Spinal cord injury in the context of major motor vehicle collision trauma: a retrospective ecological analysis of global estimates across income groups

Introduction: Road traffic injuries (RTIs) are a leading cause of death globally, especially in low- (LICs) and middle-income countries (LMICs). Despite this burden, post-crash care remains underdeveloped. Many clinical principles of post-crash care focus on spinal cord injury (SCI), yet its incidence is poorly understood. The aim of this study was to describe the incidence of death and non-fatal RTI with a specific focus on SCIs using Global Burden of Disease (GBD) 2019 data. Methods: A retrospective ecological analysis was conducted using GBD 2019 data for 204 countries and territories (2012–2019). We examined the MVC-related mortality, SCIs, and major non-fatal injuries stratified by income group and sex. Incidence rate ratios (IRRs) were compared across income groups using regression models. SCIs were analysed as a proportion of all non-fatal injuries across income groups. Results: MVC-related mortality incidence rates were significantly lower in high-income (HICs) [IRR 0.79 (95% CI: 0.69–0.91); p = 0.001], UMICs [IRR 0.72 (95% CI 0.63–0.82); p < 0.001], and LMICs [IRR 0.67 (95% CI: 0.59–0.76); p < 0.001] compared with LICs. SCIs accounted for ~ 0.5% of non-fatal injuries, with a significantly higher proportion in LICs (p < 0.001). Males consistently showed higher injury and mortality incidence rates than females. Conclusions: SCIs from MVCs are relatively rare, but disproportionately affect LICs. Strengthening bystander response, developing context-specific post-crash protocol, and improving prehospital systems may reduce disparities and improve outcomes, especially in resource-limited settings.