Increasing numbers of people with SCI in Australia

Wise Young · 02-10-2005, 01:39 PM

Incidence is the number of cases per year and prevalence is the number of people with a particular condition. While fairly good data is available concerning the incidence of spinal cord injury (due to hospital records), the prevalence of spinal cord injury in any country is based on only rough estimates. Two recent papers published in last month gives some very interesting data on incidence, prevalence, and survival from spinal cord injury in Australia. The first of these studies forecasts a significant increase in the incidence of spinal cord injury in Australia during the coming years. The incidence is expected to rise from 253 per year in 1997 to 464 per year 2021. Most of the rise will in in elderly patients with SCI, from 32 cases per year in 1997 to 233 cases per year in 2021. It also indicates that there are currently 2959 SCI patients aged 15 or over in the Australian Spinal Cord Register. In the second study, they found the cumulative survival proprotion is 94% at one year and 86% in 10 years.

Quote:

O'Connor PJ (2005). Forecasting of spinal cord injury annual case numbers in Australia. Arch Phys Med Rehabil 86: 48-51. OBJECTIVES: To forecast annual numbers of cases of spinal cord injury (SCI) and to assess the effect on case mix. DESIGN: Cohort of incident cases from 1986 to 1997, with forecasting to 2021. SETTING: Australian cases registered by treatment centers for the acute care and rehabilitation of SCI patients. PARTICIPANTS: A total of 2959 SCI patients, aged 15 years and over, identified through the Australian Spinal Cord Register. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incidence and case mix. RESULTS: If the recent trends in SCI continue (ie, a 6.21% per annum rate increase in elderly men and a 2.8% per annum rate decrease in young men), the annual number of cases will increase from 253 in 1997 to 464 in 2021. In addition, the case mix would change substantially and the number and proportion of elderly persons with SCI would increase from 32 cases per annum in 1997 (13% of cases) to 233 per annum in 2021 (47% of cases). In addition, there would be a 143% increase in the number of cases of incomplete tetraplegia, from 88 cases per annum in 1997 to 214 cases per annum in 2021. Substantial increases would occur even if the age-specific rates of SCI were stable over the period. CONCLUSIONS: Population growth, and aging, plus increasing rates of SCI in the elderly will have profound effects on the expected number of SCI patients and their case mix. Treatment centers in Australia will need to plan for these changes. At the same time, there should be increased efforts to prevent SCI in order to ameliorate the problem. Australian Spinal Cord Injury Register, Australian Institute of Health and Welfare, Canberra, Australia. peteroconnor@netscapenet.au
O'Connor PJ (2005). Survival after spinal cord injury in Australia. Arch Phys Med Rehabil 86: 37-47. OBJECTIVE: To assess survival after spinal cord injury (SCI) in Australia. DESIGN: Cohort study of incident cases from 1986 to 1997, with follow-up to the end of 1998. SETTING: Cases registered by 6 Australian treatment centers for the acute care and rehabilitation of SCI patients. PARTICIPANTS: Subjects (N=2892), age 15 years and older, from a national population-based SCI register. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cumulative and relative survival proportions and hazard ratios. RESULTS: The all-cases cumulative survival proportion was 94% at 1 year and 86% at 10 years; the relative survival proportions were 95% and 92%, respectively. Significant predictors of survival were: age at injury, sex, neurologic level, and extent of lesion. Cox regression modeling revealed a statistically significant reduction in the 2-month (36% reduction, P=.01) and 1-year (27% reduction, P=.04) hazard ratio from 1986 to 1991 to 1992 to 1997. Benchmarking analysis revealed no statistically significant difference in survival experience between the 6 spinal treatment units. CONCLUSIONS: Further improvement in survival rates can be achieved through better understanding of the predictors, temporal patterns, and causes of death, and by benchmarking. Early deaths have an important impact on overall survival rates, and warrant further study. International standardization of methods is strongly recommended. Australian Spinal Cord Injury Register, Australian Institute of Health and Welfare, Canberra, Australia.

Max · 02-10-2005, 05:05 PM

Does these increasing numbers mean that Australians more risk takers?

or because of advances in saving & prolonging life of people with sci?

http://stores.ebay.com/MAKSYM-Variety-Store

Wise Young · 02-11-2005, 05:38 AM

Max, probably both. What it is portending is a worldwide trend of more spinal cord injuries in older people. Wise.

Belle · 02-11-2005, 12:30 PM

I was curious how that compared to the US numbers that people reference. Probably not an appropriate use fo the data, but what the heck. I looked up the population of Australia: approx. 20 million. I hadn't realized it was so much smaller than the US (population approx. 290 million)!

It doesn't look like the 2959 number was really meant to indicate existing prevalence in the population, just the incidence over their time span. But the annual incidence they report is lower than the US - the same rate as 253/20 million is only 3700/290 million, and don't people quote a US incidence of about 11,000 SCI per year?

That would suggest, Max, that Australians are not greater risk takers but rather that they are either less risky or less likely to survive to receive care than people in the US. Thus, the increase in incidence would be more likely due to improved survival (or greater risk taking over time - is that what you meant?). Of course, like they say at the end, without good standardization it's comparing apples to oranges. Maybe they just counted differently.

If I ever get a research position, I'm going to use "my kingdom for a data point" as my sig file!

*************
AB wife of T8 complete para

Wise Young · 02-11-2005, 06:21 PM

Belle, you are right. Both the prevalence and incidence rates appear to be lower than in the U.S. I can't tell whether this is because the registry is not complete or because they are not counting certain people who might be spinal-injured, i.e. those who have recovered walking. Wise.

Christopher Paddon · 02-11-2005, 09:47 PM

whatever the number is so low no wonder noone takes any notice of us

Wise Young · 02-12-2005, 02:39 PM

Chris2,

People notice when people make a lot of noise. An Indian friend of mine who had gone to Rajkot and the Gujerati province after the earthquake in 2000 had injured some 6000 people with many brain and spinal cord injuries, told me that patients with brain and spinal cord injuries were typically not taken care of first because they were not making all that much noise. Those people with facial injuries and blood were always taken of first because they make the most noise and looked worst.

Take a look at traumatic brain injury. There are 10 times more traumatic brain injuries than spinal cord injuries. Yet, spinal cord injury gets more attention. I know many families with brain-injuries who wished that they could get more attention for their plight than people with spinal cord injury.

So, it is a matter of advocacy and making enough noise to attract the attention of the press and politicians. It was like that with AIDS and it will be like that for SCI. It also can't be a flash in the pan. It must be done regularly, every day, every week, every month, and every year. We must stay in view and be heard. As the saying goes, out of sight, out of mind. Out of earshot, a sigh of relief.

Wise.

dogger · 02-12-2005, 07:28 PM

This report is so wrong it is not worth reading ! The SCI unit in my state [ Queensland ] had 87 cases in 2003 . They handle all SCIs over 15 years old for the state , which has a population of 3.5 million , plus some from neighbouring areas of northern New South Wales , so i would guess a population area of 4 million people , or about 1/5 of our population . SCIs under 15 years of age are treated in paediatric hospitals . This gives an estimated annual number of about 400 new SCIs in the over 15 year old age group .

This link , is a report from 2001-2002 which cites 398 new cases in the over 15 age group for 2001-02 , with a SCI population of 12,000 . There are also some interesting facts on number of quad vs para [ 54%/45% ] ,incomplete vs complete [ SCI incomplete 39%/SCI complete 60% and quads 34% incomplete/64% complete , paras 55%incomplete/45%complete ] estimated annual cost of care [ A$200 million ] , days of initial care [ quads 168 days , paras 127 days ] and other data . We do have a lower number of injuries per population numbers than the US due to many less gunshot/knife related cases . Here is a breakdown of injury criteria of SCIs ; road related 46% , falls 31% , water related 7% , sports related 5% and other/unspecified causes 11% [ which includes gunshots etc ] .

From my experience these figures are much more accurate . This report also shows a slight decline in SCI per population count rather than the opposite .

Thank you ,
Dogger

Every day I wake up is a good one .

[This message was edited by dogger on 02-12-05 at 10:44 PM.]

[This message was edited by dogger on 02-12-05 at 10:54 PM.]

Max · 02-13-2005, 08:12 AM

Wow Dogger!

You know your stats.....

http://stores.ebay.com/MAKSYM-Variety-Store

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02-10-2005, 05:05 PM	#2
Max Senior Member Join Date: Jul 2001 Location: Montreal,Province of Quebec, CANADA Posts: 15,036	Does these increasing numbers mean that Australians more risk takers? or because of advances in saving & prolonging life of people with sci? http://stores.ebay.com/MAKSYM-Variety-Store

02-11-2005, 05:38 AM	#3
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Max, probably both. What it is portending is a worldwide trend of more spinal cord injuries in older people. Wise.

02-11-2005, 12:30 PM	#4
Belle Senior Member Join Date: Jun 2004 Location: NW Ohio Posts: 495	I was curious how that compared to the US numbers that people reference. Probably not an appropriate use fo the data, but what the heck. I looked up the population of Australia: approx. 20 million. I hadn't realized it was so much smaller than the US (population approx. 290 million)! It doesn't look like the 2959 number was really meant to indicate existing prevalence in the population, just the incidence over their time span. But the annual incidence they report is lower than the US - the same rate as 253/20 million is only 3700/290 million, and don't people quote a US incidence of about 11,000 SCI per year? That would suggest, Max, that Australians are not greater risk takers but rather that they are either less risky or less likely to survive to receive care than people in the US. Thus, the increase in incidence would be more likely due to improved survival (or greater risk taking over time - is that what you meant?). Of course, like they say at the end, without good standardization it's comparing apples to oranges. Maybe they just counted differently. If I ever get a research position, I'm going to use "my kingdom for a data point" as my sig file! ************* AB wife of T8 complete para

02-11-2005, 06:21 PM	#5
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Belle, you are right. Both the prevalence and incidence rates appear to be lower than in the U.S. I can't tell whether this is because the registry is not complete or because they are not counting certain people who might be spinal-injured, i.e. those who have recovered walking. Wise.

02-11-2005, 09:47 PM	#6
Christopher Paddon Senior Member Join Date: Oct 2001 Location: New Zealand Posts: 3,207	whatever the number is so low no wonder noone takes any notice of us

02-12-2005, 02:39 PM	#7
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Chris2, People notice when people make a lot of noise. An Indian friend of mine who had gone to Rajkot and the Gujerati province after the earthquake in 2000 had injured some 6000 people with many brain and spinal cord injuries, told me that patients with brain and spinal cord injuries were typically not taken care of first because they were not making all that much noise. Those people with facial injuries and blood were always taken of first because they make the most noise and looked worst. Take a look at traumatic brain injury. There are 10 times more traumatic brain injuries than spinal cord injuries. Yet, spinal cord injury gets more attention. I know many families with brain-injuries who wished that they could get more attention for their plight than people with spinal cord injury. So, it is a matter of advocacy and making enough noise to attract the attention of the press and politicians. It was like that with AIDS and it will be like that for SCI. It also can't be a flash in the pan. It must be done regularly, every day, every week, every month, and every year. We must stay in view and be heard. As the saying goes, out of sight, out of mind. Out of earshot, a sigh of relief. Wise.

02-12-2005, 07:28 PM	#8
dogger Senior Member Join Date: Jun 2002 Location: Mitchell , Qld. Australia Posts: 2,239	This report is so wrong it is not worth reading ! The SCI unit in my state [ Queensland ] had 87 cases in 2003 . They handle all SCIs over 15 years old for the state , which has a population of 3.5 million , plus some from neighbouring areas of northern New South Wales , so i would guess a population area of 4 million people , or about 1/5 of our population . SCIs under 15 years of age are treated in paediatric hospitals . This gives an estimated annual number of about 400 new SCIs in the over 15 year old age group . This link , is a report from 2001-2002 which cites 398 new cases in the over 15 age group for 2001-02 , with a SCI population of 12,000 . There are also some interesting facts on number of quad vs para [ 54%/45% ] ,incomplete vs complete [ SCI incomplete 39%/SCI complete 60% and quads 34% incomplete/64% complete , paras 55%incomplete/45%complete ] estimated annual cost of care [ A$200 million ] , days of initial care [ quads 168 days , paras 127 days ] and other data . We do have a lower number of injuries per population numbers than the US due to many less gunshot/knife related cases . Here is a breakdown of injury criteria of SCIs ; road related 46% , falls 31% , water related 7% , sports related 5% and other/unspecified causes 11% [ which includes gunshots etc ] . From my experience these figures are much more accurate . This report also shows a slight decline in SCI per population count rather than the opposite . Thank you , Dogger Every day I wake up is a good one . [This message was edited by dogger on 02-12-05 at 10:44 PM.] [This message was edited by dogger on 02-12-05 at 10:54 PM.]

02-13-2005, 08:12 AM	#9
Max Senior Member Join Date: Jul 2001 Location: Montreal,Province of Quebec, CANADA Posts: 15,036	Wow Dogger! You know your stats..... http://stores.ebay.com/MAKSYM-Variety-Store