Population aging and divergent burden trajectories of fall-related spinal cord injury: a cross national analysis

OBJECTIVES: To examine how population aging influences the burden of fall-related spinal cord injury (SCI) across countries at different demographic stages. METHODS: Using GBD 2023 data, we analyzed age-standardized incidence, prevalence, and years lived with disability (YLD) rates of fall-related SCI in India, China, the United States, and Japan. Trends and drivers were assessed using EAPC, joinpoint regression, age-period-cohort models, and demographic decomposition. RESULTS: China showed a significant increase in incidence (AAPC = 1.62%, 95% CI: 0.89-2.36) with a rise-peak-decline-rebound pattern. The United States maintained stable incidence but achieved a marked reduction in YLD burden (AAPC = -2.58%, 95% CI: -3.13 to -2.03). India and Japan exhibited lower burdens and sustained improvements; India's YLD rate declined by 1.58% annually (95% CI: -1.93 to -1.22). APC analysis identified an age-progressive risk pattern in China but age-regressive patterns in the United States and India. Population aging was the main driver of increased prevalence in China (39.53%). CONCLUSION: Fall-related SCI burden varies across demographic stages. Population aging is a key determinant in aging societies, highlighting the need for stage-specific prevention and care strategies.