Trends in traumatic spinal cord injuries in Estonia from 1997 to 2018

To analyze time trends in incidence, causes and risk factors for traumatic spinal cord injuries (TSCI) in Estonia between 1997–2007 and 2008–2018. Retrospective, population-based cohort study. Specialized trauma centres in Estonia. Medical records of patients with TSCI from 1997 to 2018. None. Demographical data, crude and age- and sex-adjusted incidence rates, causes of TSCI, level and extent of injury, associated injuries. A total of 940 new patients with TSCI were identified for the period of 1997–2018. The average annual incidence rate (standardized to the Estonian population by age and sex in 2011) decreased significantly from 37.8 (95% confidence interval (CI) 34.6–41.1) in the first period (1997–2008) to 28.2 per million population (95% CI 25.3–31.0) during the second period (2008–2018) (incidence rate ratio 0.74 (95% CI 0.65–0.85), P < 0.0001). The decrease in incidence was most significant among young men. The mean age at injury increased from 38.7 (±16.7) years to 46.6 (±19.9) years, P < 0.0001. Falls were the leading cause of injury during both periods followed by traffic accidents and sports injuries. Still, traffic accidents as a cause of TSCI decreased significantly (from 30.5% to 20.6%, P = 0.001) and falls increased (from 39.9% to 59.5%, P < 0.0001) during the second period. Alcohol consumption prior to injury also decreased significantly from 66.0% to 55.1% (P = 0.006). Estonia has become closer to other European countries regarding TSCI during the last decade; TSCI incidence has significantly decreased, the mean age at injury and the percentage of falls have increased.