Data Sheet 6_Global, regional, and national burdens of traumatic brain injury, spinal cord injury, and skull fracture and their attributable risk factors from 1990 to 2021: a systematic analysis of the global burden of disease study 2021.pdf

BackgroundTraumatic central nervous system (CNS) injuries—particularly traumatic brain injury (TBI), spinal cord injury (SCI), and skull fractures—represent a significant global health challenge. Previous estimates have lacked a comprehensive global analysis of these injuries and their associated risk factors. Herein, we aimed to examine the epidemiological patterns, temporal trends and risk factors of TBI, SCI, and skull fractures globally from 1990 to 2021.
MethodsWe extracted data from the Global Burden of Disease Study (GBD) 2021, including the prevalence, incidence, and years lived with disability (YLDs) of TBI, SCI, and skull fractures across 204 countries and territories from 1990 to 2021. Data were presented as both numerical counts and age-standardized rates (ASRs) per 100,000 population, with corresponding uncertainty intervals. To assess temporal trends in disease burden, we calculated the estimated annual percentage change (EAPC) with associated 95% confidence intervals.
ResultsCompared with 1990, the number of global incident cases in 2019 changed by 122.56, 121.29, and 97.49% for TBI, SCI, and skull fracture, respectively. During the 30-year study period, there was a downward trend in the ASR of prevalence, incidence and YLDs for TBI (EAPC = −0.68, −0.8 and −0.66, respectively), SCI (EAPC = −0.73, −0.81 and −1.01, respectively) and skull fracture (EAPC = −1.37, −1.15 and −1.38, respectively). Regions with higher sociodemographic indices had higher incidences, incidence rates, and YLDs for all three types of CNS injury. The burden of CNS injury varies notably among regions and nations. Eastern Europe, Central Europe, southern Latin America, Australasia, and high-income North America were the GBD regions with the highest burden of CNS injury, and the burdens of TBI, SCI, and skull fracture showed the most significant increasing trends in the Caribbean. Young-to-middle-aged men (15–39 years) bore the primary burden of TBI, SCI, and skull fractures. Falls were the leading specific risk factor for all three types of CNS injury, followed by motor vehicle road injuries. The global burden of TBI, SCI, and skull fractures is projected to decline through 2040, both in terms of absolute case counts and age-standardized incidence rates.
ConclusionThe global, regional, and national burdens of TBI, SCI, and skull fractures—reflected by their prevalence, incidence, and YLDs—exhibit significant disparities. Our findings can inform policymakers in formulating future strategies for managing traumatic CNS injuries, with priority given to targeted preventive measures against risk factors to mitigate the burden of these life-threatening and disabling CNS conditions.

背景
创伤性中枢神经系统（Central Nervous System, CNS）损伤——尤其是创伤性脑损伤（Traumatic Brain Injury, TBI）、脊髓损伤（Spinal Cord Injury, SCI）及颅骨骨折——是一项严峻的全球公共卫生挑战。此前的相关研究尚未针对此类损伤及其相关危险因素开展全面的全球分析。本研究旨在分析1990年至2021年全球范围内TBI、SCI及颅骨骨折的流行病学特征、时间趋势及危险因素。

方法
本研究提取了2021年全球疾病负担研究（Global Burden of Disease Study, GBD）的数据，涵盖1990年至2021年间204个国家和地区的TBI、SCI及颅骨骨折的患病率、发病率与伤残生存年数（years lived with disability, YLDs）。研究数据以绝对计数及每10万人口年龄标化率（age-standardized rates, ASRs）形式呈现，并附带相应的不确定区间。为评估疾病负担的时间趋势，本研究计算了估计年度百分比变化（estimated annual percentage change, EAPC）及其95%置信区间。

结果
与1990年相比，2019年全球TBI、SCI及颅骨骨折的新发病例数分别增长了122.56%、121.29%及97.49%。在30年的研究周期内，TBI、SCI及颅骨骨折的患病率、发病率与YLDs的年龄标化率均呈下降趋势：TBI的EAPC分别为-0.68、-0.8及-0.66，SCI为-0.73、-0.81及-1.01，颅骨骨折为-1.37、-1.15及-1.38。社会人口学指数较高的地区，三类中枢神经系统损伤的发病率、发病密度及YLDs均更高。不同地区及国家的中枢神经系统损伤负担存在显著差异。东欧、中欧、拉丁美洲南部、澳大拉西亚及高收入北美地区是GBD区域中中枢神经系统损伤负担最高的区域；加勒比地区的TBI、SCI及颅骨骨折负担增幅最为显著。15~39岁的中青年男性是TBI、SCI及颅骨骨折的主要负担人群。跌倒为三类中枢神经系统损伤的首要危险因素，其次为道路交通伤害。预计至2040年，全球TBI、SCI及颅骨骨折的负担（按绝对病例数及年龄标化发病率计算）均将呈下降趋势。

结论
以患病率、发病率及YLDs为评估指标，全球、各区域及国家层面的TBI、SCI及颅骨骨折负担存在显著差异。本研究结果可为政策制定者制定创伤性中枢神经系统损伤的后续管理策略提供参考，建议优先针对危险因素制定靶向预防措施，以减轻此类危及生命并导致失能的中枢神经系统疾病负担。