Original research| Volume 97, ISSUE 10, P1610-1619, October 2016

Changing Demographics and Injury Profile of New Traumatic Spinal Cord Injuries in the United States, 1972–2014

Published:April 21, 2016DOI:



      To document trends in the demographic and injury profile of new spinal cord injury (SCI) over time.


      Cross-sectional analysis of longitudinal data by injury years (1972–1979, 1980–1989, 1990–1999, 2000–2009, 2010–2014).


      Twenty-eight Spinal Cord Injury Model Systems centers throughout the United States.


      Persons with traumatic SCI (N=30,881) enrolled in the National Spinal Cord Injury Database.


      Not applicable.

      Main Outcome Measures

      Age, sex, race, education level, employment, marital status, etiology, and severity of injury.


      Age at injury has increased from 28.7 years in the 1970s to 42.2 years during 2010 to 2014. This aging phenomenon was noted for both sexes, all races, and all etiologies except acts of violence. The percentage of racial minorities expanded continuously over the last 5 decades. Virtually among all age groups, the average education levels and percentage of single/never married status have increased, which is similar to the trends noted in the general population. Although vehicular crashes continue to be the leading cause of SCI overall, the percentage has declined from 47.0% in the 1970s to 38.1% during 2010 to 2014. Injuries caused by falls have increased over time, particularly among those aged ≥46 years. Progressive increases in the percentages of high cervical and motor incomplete injuries were noted for various age, sex, race, and etiology groups.


      Study findings call for geriatrics expertise and intercultural competency of the clinical team in the acute and rehabilitation care for SCI. This study also highlights the need for a multidimensional risk assessment and multifactorial intervention, especially to reduce falls and SCI in older adults.


      List of abbreviations:

      AIS (American Spinal Injury Association Impairment Scale), NSCID (National Spinal Cord Injury Database), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model Systems)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cao Y.
        • Chen Y.
        • DeVivo M.J.
        Lifetime direct cost after spinal cord injury.
        Top Spinal Cord Inj Rehabil. 2011; 16: 10-16
        • Kirshblum S.
        • Campagnolo D.I.
        • Nash M.S.
        • Heary R.F.
        • Gorman P.H.
        Spinal cord medicine.
        2nd ed. Lippincott Williams & Wilkins, Philadelphia2011
        • Tator C.H.
        • Hashimoto R.
        • Raich A.
        • et al.
        Translational potential of preclinical trials of neuroprotection through pharmacotherapy for spinal cord injury.
        J Neurosurg Spine. 2012; 17: 157-229
        • Chen Y.
        • Deutsch A.
        • DeVivo M.J.
        • et al.
        Current research outcomes from the Spinal Cord Injury Model Systems.
        Arch Phys Med Rehabil. 2011; 92: 329-331
        • DeVivo M.J.
        Epidemiology of traumatic spinal cord injury: trends and future implications.
        Spinal Cord. 2012; 50: 365-372
        • DeVivo M.J.
        • Chen Y.
        Trends in new injuries, prevalent cases, and aging with spinal cord injury.
        Arch Phys Med Rehabil. 2011; 92: 332-338
        • Go B.K.
        • DeVivo M.J.
        • Richards J.S.
        The epidemiology of spinal cord injury.
        in: Stover S.L. DeLisa J.A. Whiteneck G.C. Spinal cord injury: clinical outcomes from the model systems. Aspen, Gaithersburg1995: 21-55
        • Jackson A.B.
        • Dijkers M.
        • DeVivo M.J.
        • Poczatek R.B.
        A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years.
        Arch Phys Med Rehabil. 2004; 85: 1740-1748
        • Nobunaga A.I.
        • Go B.K.
        • Karunas R.B.
        Recent demographic and injury trends in people served by the Model Spinal Cord Injury Care Systems.
        Arch Phys Med Rehabil. 1999; 80: 1372-1382
      1. National Spinal Cord Injury Statistical Center. Spinal cord injury facts and figures at a glance. Available at: Accessed February 24, 2015.

        • DeVivo M.J.
        • Jackson A.B.
        • Dijkers M.P.
        • Becker B.E.
        Current research outcomes from the Model Spinal Cord Injury Care Systems.
        Arch Phys Med Rehabil. 1999; 80: 1363-1364
        • Chen Y.
        • DeVivo M.J.
        • Richards J.S.
        • SanAugustin T.B.
        Spinal Cord Injury Model Systems: review of program and national database from 1970 to 2015.
        Arch Phys Med Rehabil. 2016; 97: 1797-1804
        • Chen Y.
        • Tang Y.
        • Vogel L.C.
        • DeVivo M.J.
        Causes of spinal cord injury.
        Top Spinal Cord Inj Rehabil. 2013; 19: 1-8
        • Kirshblum S.C.
        • Burns S.P.
        • Biering-Sorensen F.
        • et al.
        International Standards for Neurological Classification of Spinal Cord Injury (revised 2011).
        J Spinal Cord Med. 2011; 34: 535-546
        • Frankel H.L.
        • Hancock D.O.
        • Hyslop G.
        • et al.
        The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I.
        Paraplegia. 1969; 7: 179-192
        • Selvarajah S.
        • Hammond E.R.
        • Haider A.H.
        • et al.
        The burden of acute traumatic spinal cord injury among adults in the United States: an update.
        J Neurotrauma. 2014; 31: 228-238
        • Jain N.B.
        • Ayers G.D.
        • Peterson E.N.
        • et al.
        Traumatic spinal cord injury in the United States, 1993-2012.
        JAMA. 2015; 313: 2236-2243
        • Acton P.A.
        • Farley T.
        • Freni L.W.
        • Ilegbodu V.A.
        • Sniezek J.E.
        • Wohlleb J.C.
        Traumatic spinal cord injury in Arkansas, 1980 to 1989.
        Arch Phys Med Rehabil. 1993; 74: 1035-1040
        • Burke D.A.
        • Linden R.D.
        • Zhang Y.P.
        • Maiste A.C.
        • Shields C.B.
        Incidence rates and populations at risk for spinal cord injury: a regional study.
        Spinal Cord. 2001; 39: 274-278
        • Price C.
        • Makintubee S.
        • Herndon W.
        • Istre G.R.
        Epidemiology of traumatic spinal cord injury and acute hospitalization and rehabilitation charges for spinal cord injuries in Oklahoma, 1988-1990.
        Am J Epidemiol. 1994; 139: 37-47
        • Surkin J.
        • Gilbert B.J.
        • Harkey III, H.L.
        • Sniezek J.
        • Currier M.
        Spinal cord injury in Mississippi. Findings and evaluation, 1992-1994.
        Spine (Phila Pa 1976). 2000; 25: 716-721
        • Williams D.R.
        • Wyatt R.
        Racial bias in health care and health: challenges and opportunities.
        JAMA. 2015; 314: 555-556
        • Frieden L.
        • Winnegar A.J.
        Opportunities for research to improve employment for people with spinal cord injuries.
        Spinal Cord. 2012; 50: 379-381
        • Cao Y.
        • Krause J.S.
        • Saunders L.L.
        • Clark J.M.
        Impact of marital status on 20-year subjective well-being trajectories.
        Top Spinal Cord Inj Rehabil. 2015; 21: 208-217
        • Chen Y.
        • Anderson C.J.
        • Vogel L.C.
        • Chlan K.M.
        • Betz R.R.
        • McDonald C.M.
        Change in life satisfaction of adults with pediatric-onset spinal cord injury.
        Arch Phys Med Rehabil. 2008; 89: 2285-2292
        • Kalpakjian C.Z.
        • Houlihan B.
        • Meade M.A.
        • et al.
        Marital status, marital transitions, well-being, and spinal cord injury: an examination of the effects of sex and time.
        Arch Phys Med Rehabil. 2011; 92: 433-440
        • Kreuter M.
        Spinal cord injury and partner relationships.
        Spinal Cord. 2000; 38: 2-6
        • DeVivo M.J.
        • Sekar P.
        Prevention of spinal cord injuries that occur in swimming pools.
        Spinal Cord. 1997; 35: 509-515
        • Chen Y.
        • Tang Y.
        • Allen V.
        • DeVivo M.J.
        Fall-induced spinal cord injury: external causes and implications for prevention.
        J Spinal Cord Med. 2016; 39: 24-31
        • Chen Y.
        • Tang Y.
        • Allen V.
        • DeVivo M.J.
        Aging and spinal cord injury: external causes of injury and implications for prevention.
        Top Spinal Cord Inj Rehabil. 2015; 21: 218-226
        • van Middendorp J.J.
        • Hosman A.J.
        • Doi S.A.
        The effects of the timing of spinal surgery after traumatic spinal cord injury: a systematic review and meta-analysis.
        J Neurotrauma. 2013; 30: 1781-1794
        • Strauss D.J.
        • DeVivo M.J.
        • Paculdo D.R.
        • Shavelle R.M.
        Trends in life expectancy after spinal cord injury.
        Arch Phys Med Rehabil. 2006; 87: 1079-1085
        • Cuthbert J.
        • Charlifue S.
        • Chen D.
        • et al.
        Generalizability of Spinal Cord Injury Model Systems data 2001-2010.
        J Spinal Cord Med. 2014; 37 ([abstract]): 438-439