Article(id=1324050739647098908, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050669933572771, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202512022, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1764604800000, receivedDateStr=2025-12-02, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793607896004, onlineDateStr=2026-11-02, pubDate=1778342400000, pubDateStr=2026-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793607896004, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793607896004, creator=13701087609, updateTime=1793607896004, updator=13701087609, issue=Issue{id=1324050669933572771, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='1778342400000', pubDateStr='2026-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793607879384, creator='13701087609', updateTime=1793670100562, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311644528050975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050669933572771, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311644528050976, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050669933572771, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1549, endPage=1556, ext={EN=ArticleExt(id=1324050739890368541, articleId=1324050739647098908, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Burden trend of spinal cord injuries due to falls in China from 1990 to 2021, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

This study systematically analyzed temporal trends in the burden of spinal cord injury (SCI) attributable to falls in China from 1990 to 2021, focusing on incidence, prevalence, and years lived with disability (YLD).

Methods

Data were obtained from the Global Burden of Disease (GBD) 2021 database, using publicly available national estimates of fall-related SCI in China from 1990 to 2021. Descriptive analyses were conducted to characterize changes in incidence, prevalence, and YLD. Temporal trends were further examined using Joinpoint regression and age-period-cohort (APC) models.

Results

In 2021, the number of prevalent cases of fall-related SCI in China was estimated at 1 480 074, with 62 724 incident cases. The age-standardized prevalence rate (ASPR) was 80.21 per 100 000 population and the age-standardized incidence rate (ASIR) was 3.76 per 100 000 population. Total YLDs reached 397 472 years, corresponding to an age-standardized YLD rate (ASYR) of 21.74 per 100 000 population. Sex-based analysis showed a substantially higher disease burden in males than in females. Joinpoint regression indicated a modest increase in ASIR during 1995—2000 (APC=1.89), a marked decline during 2000—2005 (APC=-6.12), followed by a rapid increase during 2010—2021 (2010—2015: APC=5.90; 2015—2021: APC=4.59). Similarly, ASPR showed a slight increase during 1990—2001 (APC=0.55), a significant decline during 2001—2005 (APC=-8.58), and a renewed rapid increase during 2010—2021 (APC=5.08). YLDs remained relatively stable from 1990 to 2000, declined during 2000—2007 (APC=-9.94), and increased during 2010—2021 (APC=4.68). Overall trends were comparable between males and females. APC analysis revealed a pronounced increase in SCI risk with advancing age, while period and cohort effects fluctuated but showed an overall upward pattern, suggesting that economic development, improvements in healthcare, and population aging may jointly contribute to the increasing burden.

Conclusion

From 1990 to 2021, the disease burden of SCI in China has increased substantially, with males and older adults experiencing markedly higher risks than females and younger populations. Targeted public health strategies addressing population aging and risk management among high-risk groups are urgently needed to mitigate the long-term health and societal impacts of SCI.

, authors=Jie-hui LI1, Zhi-fei LI2, bin HAN1, Jun-hua LI1, Xiang-xuan ZENG1, Jia-hao LIANG1, jin-tao FANG1, Yi-sheng ZHANG2, authorsList=Jie-hui LI, Zhi-fei LI, bin HAN, Jun-hua LI, Xiang-xuan ZENG, Jia-hao LIANG, jin-tao FANG, Yi-sheng ZHANG, authorCompany=null, correspAuthors=Yi-sheng ZHANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324050740880224294, articleId=1324050739647098908, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=1990—2021年中国因跌倒导致的脊髓损伤的负担趋势分析, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

本研究系统分析了1990—2021年中国因跌倒导致的脊髓损伤负担变化趋势,具体包括发病率、患病率及伤残生命年(years lived with disability,YLD)。

方法

研究基于全球疾病负担2021数据库,使用1990—2021年中国因跌倒导致的脊髓损伤相关开放数据,评估发病率、患病率和YLD的变化特征,同时应用joinpoint回归分析和年龄-时期-队列(age-period-cohort,APC)模型分析探讨时间趋势。

结果

2021年中国因跌倒导致的脊髓损伤患病人数为1 480 074例,发病人数为62 724例,年龄标准化患病率(age-standardized prevalence rate,ASPR)为80.21/10万,年龄标准化发病率(age-standardized incidence rate,ASIR)为3.76/10万,伤残生命年总数为397 472年,相应的年龄标准化伤残生命年为21.74/10万。性别差异分析显示,男性的疾病负担远高于女性。Joinpoint回归结果表明,ASIR在1995—2000年呈缓慢上升趋势(APC=1.89),2000—2005年出现显著下降(APC=-6.12),而在2010—2021年迅速上升(2010—2015年APC=5.90;2015—2021年APC=4.59)。相应地,ASPR在1990—2001年略有上升(APC=0.55),2001—2005年显著下降(APC=-8.58),并在2010—2021年再次快速增长(APC=5.08)。在YLD方面,1990—2000年保持稳定,2000—2007年下降(APC = -9.94),在2010—2021年上升(APC = 4.68),男性与女性总体趋势一致。APC模型分析结果提示,脊髓损伤发病风险随年龄增长显著上升,时期效应与队列效应虽存在波动但总体呈上升趋势,表明经济发展、医疗改善及人口老龄化可能共同推动了疾病负担的增加。

结论

1990—2019年中国因跌倒导致的脊髓损伤的疾病负担持续上升,其中男性和老年人群的发病风险显著高于女性和年轻人。相关公共卫生政策需积极应对人口老龄化及高危人群风险管理等挑战,以有效遏制脊髓损伤带来的长期健康与社会影响。

, authors=李杰辉1, 李智斐2, 韩斌1, 李俊华1, 曾祥轩1, 梁家豪1, 方锦涛1, 张翼升2, authorsList=李杰辉, 李智斐, 韩斌, 李俊华, 曾祥轩, 梁家豪, 方锦涛, 张翼升, authorCompany=null, correspAuthors=张翼升, authorNote=

李杰辉(2001—),男,硕士在读,研究方向:脊柱相关疾病的中医诊治研究

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张翼升,E-mail:
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China CDC Wkly, 2024, 6(14): 277-281., articleTitle=Evaluation of the Effectiveness of "5E"Comprehensive Injury Prevention Strategy for Fall Prevention Among the Rural Elderly - Six Pilot Villages, Yunnan Province and Chongqing Municipality, China, 2018-2023, refAbstract=null)], funds=[Fund(id=1324050753366667369, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, awardId=82260942, language=CN, fundingSource=国家自然科学基金(82260942), fundOrder=null, country=null), Fund(id=1324050753693823082, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, awardId=2022JJA140858, language=CN, fundingSource=广西自然科学基金(2022JJA140858), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324050741173825575, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, xref=1., ext=[AuthorCompanyExt(id=1324050741182214184, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, companyId=1324050741173825575, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Graduate School, Guangxi University of Chinese Medicine, Nanning, Guangxi 530000, China), AuthorCompanyExt(id=1324050741190602793, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, companyId=1324050741173825575, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.广西中医药大学研究生院,广西 南宁 530000)]), AuthorCompany(id=1324050741261905962, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, xref=2., ext=[AuthorCompanyExt(id=1324050741270294571, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, companyId=1324050741261905962, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.广西中医药大学附属第一医院脊柱骨伤科,广西 南宁 530000)])], figs=[ArticleFig(id=1324050749654708317, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, language=EN, label=Figure 1, caption=Gender differences in the burden of SCI caused by falls among different age groups in China, figureFileSmall=YjAUFL281V/e95UbvIs5Xw==, figureFileBig=rN5liyc+xHdCBIfAJKrDsw==, tableContent=null), ArticleFig(id=1324050749738594398, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, language=CN, label=图1, caption=中国不同年龄组因跌倒导致的脊髓损伤负担的性别差异, figureFileSmall=YjAUFL281V/e95UbvIs5Xw==, figureFileBig=rN5liyc+xHdCBIfAJKrDsw==, tableContent=null), ArticleFig(id=1324050750011224159, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, language=EN, label=Figure 2, caption=Gender trends in the number of cases, ASIR, ASPR, and ASYR of SCI caused by falls in China from 1990 to 2021, figureFileSmall=Ouk2Buu65rJgilAKl+0YPg==, figureFileBig=g3DmyZM1vlrhyT9/EmNvSw==, tableContent=null), ArticleFig(id=1324050750082527328, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, language=CN, label=图2, caption=1990—2021年中国因跌倒导致的脊髓损伤的病例数和ASIR、ASPR和ASYR的性别趋势, figureFileSmall=Ouk2Buu65rJgilAKl+0YPg==, figureFileBig=g3DmyZM1vlrhyT9/EmNvSw==, tableContent=null), ArticleFig(id=1324050750158024801, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, language=EN, label=Figure 3, caption=Results of Joinpoint regression analysis of ASPR, ASIR, and ASYR of SCI caused by falls in China from 1990 to 2019, figureFileSmall=HtmoqhKajBiAJGeaIe7Cpw==, figureFileBig=BoS6rkPsCUhn5x2/pmx+yQ==, tableContent=null), ArticleFig(id=1324050750216745058, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, language=CN, label=图3, caption=中国1990—2019年因跌倒导致的脊髓损伤ASPR、ASIR和ASYR的连接点回归分析结果

注:A、B、C为ASPR的joinpoint回归分析图;D、E、F为ASIR的joinpoint回归分析图;G、H、I为ASYR的joinpoint回归分析图。

, figureFileSmall=HtmoqhKajBiAJGeaIe7Cpw==, figureFileBig=BoS6rkPsCUhn5x2/pmx+yQ==, tableContent=null), ArticleFig(id=1324050750397100131, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, language=EN, label=Figure 4, caption=Age-period-cohort (APC) model of SCI caused by falls in China, figureFileSmall=kEcK1sRUTwNIFvaMhbycuA==, figureFileBig=UHxA0rOiEPBrFUhEVLLDRg==, tableContent=null), ArticleFig(id=1324050750522929252, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, language=CN, label=图4, caption=中国因跌倒导致的脊髓损伤APC模型

注:A为年龄曲线图展现了年龄效应;B为时期风险比图展现了时期效应;C为队列风险比图展现出生队列效应;D为净漂移和局部漂移图,进一步展现年龄效应。

, figureFileSmall=kEcK1sRUTwNIFvaMhbycuA==, figureFileBig=UHxA0rOiEPBrFUhEVLLDRg==, tableContent=null), ArticleFig(id=1324050750782976101, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, language=EN, label=Table 1, caption=

All age cases of SCI caused by falls in China in 2021, along with ASPR, ASIR, and YLD

, figureFileSmall=null, figureFileBig=null, tableContent=
测量指标人数年龄标准化率(/10万)
两性男性女性两性男性女性
ASPR1480 074
(1 279 782~1 716 100)
917 057
(796 955~1 054 336)
563 017
(480 709~660 652)
80.21
(69.21~92.94)
99.14
(85.83~114.47)
60.09
(51.17~71.26)
ASIR62 724
(38 326~99 430)
38 067
(24 512~59 054)
24 657
(13 646~41 534)
3.76
(2.35~5.94)
4.68
(3.05~7.14)
2.79
(1.56~4.69)
YLD397 472
(279 486~536 646)
252 626
(177 456~338 707)
144 846
(100 167~195 581)
21.74
(15.1~29.54)
27.53
(19.09~37.48)
15.62
(10.75~21.37)
), ArticleFig(id=1324050751147880550, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, language=CN, label=表1, caption=

2021年中国因跌倒导致的脊髓损伤的所有年龄病例和ASPR、ASIR和YLD

, figureFileSmall=null, figureFileBig=null, tableContent=
测量指标人数年龄标准化率(/10万)
两性男性女性两性男性女性
ASPR1480 074
(1 279 782~1 716 100)
917 057
(796 955~1 054 336)
563 017
(480 709~660 652)
80.21
(69.21~92.94)
99.14
(85.83~114.47)
60.09
(51.17~71.26)
ASIR62 724
(38 326~99 430)
38 067
(24 512~59 054)
24 657
(13 646~41 534)
3.76
(2.35~5.94)
4.68
(3.05~7.14)
2.79
(1.56~4.69)
YLD397 472
(279 486~536 646)
252 626
(177 456~338 707)
144 846
(100 167~195 581)
21.74
(15.1~29.54)
27.53
(19.09~37.48)
15.62
(10.75~21.37)
), ArticleFig(id=1324050752842379367, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, language=EN, label=Table 2, caption=

AAPCs of ASIR, ASPR, and ASYR of SCI caused by falls in China from 1990 to 2019

, figureFileSmall=null, figureFileBig=null, tableContent=
性别AAPC(%)
ASIRASPRASYR
两性1.04
(0.74~1.34)
1.16
(0.83~1.49)
0.25
(-0.05~0.54)
女性1.12
(0.80~1.44)
1.22
(0.87~1.57)
0.31
(-0.02~0.63)
男性1.02
(0.72~1.32)
1.18
(0.85~1.50)
0.24
(-0.05~0.53)
), ArticleFig(id=1324050753039511656, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050739647098908, language=CN, label=表2, caption=

1990—2021年中国因跌倒导致的脊髓损伤ASIR、ASPR和ASYR的AAPC

, figureFileSmall=null, figureFileBig=null, tableContent=
性别AAPC(%)
ASIRASPRASYR
两性1.04
(0.74~1.34)
1.16
(0.83~1.49)
0.25
(-0.05~0.54)
女性1.12
(0.80~1.44)
1.22
(0.87~1.57)
0.31
(-0.02~0.63)
男性1.02
(0.72~1.32)
1.18
(0.85~1.50)
0.24
(-0.05~0.53)
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1990—2021年中国因跌倒导致的脊髓损伤的负担趋势分析
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李杰辉 1 , 李智斐 2 , 韩斌 1 , 李俊华 1 , 曾祥轩 1 , 梁家豪 1 , 方锦涛 1 , 张翼升 2
现代预防医学 | 流行病与统计方法 2026,53(9): 1549-1556
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现代预防医学 |流行病与统计方法 2026 , 53 (9) : 1549 -1556
1990—2021年中国因跌倒导致的脊髓损伤的负担趋势分析
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李杰辉1, 李智斐2, 韩斌1, 李俊华1, 曾祥轩1, 梁家豪1, 方锦涛1, 张翼升2
作者信息
  • 1.广西中医药大学研究生院,广西 南宁 530000
  • 2.广西中医药大学附属第一医院脊柱骨伤科,广西 南宁 530000
通讯作者:
张翼升,E-mail:
作者简介:

李杰辉(2001—),男,硕士在读,研究方向:脊柱相关疾病的中医诊治研究

Burden trend of spinal cord injuries due to falls in China from 1990 to 2021
Jie-hui LI1, Zhi-fei LI2, bin HAN1, Jun-hua LI1, Xiang-xuan ZENG1, Jia-hao LIANG1, jin-tao FANG1, Yi-sheng ZHANG2
Affiliations
  • Graduate School, Guangxi University of Chinese Medicine, Nanning, Guangxi 530000, China
出版时间: 2026-05-10 doi: 10.20043/j.cnki.MPM.202512022
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目的

本研究系统分析了1990—2021年中国因跌倒导致的脊髓损伤负担变化趋势,具体包括发病率、患病率及伤残生命年(years lived with disability,YLD)。

方法

研究基于全球疾病负担2021数据库,使用1990—2021年中国因跌倒导致的脊髓损伤相关开放数据,评估发病率、患病率和YLD的变化特征,同时应用joinpoint回归分析和年龄-时期-队列(age-period-cohort,APC)模型分析探讨时间趋势。

结果

2021年中国因跌倒导致的脊髓损伤患病人数为1 480 074例,发病人数为62 724例,年龄标准化患病率(age-standardized prevalence rate,ASPR)为80.21/10万,年龄标准化发病率(age-standardized incidence rate,ASIR)为3.76/10万,伤残生命年总数为397 472年,相应的年龄标准化伤残生命年为21.74/10万。性别差异分析显示,男性的疾病负担远高于女性。Joinpoint回归结果表明,ASIR在1995—2000年呈缓慢上升趋势(APC=1.89),2000—2005年出现显著下降(APC=-6.12),而在2010—2021年迅速上升(2010—2015年APC=5.90;2015—2021年APC=4.59)。相应地,ASPR在1990—2001年略有上升(APC=0.55),2001—2005年显著下降(APC=-8.58),并在2010—2021年再次快速增长(APC=5.08)。在YLD方面,1990—2000年保持稳定,2000—2007年下降(APC = -9.94),在2010—2021年上升(APC = 4.68),男性与女性总体趋势一致。APC模型分析结果提示,脊髓损伤发病风险随年龄增长显著上升,时期效应与队列效应虽存在波动但总体呈上升趋势,表明经济发展、医疗改善及人口老龄化可能共同推动了疾病负担的增加。

结论

1990—2019年中国因跌倒导致的脊髓损伤的疾病负担持续上升,其中男性和老年人群的发病风险显著高于女性和年轻人。相关公共卫生政策需积极应对人口老龄化及高危人群风险管理等挑战,以有效遏制脊髓损伤带来的长期健康与社会影响。

跌倒  /  脊髓损伤  /  趋势  /  全球疾病负担
Objective

This study systematically analyzed temporal trends in the burden of spinal cord injury (SCI) attributable to falls in China from 1990 to 2021, focusing on incidence, prevalence, and years lived with disability (YLD).

Methods

Data were obtained from the Global Burden of Disease (GBD) 2021 database, using publicly available national estimates of fall-related SCI in China from 1990 to 2021. Descriptive analyses were conducted to characterize changes in incidence, prevalence, and YLD. Temporal trends were further examined using Joinpoint regression and age-period-cohort (APC) models.

Results

In 2021, the number of prevalent cases of fall-related SCI in China was estimated at 1 480 074, with 62 724 incident cases. The age-standardized prevalence rate (ASPR) was 80.21 per 100 000 population and the age-standardized incidence rate (ASIR) was 3.76 per 100 000 population. Total YLDs reached 397 472 years, corresponding to an age-standardized YLD rate (ASYR) of 21.74 per 100 000 population. Sex-based analysis showed a substantially higher disease burden in males than in females. Joinpoint regression indicated a modest increase in ASIR during 1995—2000 (APC=1.89), a marked decline during 2000—2005 (APC=-6.12), followed by a rapid increase during 2010—2021 (2010—2015: APC=5.90; 2015—2021: APC=4.59). Similarly, ASPR showed a slight increase during 1990—2001 (APC=0.55), a significant decline during 2001—2005 (APC=-8.58), and a renewed rapid increase during 2010—2021 (APC=5.08). YLDs remained relatively stable from 1990 to 2000, declined during 2000—2007 (APC=-9.94), and increased during 2010—2021 (APC=4.68). Overall trends were comparable between males and females. APC analysis revealed a pronounced increase in SCI risk with advancing age, while period and cohort effects fluctuated but showed an overall upward pattern, suggesting that economic development, improvements in healthcare, and population aging may jointly contribute to the increasing burden.

Conclusion

From 1990 to 2021, the disease burden of SCI in China has increased substantially, with males and older adults experiencing markedly higher risks than females and younger populations. Targeted public health strategies addressing population aging and risk management among high-risk groups are urgently needed to mitigate the long-term health and societal impacts of SCI.

Falls  /  Spinal cord injury  /  Trends  /  Global burden of disease
李杰辉, 李智斐, 韩斌, 李俊华, 曾祥轩, 梁家豪, 方锦涛, 张翼升. 1990—2021年中国因跌倒导致的脊髓损伤的负担趋势分析. 现代预防医学, 2026 , 53 (9) : 1549 -1556 . DOI: 10.20043/j.cnki.MPM.202512022
Jie-hui LI, Zhi-fei LI, bin HAN, Jun-hua LI, Xiang-xuan ZENG, Jia-hao LIANG, jin-tao FANG, Yi-sheng ZHANG. Burden trend of spinal cord injuries due to falls in China from 1990 to 2021[J]. Modern Preventive Medicine, 2026 , 53 (9) : 1549 -1556 . DOI: 10.20043/j.cnki.MPM.202512022
世界卫生组织(World Health Organization,WHO)将“跌倒”界定为个体在非自愿情形下,身体意外下移至地面、地板或其他较低位置的事件[1-2]。从全球视角看,跌倒是继道路交通事故之后导致非故意伤害死亡的第二大主要因素,每年约造成68.4万人死亡[1]。目前,跌倒已被认为是脊髓损伤(spinal cord injury)的首要外部诱因之一,其带来的健康与社会经济影响深远[3-4]。脊髓损伤通常会引起长期或永久性功能障碍、寿命缩短及沉重的医疗与康复负担,患者在多数情况下需依赖长期医疗服务与持续照护[5]。在不同人群中,跌倒所致脊髓损伤的风险存在显著差异。尤其在老年个体及从事高坠落风险或体力劳动岗位的群体中,相关伤害更为常见且后果严重[6]。然而,尽管跌倒相关脊髓损伤的健康负担持续上升,针对其全球变化趋势及各国差异的系统性分析仍相对不足。基于此,本研究利用《全球疾病负担研究》(Global Burden of Disease, GBD)2021数据库,对1990—2021年中国因跌倒导致的脊髓损伤负担进行系统评估,旨在为制定公共卫生政策和资源配置方案提供科学依据。通过结合实际数据,能够为未来干预措施提供有效的策略建议,减轻跌倒引发的脊髓损伤带来的社会、经济及个人负担,并推动相关公共卫生政策的改进和优化。
本研究所使用的脊髓损伤相关数据来源于《全球疾病负担研究》(Global Burden of Disease, GBD)2021数据库。该数据库涵盖了1990—2021年全球371种疾病和损伤的流行病学估计值,覆盖21个GBD地区及204个国家和地区[7]。本研究从中提取了中国1990—2021年与脊髓损伤相关的全部数据。选择“跌倒”作为主要结局变量。在年龄分析中,既包含了“所有年龄组”与“年龄标准化”指标,也进一步考察了以下具体年龄段:<5岁、5~9岁、10~14岁、15~19岁、20~24岁、25~29岁、30~34岁、35~39岁、40~44岁、45~49岁、50~54岁、55~59岁、60~64岁、65~69岁、70~74岁、75~79岁、80~84岁、85~89岁、90~94岁以及95岁及以上组。分析中纳入了“男性”“女性”“两性合计”三类性别分组。
本研究报告了与脊髓损伤相关的年龄标准化发病率(age-standardized incidence rate,ASIR)、年龄标准化患病率(age-standardized prevalence rate,ASPR)以及年龄标准化伤残生命年率(age-standardized years lived with disability rate,ASYR)。其中,伤残生命年(years lived with disability,YLD)用于量化由脊髓损伤所致的总体健康损失,通过估算患者因功能受限而损失的健康年数来反映疾病负担。年龄标准化率的计算基于GBD数据库所采用的标准化全球人口结构。为了评估各项指标的不确定性与波动范围,本研究使用了95%不确定性区间(95% uncertainty interval, UI)进行统计分析。此外,采用joinpoint回归模型对时间序列数据进行趋势变化分析[8-9],相关分析由Joinpoint软件完成。本研究采用年龄–时期–队列(age-period-cohort, APC)模型来评估不同年龄、时期及出生队列对脊髓损伤流行特征的独立影响。
2021年,中国因跌倒导致的脊髓损伤全年龄发病例数估计为62 724例。其中,男性为38 067例,女性为24 657例。ASIR为3.76/10万,其中男性为4.6/10万,女性为2.79/10万。男性及女性发病率在70岁以下相对稳定,在70~94岁年龄段快速上升,男性发病率峰值出现在90~94岁,为36/10万(95% CI:66/10万~18/10万);女性的发病率峰值出现在95岁及以上,为39/10万(95% CI:79/10万~16/10万)。
2021年中国因跌倒相关脊髓损伤的全年龄患病人数为1 480 074例。其中男性患病917 057例,女性患病563 017例。对应的ASPR为80.21/10万,其中男性为99.14/10万,女性为60.09/10万。年龄差异方面,男性患病率随年龄升高,在0~70年龄段之间稳定增长,最高值出现在70~74岁,为238/10万(95% CI:283/10万~198/10万),随后开始下降。而女性的患病率在0~85岁年龄段呈稳定增长趋势,峰值出现在85~89岁,为222/10万(95% CI:318/10万~145/10万),在90~95岁及以上年龄段呈下降趋势。
2021年中国因跌倒导致脊髓损伤的YLD总数为397 472年,其中男性为252 626年,女性为144 846年。相应的ASYR为21.74/10万,男性为27.53/10万,女性为15.62/10万。YLD的年龄差异方面与患病率类似,男性YLD在65岁之前稳定增长,最高值出现在65~69岁,为61/10万(95% CI:83/10万~42/10万),而女性的YLD在80岁之前呈上升趋势,峰值出现在80~84岁,为51/10万(95% CI:76/10万~32/10万)。见表1,图1、2。
本研究对中国1990—2021年因跌倒导致的脊髓损伤ASIR、ASPR及ASYR进行了joinpoint回归分析。分析结果显示,ASIR在不同时间段呈现明显波动:1995—2000年呈缓慢上升趋势(APC=1.89,95% CI:0.90~2.90),随后在2000—2005年迅速下降(APC=-6.12,95% CI:-7.04~-5.19),而2010—2015年再次快速上升(APC=5.90,95% CI:4.84~6.97),2015—2021年继续增长(APC=4.59,95% CI:4.03~5.16)。ASPR在1990—2001年缓慢增长(APC=0.55,95% CI:0.28~0.81),2001—2005年出现显著下降(APC=-8.58,95% CI:-10.24~-6.89),而2010—2021年再次快速上升(APC=5.08,95% CI:4.83~5.33)。ASYR在1990—2000年保持稳定,2000—2007年下降(APC=-9.94,95% CI:-11.51~-8.35),在2010—2021年上升(APC=4.68,95% CI:4.43~ 4.96)。性别分层分析显示,男性与女性的ASIR、ASPR和YLD变化趋势基本一致,均呈现先下降、随后快速上升的模式。见图3。
1990—2021年,中国因跌倒导致的脊髓损伤的ASIR、ASPR及ASYR分别累积上升1.04%、1.16%、0.25%。进一步分析显示,女性的平均年度变化百分比(average annual percentage change,AAPC)在ASIR、ASPR及YLD方面均高于男性。见表2。
图4A展示了中国因跌倒导致的脊髓损伤的年龄效应。随着年龄增加,因跌倒导致的脊髓损伤的发病率呈逐步上升趋势,在60岁之后显著增加。图4B显示了时期效应,以2004年为参考,1999—2004年发病率略有下降,而自2009年起持续上升。图4C反映了出生队列效应,以1957年出生队列为基准,发病率逐步上升,直至2007年出生队列后出现下降趋势。图4D进一步说明,60岁以上人群因跌倒导致的脊髓损伤发病风险持续升高。
跌倒是导致脊髓损伤的重要因素,本研究基于GBD 2021数据库,系统评估了中国因跌倒导致的脊髓损伤的ASIR、ASPR及YLD。结果显示,2021年脊髓损伤疾病负担中,因跌倒引发的脊髓损伤发病率随年龄而升高,70岁以后老年群体为高风险人群;中国男性群体在脊髓损伤的流行病学负担中占据较高位置,而女性则整体水平相对较低。1990—2021年中国脊髓损伤的ASIR、ASPR及YLD均显著上升,年龄效应脊髓损伤发病风险的主要驱动因素。
在性别差异方面,2021年男性的脊髓损伤患病人数和发病人数均高于女性。男女发病率差异不大,但男性患病率峰值较女性提早15岁,表明中国男性群体在脊髓损伤的流行病学负担中占据较高位置,而女性则整体水平相对较低。这可能与男性更常从事建筑、制造等高体力劳动相关,其跌倒和受伤的风险较高,从而增加脊髓损伤发生的概率。相比之下,女性通常从事低能量或家庭为主的活动,暴露于高风险伤害的机会较少,部分研究[10-11]亦报道了类似趋势。
年龄方面,中国因跌倒引发的脊髓损伤发病率随年龄而升高,跌倒导致的脊髓损伤主要集中于30岁及以上人群,70岁以后老年群体为高风险人群。老年人群的脊髓损伤患病率明显高于年轻人群。这是由于随着身体功能和健康状况下降,老年人更易受到跌倒的影响,且寿命延长使其累积更多因椎管狭窄、骨质疏松及跌倒相关损伤的风险[12-13]。年龄增长还会导致活动能力和肌肉力量下降,进一步加速骨密度丧失,从而增加跌倒、骨折和脊髓损伤的风险[14-15]。
在性别与年龄的交互分析中,老年女性的受伤风险更高,而男性中年群体的患病率较为集中。随着男性年龄增长,脊髓损伤负担相对减轻,这可能反映其接触高风险职业或活动的减少。相对而言,女性特别是绝经后,脊髓损伤发病率逐渐升高,这与女性激素变化导致的骨质疏松密切相关[16]。因为女性寿命较长,累积了更多脊柱损伤相关风险[17-18]。因此,从性别角度来看,老年女性面临更复杂的健康挑战,退行性疾病增加了脊髓损伤风险,同时可能延缓康复进程,需要制定针对性的康复策略;男性则应强化职业防护措施,以降低高风险活动中受伤的概率[19]。
Joinpoint回归分析显示 中国因跌倒导致的脊髓损伤ASIR和ASPR呈现相似的时间趋势:1990—2001年缓慢上升,2001—2005年显著下降,而2010—2021年则再次迅速上升,相关研究[20]也报道了类似趋势。这些变化可能受到多重因素影响,包括经济发展、医疗服务改善及康复技术进步。值得注意的是,2001—2005年脊髓损伤的ASIR和ASPR下降可能与这一时期的历史事件相关。2001年中国加入世界贸易组织,标志着经济改革和开放的关键节点,促进了基础设施建设和医疗条件改善。经济增长和轻体力劳动职业的增加降低了跌倒风险,从而对脊髓损伤发病率及患病率产生了抑制作用。2001—2005年发病率和患病率同步变化,在理论上,患病率通常滞后于发病率变化,但在高致死率或短期死亡率显著变化的情况下,两者可出现同步波动。脊髓损伤在我国早期医疗条件下具有较高死亡风险,因此发病与患病之间的时间积累效应在该阶段明显弱化。而发病率和患病率都显著下降,最直接、最关键的驱动力是国家层面的公共安全干预。特别是2004年《中华人民共和国道路交通安全法》的实施,对减少交通事故这一重要诱因产生了立竿见影的效果。同期,部分高危行业的安全生产监管也可能加强,共同导致了整体创伤性脊髓损伤发生率的短暂下降。2010年后,趋势发生根本性逆转,并转为快速上升。其核心驱动力已从“青壮年职业与交通伤害”转变为 “老年人跌倒” 。中国在这一时期加速进入老龄化社会,而老年人因骨密度下降、平衡能力减退,跌倒风险显著增高。跌倒已成为中国脊髓损伤的首要致病原因,且老年人跌倒后发生脊髓损伤的比例非常高[21]。此外,全国范围医疗水平提升,使得更多脊髓损伤病例被诊断和记录,也从数据层面反映了真实负担的增加。自2010年起,ASPR和ASIR再次上升,这与人口老龄化持续存在密切相关。根据2020年中国第七次全国人口普查,60岁及以上人口占总人口18.3%,较2010年增加5.44%[22]。同时,医学技术的进步,尤其是影像学与神经外科诊断能力的提升,以及2009年新一轮医疗改革的实施中国开展了新一轮的医疗改革,意在提高医疗水平,促进医疗公平,建设小康社会[23],使更多潜在患者获得及时诊治,对发病率和患病率变化产生了影响。
APC模型分析显示,年龄效应是脊髓损伤发病风险的主要驱动因素,随着年龄增长,发病风险明显升高,与老年人跌倒和脊髓损伤高发的观察结果一致。时期效应表明,60岁以上群体的发病率快速上升,这可能与骨质疏松患病率增加有关[24]。队列效应反映早年生活中的社会经济、行为和环境因素对脊髓损伤的影响,其发病率在2007年出生队列达到峰值后逐步下降,这可能与健康意识提升、生活水平改善以及医疗条件优化有关。
本研究从病因分层角度系统揭示了中国跌倒相关脊髓损伤疾病负担的长期演变规律,明确了人口老龄化背景下疾病风险结构的转变,也为老年跌倒综合防控、康复资源规划及健康老龄化政策制定提供了重要的循证依据。根据本研究结果,我国因跌倒引发的脊髓损伤疾病负担依然沉重,并呈现逐年增长的趋势。随着人口老龄化的加剧,跌倒已成为全球社会面临的重大公共卫生问题,且其导致的医疗费用持续增加[25-26]。我国正逐步步入老龄化社会,尤其是在骨质疏松症患者群体中,跌倒事件更易引发严重的脊髓损伤疾病,从而加重相关疾病负担。因此,鉴于跌倒所带来的疾病负担以及已有防治干预措施的积极成效,强化预防措施,减轻因跌倒引发的脊髓损伤带来的社会、经济及个人负担应成为健康政策的优先任务[27]。老年人跌倒的控制与预防应当纳入社会系统进行综合管理。
本研究存在一定的局限性。一方面,GBD 2021数据中缺少中国脊髓损伤的省级数据,因此无法对各地区脊髓损伤的流行病学特征进行更细致的分析。另一方面,GBD 2021数据有多个数据源,并通过模型进行整合,无法直接获取原始数据,数据的可靠性受到模型样本数据质量的影响,可能会引发一定的偏差。
综上所述,因跌倒导致的脊髓损伤是全球重要的健康挑战,我国因跌倒引发的脊髓损伤疾病负担呈现上升趋势,表现出显著的性别和年龄差异。随着人口增长和老龄化,中国的脊髓损伤负担仍然沉重。政策制定者需制定有效策略,通过预防跌倒、减轻跌倒相关脊柱损伤的长期影响来优化医疗保健体系,提高患者生活质量。
  • 国家自然科学基金(82260942)
  • 广西自然科学基金(2022JJA140858)
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2026年第53卷第9期
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doi: 10.20043/j.cnki.MPM.202512022
  • 接收时间:2025-12-02
  • 首发时间:2026-11-02
  • 出版时间:2026-05-10
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  • 收稿日期:2025-12-02
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国家自然科学基金(82260942)
广西自然科学基金(2022JJA140858)
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    1.广西中医药大学研究生院,广西 南宁 530000
    2.广西中医药大学附属第一医院脊柱骨伤科,广西 南宁 530000

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2种不同金属材料的力学参数
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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