Global Burden of Spinal Cord Injuries Attributable to Falls and Road Traffic Injuries in Working-Age Individuals, 1990 to 2021, with Projections through 2040: An Age-Period-Cohort Analysis

Background: Spinal cord injury (SCI) attributable to falls and road injuries imposes a significant burden on working-age individuals; however, its temporal and geographic patterns in this demographic remain underexplored. This study aimed to evaluate the global, regional, and national burden of SCI attributable to falls (SCIF) and road injuries (SCIR) among working-age individuals (aged 15–64 years) from 1990 to 2021 and project trends through 2040. Methods: Using Global Burden of Disease (GBD) 2021 data, global, regional, and national age-standardized incidence rates (ASIR), prevalence rates (ASPR), and years lived with disability rates (ASYR) were assessed according to global parameters and socio-demographic stratification. Trends were quantified by the average annual percentage change (AAPC) and future burdens projected using Bayesian age–period–cohort (BAPC) models. Results: From 1990 to 2021, global ASIR, ASPR, and ASYR for SCIR declined markedly (AAPC −1.54 [95% confidence interval (CI) −1.54 to −1.53], −1.88 [−1.89 to −1.87], and −2.03 [−2.05 to −2.01]), whereas SCIF showed modest or stagnant reductions with regional increases (AAPC −0.24 [−0.27 to −0.22], −0.39 [−0.41 to −0.36], and −0.67 [−0.69 to −0.65]). Males exhibited higher burdens than females, with SCIF increasing with age and peaking at 60–64 years, whereas SCIR shifted toward older groups. High-SDI regions experienced declines in both, whereas middle-SDI areas saw SCIF increases, despite SCIR decreases; low-SDI regions showed slight SCIF rises. Regionally, Western Europe displayed steady reductions, whereas Central Asia experienced an increase in SCIF and Sub-Saharan Africa showed stable or slightly increasing SCIF indicators. National variations were pronounced, with burdens often exceeding SDI expectations in rapidly developing countries. Projections to 2040 indicate a modest rise in SCIF burden (predicted ASIR 3.72 [95% uncertainty interval (UI) 1.82–5.63] per 100 000) but a decrease in SCIR (predicted ASIR 1.22 [0.73–1.72] per 100 000). Conclusions: Although the burden of SCIR has declined substantially from 1990 to 2021 and is projected to continue decreasing, persistent or rising SCIF trends—expected to modestly increase by 2040—alongside male predominance, age shifts, and socioeconomic disparities emphasize the urgency for tailored prevention: enhanced road safety measures and occupational reforms targeting falls in high-risk groups to reduce inequities and socioeconomic costs.