Compared with other areas of China, there are several unique characteristics at northwest. The northwest is located in the hinterland of mainland China, mostly plateaus and basins. Compared with the economically developed areas in the eastern coastal areas, the level of economic and political are poor. In addition, the Northwest China is dominated by agriculture, with farmers accounting for the majority of the labor force, accompanied by lower levels of health insurance, education and lower household incomes. Our Hospital is the tertiary trauma center located in Xi'an, which is the economic and cultural centers of the Northwest China. Therefore, the SCI patients admitted by our hospital can objectively represent the epidemiological characteristics of SCI patients in northwest China.
Based on the epidemiological characteristics of SCI in our hospital over the past five years, we found that SCI not only causes abnormal sensory and motor functions below the injury level, but also causes many important organ dysfunction, including respiratory system, urinary system, digestive system and so on, which adds extra hospital costs. Thus, SCI should not be neglected in Northwest China, the prevention of spinal cord injury is particularly important, comprehensive and detailed epidemiological investigation is the basis of effective prevention countermeasures.
In this investigation, the male to female ration of SCI was 2.57:1, which was distinct with Beijing, Shanghai, Guangdong, Chongqing ,Anhui and Heilongjiang(6–11). This may have something to do with the different responsibilities and social division of labor between men and women in different provinces in China. Considering the reasons, the patients mainly come from the Northwest region, which is economically backward and resource-poor. Women's exposure to high-risk industries, such as construction and transportation, increases. At the same time, women are prone to osteoporotic fracture, which increases the proportion of women in SCI patients, there have the same true in South Africa (12).
The highest proportion of SCI in Northwest China was noted in the 30–49 years. In traditional Chinese culture, it is a unshirkable responsibility of the young and middle-age to support their parents and raise their children. Because of the large financial responsibility, they need to take a huge risk to raise their families. Meanwhile, the roads in northwestern China are rugged and complicated. Various reasons increase the possibility that they suffer from work-related SCI, making people aged 30–49 a high-risk group. China's aging population is increasing, with more elderly people suffering from SCI. For the elderly patients, SCI may coexist with degenerative spine disease and/or osteoporotic compression fractures. Therefore, attention should be paid to the needs of the elderly in SCI rehabilitation(13). In this study, the proportion of farmers and laborers was as high as 59.51% and 27.04%, respectively. It is different with previous reports in Guangdong(8), Turkish(14) and México(15). Differences may rooted from the diversity of economic and political environments. Northwest China has a high proportion of the population engaged in agriculture-related occupations; and the probability of SCI occurrence is higher than that of any other occupation.
The causes of SCI include, falls (high fall and low fall), MVCs, fall objects, sports and violent injuries. there are also some differences among countries or regions. We found that falling (high fall and low fall) was the mainly cause of SCI, followed by MVCs, which happened at almost all ages. An epidemiological survey in Canada in 2006 showed that MVCs were the main cause of SCI, but the fall became the mainly cause in 2009(16, 17). The incidence of violence in the various countries or regions were also distinct, the cause of this injury is only 0.40% in Beijing(6), while 11.90% in Brazil(18). Like violent injuries, gunshot wounds were rare in our country, mainly because the state strictly manages social security and strictly controls guns. Similar to other developing countries, the per capita car ownership in China is increasing, meanwhile, the improvement of transport safety measures and the increase in traffic safety awareness, those made the proportion of SCI related to traffic injuries has declined.
Similar to the finding of previous studies (9, 19), the damaged region in this study showed a bimodal distribution, with C4-C6 and T11-L3 being the most common levels of injury; and the incidence of cervical SCI was the highest (47.29%). Additionally, we also found an association between the severity of spinal cord injury and the cause of the injury. MCVs and high fall injuries mostly led to complete SCI, mainly grade A. However, the grade D spinal cord injuries are mostly caused by low falls, which are mostly manifested as incomplete SCI. Williams et al(20) and Thietje et al(21) reported that patients with grade A spinal cord injuries are more likely to suffer from depressive disorders and suicide, and doctors and their families should give more care and help to prevent the occurrence of suicide caused by depression.
The results of this study showed that there were 1341 patients with complications, the incidence rate was 36.49%. Of all the complications, respiratory diseases were the most common (30.7%). This is associated with long-term bed rest, basic lung disease caused by smoking before incidence and rib fractures. Cervical spinal cord injury can reflect the function of diaphragm or intercostal muscle, weaken the strength of respiration and cough, and the sputum was not easy to cough out, which were also related to respiratory complications(22). The higher the level of SCI, the higher the incidence of pulmonary infection. The incidence of pulmonary infection can reach more than 90% when the SCI located above the level of C5 and causing diaphragm movement dysfunction (23). The results also showed that the average hospitalization time of SCI patients was 10.70 days, the longest was 94 days, and the hospitalization cost was 4,352 yuan to 45,6320 yuan (average 37,850 yuan). It is pointed out that the hospitalization period of SCI patients is long, the cost is high, and the income of most patients is low and the ability to pay is limited, so it is difficult to get comprehensive and effective treatment. However, it is a pity that there were only 15.14% of the SCI patients received rehabilitation. Although this may be related to the low overall SCI rehabilitation level in Northwest China, it also reflects our insufficient attention to SCI postoperative rehabilitation.
Our study has several limitations:(1) This study is a hospital-based descriptive SCI study that only identified a small proportion of all SCI patients in Northwest China. (2) We only collected the information who admitted to hospital with SCI, leaved out the information on patients who died in hospitals before admission. (3) The number and cycle of studies subjects were restively limited. (4) We lack systematic training and there are omissions in the process of collecting data.