Supplementary Material for: The Global Macroeconomic Burden of Spinal Cord Injury: A Dynamic Modelling Study from 2020 to 2050

Background Spinal cord injury (SCI) is a debilitating condition that imposes profound and persistent socioeconomic burdens. Despite its relatively low prevalence, SCI results in lifelong disability, reduced productivity, and sustained healthcare costs, particularly among working-age populations. While clinical aspects of SCI have been extensively studied, its broader macroeconomic burden remains underexplored. Methods We developed a dynamic macroeconomic model to estimate the long-term economic burden of SCI across 191 countries and territories from 2020 to 2050. The model integrated epidemiological data from the Global Burden of Disease (GBD) 2019 study with macroeconomic indicators to assess the impact of SCI on labor supply and physical capital accumulation. A counterfactual scenario, assuming the absence of SCI-related disability and healthcare costs, was used to estimate the economic burden. Sensitivity analyses were performed using Monte Carlo simulations and varying social discount rates. Findings Globally, the cumulative macroeconomic burden of SCI between 2020 and 2050 is estimated at INT$5.58 trillion. The highest absolute burdens were observed in China, the USA, and India, while the highest relative burdens as a share of GDP occurred in Iraq (0.26%), Burundi (0.20%), and Sri Lanka (0.17%). High-income countries (HICs) bore the greatest total cost (INT$2.84 trillion), driven by intensive care utilization and prolonged survival. However, low-income countries experienced the highest burden relative to income per capita, highlighting fiscal vulnerability. The burden of SCI was primarily driven by reduced labor force participation and long-term healthcare expenditures, significantly constraining national savings and investment. Interpretation SCI imposes a substantial and uneven macroeconomic burden, with profound implications for national productivity and fiscal resilience. Economic consequences are shaped not only by disease prevalence but also by institutional capacity and health system responsiveness. Investments in SCI prevention, rehabilitation, and social protection are urgently needed, particularly in LMICs, to mitigate long-term economic burden. Our findings offer empirical evidence to inform global health financing and disability policy.