Employment and productivity losses from cervical spinal cord injury: a 7-year nationwide cohort study in Taiwan, 2012–2018

To investigate the extent to which employment and productivity losses could be prevented by mitigating cervical spinal cord injury (SCI) and concurrent traumatic brain injury (TBI) in Taiwan. Using Taiwan’s National Health Insurance Database, we identified individuals with cervical SCI and concurrent TBI, with the 7-year data collection period (2012–2018) and a general population cohort as the reference. Survival and employment status were extrapolated to lifetime and age using rolling extrapolation with restricted cubic spline regression and generalized linear models. This study included 2,852 patients with cervical SCI and 367 with concurrent TBI. In cervical SCI, loss-of-life expectancy, loss-of-lifetime employment duration (LED), and loss-of-lifetime insured salary (LIS; a proxy for productivity) were 19.3 years, 7.5 years, and $122,998, respectively. The relative loss-of-LED of motor-vehicle-related cervical SCI with concurrent TBI was significantly higher than that without TBI (72.7% vs. 64.2%). The relative loss-of-LED in middle-aged cervical SCI was significantly higher than loss-of-LIS (58.2% vs. 63.5%), suggesting that total productivity was more severely affected than working time. This 7-year nationwide cohort provides the first lifetime employment and productivity loss estimates for cervical SCI, demonstrating that concurrent TBI and younger age amplify economic burden. The findings shift the policy focus from generic SCI prevention to specific, high-yield interventions: mandatory TBI screening, age-tailored vocational programs, and productivity-targeted workplace accommodations. These evidence-based figures enable precise cost-benefit analyses for preventive measures (e.g. enhanced helmet legislation, road safety) and rehabilitation investments, offering actionable data for Taiwan’s health and labor policymakers. This study examined how cervical spinal cord injuries (SCI) affect individuals’ ability to work and earn income over their lifetime in Taiwan, as well as whether having a concurrent traumatic brain injury (TBI) further worsens the outcomes. Cervical SCI is a life-altering condition that often results in paralysis and long-term health complications. Although it is well known that these injuries reduce the likelihood of returning to work, precise estimates of the lifetime income loss associated with cervical SCI have been lacking. By quantifying these losses, this study highlights the full social and financial impact of SCI. The results showed that cervical SCI has severe and lasting consequences for employment, productivity, and economic well-being. The findings offer valuable guidance for policymakers in shaping injury prevention initiatives, allocating rehabilitation resources, and developing workplace support systems aimed at helping individuals with cervical SCI maintain economic independence and quality of life.本研究旨在探究在台湾地区，通过干预颈椎脊髓损伤（cervical spinal cord injury, SCI）及合并创伤性脑损伤（traumatic brain injury, TBI）的病情，可避免的就业与生产力损失规模。本研究依托台湾地区全民健康保险数据库（National Health Insurance Database），筛选出2012至2018年共7年数据收集周期内的颈椎脊髓损伤合并创伤性脑损伤患者，并以普通人群队列作为参照组。采用限制性立方样条回归与广义线性模型的滚动外推法，将受试者生存状况与就业状态外推至终生及全年龄段。本研究共纳入2852名颈椎脊髓损伤患者，其中367名合并创伤性脑损伤。在颈椎脊髓损伤患者群体中，预期寿命损失、终生就业时长损失（LED）、终生参保薪资损失（LIS，即生产力替代指标）分别为19.3年、7.5年与122998美元。合并创伤性脑损伤的机动车相关颈椎脊髓损伤患者的相对终生就业时长损失显著高于未合并创伤性脑损伤者（72.7% vs 64.2%）。中年颈椎脊髓损伤患者的相对终生就业时长损失显著高于相对终生参保薪资损失（58.2% vs 63.5%），提示总生产力受影响程度较工作时长更为严重。这项为期7年的全国性队列研究首次针对颈椎脊髓损伤提供了终生就业与生产力损失的量化评估结果，证实合并创伤性脑损伤与更年轻的年龄会放大经济负担。本研究结果推动政策重点从通用脊髓损伤预防转向针对性、高收益干预举措：强制创伤性脑损伤筛查、适配年龄的职业康复项目，以及针对生产力的职场适配方案。这些基于证据的量化数据可为预防措施（例如强化头盔立法、道路安全举措）与康复投入开展精准的成本效益分析，为台湾地区卫生与劳动政策制定者提供可落地的数据支撑。 本研究探讨了台湾地区颈椎脊髓损伤对个体终生工作能力与收入水平的影响，以及合并创伤性脑损伤是否会进一步恶化此类结局。颈椎脊髓损伤是一种彻底改变人生轨迹的病症，常导致瘫痪与长期健康并发症。尽管学界已明确此类损伤会降低重返工作岗位的可能性，但此前仍缺乏颈椎脊髓损伤相关终生收入损失的精准评估数据。通过量化此类损失，本研究揭示了脊髓损伤的全面社会与经济影响。研究结果显示，颈椎脊髓损伤对就业、生产力与经济福祉均会造成严重且持久的影响。本研究结果可为政策制定者制定损伤预防方案、分配康复资源、构建职场支持体系提供宝贵指导，助力颈椎脊髓损伤患者维持经济独立性与生活质量。