J Korean Med Sci.  2023 Feb;38(7):e26. 10.3346/jkms.2023.38.e26.

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

• Choi Y
• Kim YE
• Leigh JH
• Lee YS
• Kim HK
• Yi YG
• Lee J
• Lee MY
• Lee G
• Shin HI
• Bang MS

• KMID: 2539532
• DOI: http://doi.org/10.3346/jkms.2023.38.e26

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 quasinational 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.

Keyword

Spinal Cord Injuries; Wounds and Injuries; Incidence; National Health Programs; Population; Korea

Figure

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  Fig. 1 Age-specific incidence of traumatic spinal cord injury in the National Health Insurance Service database from 2009 to 2018.*P < 0.05; **P < 0.01; ***P < 0.001.Red asterisk indicates increased the annual percentage changes; Blue asterisk indicates decreased the annual percentage changes.

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  Fig. 2 Distribution of patients with traumatic spinal cord injury according to age groups across the three trauma-related insurance databases in 2018.IACI = Industrial Accident Compensation Insurance, AUI = automobile insurance, NHIS = National Health Insurance Service.

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  Fig. 3 Number of patients with traumatic spinal cord injury according to sex and age groups in the National Health Insurance Service databases in 2009 and 2018.

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  Fig. 4 Distribution of injured body regions in patients with traumatic spinal cord injury in the National Health Insurance Service databases from 2009 to 2018.*P for trend < 0.05; **P for trend < 0.01; ***P for trend < 0.001.Red asterisk indicates increased trend; Blue asterisk indicates decreased trend.

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