Global burden of spinal cord injury: future directions

Findings from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) have provided valuable insight into the descriptive epidemiology of diseases and injuries for many countries over time.1 GBD 2019 approximates incidence, prevalence, and years of life lived with disability (YLDs) for more than 350 unique diseases and injuries for 204 countries and territories from 1990 to 2019.2 Among these diseases and injuries is spinal cord injury, a debilitating neurological condition that can result in lifelong disability and costly medical care, which has become a global health priority owing to the preventability of some injuries. For the GBD 2019 spinal cord injury findings to reliably “facilitate health-care planning, especially in terms of guiding evidence-based prevention and resource allocation”,5 readers must understand the data from which the estimates were derived, including all data items outlined in the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).7 GATHER consists of a checklist of 18 items that are essential for best practice reporting in studies that use many information sources to compute health estimates for more than one population.7 Although the GBD Spinal Cord Injuries Collaborators acknowledge that data were unavailable for 111 (54%) of 204 countries studied, data availability is not explicitly reported by country for each year. Valid self-report proxies of spinal cord injury, its severity, and its completeness are also needed; for example, self-reported spinal cord injury in population-based surveys can be confused with lower back injuries.8 With respect to increasing the volume of spinal cord injury data that are collected, greater awareness of health registries and administrative claims data sources (consisting of insurance claims and electronic health data), and their value, is needed among researchers.