169. Trends and epidemiology of cervical fractures in the United States, 2001-2020

Abstract

<h3>BACKGROUND CONTEXT</h3> Cervical fractures have been described as having a bimodal age distribution with a peak in young age and another in old age. With an aging and more active population, it is thought that the number of patients sustaining cervical fractures is increasing. However, epidemiologic data regarding the incidence of cervical fractures is scarce, and there are currently no up-to-date, population-based studies describing the incidence and demographics of cervical fractures in the United States (US). <h3>PURPOSE</h3> To investigate the incidence and demographic characteristics of patients with cervical fractures in the US over the last 20 years. <h3>STUDY DESIGN/SETTING</h3> Descriptive epidemiology study using the National Electronic Injury Surveillance System (NEISS). NEISS data are obtained from a national sample of hospitals which are selected as a stratified probability sample of hospitals in the US. The data provides a nationally representative sample of US hospitals from which nationwide injury estimates can be made. <h3>PATIENT SAMPLE</h3> This study included 8,913 unweighted patient records, representing a national estimate of 319,169 cervical fractures over a 20-year period (2001-2020). <h3>OUTCOME MEASURES</h3> Annual, overall and age-adjusted cervical fracture incidence rates; patient demographics (age, sex); injury characteristics (mechanism, associated injuries). <h3>METHODS</h3> All patients diagnosed with an acute cervical fracture between 2001-2020 were identified using the NEISS dataset. US Census Bureau population estimates were used to calculate at-risk person-years. Incidence rates are expressed as the number of injuries per 100,000 person-years at-risk (PYR). Patients were split into four different age groups for comparisons (<18 years, 18-64 years, 65-79 years, 80+ years). <h3>RESULTS</h3> An estimated 319,169 patients sustained cervical fractures over the 20-year study period for an overall incidence rate of 5.2 PYR. Of these, 11% of cases involved multiple cervical levels. Slightly more than half (53%) occurred in males and the mean age was 66 years. The mean age of female patients was significantly higher than that of male patients (73 vs 59 years, respectively; p 70 years old). The mean age of patients with cervical fractures increased significantly over the course of the study period from 52 years in 2001 to 68 years in 2020 (p<0.0001). There was a substantial increase in incidence rate with age (<18 yrs: 0.9 PYR; 18-64 yrs: 2.9 PYR; 65-79 yrs: 13.4 PYR; 80+ yrs: 47.9 PYR). The most common mechanism was a low energy fall (64%). A large percentage (42%) of patients sustained at least one associated injury. Concomitant injuries of the head and spine were common. Neurologic injury occurred infrequently (2.1% of cases). Accounting for population growth yielded a significantly increasing incidence from 1.8 PYR in 2001 to 10.6 PYR in 2020 p < 0.0001). The annual incidence increased at a significantly higher rate in females when compared with males (average annual percent change: 12.1% vs 8.8%, respectively; p < 0.0001). Additionally, disproportionately large increases in incidence rates were observed in the oldest patient groups. <h3>CONCLUSIONS</h3> Cervical fractures are increasing in the US, especially among females and the elderly. The annual incidence increased nearly 500% over the course of the study period and in 2020 was over 10 PYR overall. Age-adjusted incidence was highest in elderly patients >80 years old, with the most recent annual incidence rate in this age group over 88 PYR. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.