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People with Spinal Cord Injury in Switzerland

EPIDEMIOLOGY OF SPINAL CORD INJURY IN SWITZERLAND Epidemiological data of spinal cord injury (SCI) for Switzerland is limited, although 2 studies based hospitalization and rehabilitation data from specialized SCI centers for SCI incidence until 2002. More recent evidence comes from the Swiss Spinal Cord Injury Cohort (SwiSCI), which, using data from a rehabilitation-based study of medical files for 2005 to 2012, estimates 18.0 (95% confidence interval [CI], 16.9–19.2) traumatic SCI (TSCI) cases per 1 million population per year. This seems intermediate to the annual TSCI incidence in other European countries. Incidence rates in Switzerland typically vary by age and sex. The elderly have the highest incidence rate, with 22.4 (18.5–27.3) per 1 million population per year, with males higher (27.5; 25.5–29.6) than females (9.0; 7.9–10.2). Between 2005 and 2012, 932 new TSCI cases were registered; and falls (37.1%), sports and leisure-related activities (26.5%), and transport-related accidents (22.9% due to bicycle crash, car crash, motorcycle, moped, pedestrian hit by vehicle, and other/unspecified transport accident) were identified as the leading causes. In the youngest cohort (16–30 years), sports and leisure and transport-related activities are predominant causes, whereas falls are the most common cause in persons 76 years and older. Data on the prevalence of SCI have not been published so far, but from the medical files study, paraplegia is 3 times more frequent than tetraplegia, and the latter is more prevalent in the elderly. The epidemiological evidence for nontraumatic SCI is less complete as both acute care and rehabilitation of new cases less frequently occur in specialized SCI centers and so is missed by the SwiSCI study. This is because in these cases, SCI is a complication of the primary disease (eg, tumors or infections) and requires a comprehensive medical-therapeutic approach that is usually provided in specialized units other than SCI rehabilitation centers. As in other European countries, it is mostly the elderly that are affected by nontraumatic SCI in Switzerland (median age, 64 years, according to SwiSCI data). Owing to the higher age and prevailing multimorbidity character of nontraumatic SCI compared to TSCI, patients have worse prognosis for rehabilitation, and some cases are treated in a palliative care setting that is outside the scope of the specialized SCI centers in Switzerland. As the Swiss