction and education to improve outcomes are needed.