Another piece to the epidemiological puzzle of traumatic spinal cord injury in Cape Town, South Africa: A population-based study

Abstract

Background. The epidemiology of traumatic spinal cord injury (TSCI) is poorly understood in developing countries. In South Africa (SA) specifically, two healthcare systems (private v. government funded) exist, and it is therefore important to assess patient characteristics in order to plan appropriately. Objectives. To determine epidemiological characteristics of TSCI in the private healthcare system in Cape Town, SA, and compare findings with previously published data from the government sector. Methods. A regional, population-based design was used, including all private and government-funded hospitals in the catchment area (Cape Town Metropolitan Municipality). All eligible survivors of TSCI in the private sector were retrospectively identified from admission records for a 1-year period. The International Spinal Cord Injury Core Data Set was systematically completed using patient medical records. Epidemiological data from the government cohort were secondarily analysed; however, socioeconomic variables were primarily analysed in this study. Inferential statistics were used to assess differences between the two healthcare systems. Results. The annual crude incidence of 20.0 per million in the private sector was significantly lower than the 75.6 per million in the government sector (p<0.001). In addition, the two cohorts differed significantly with regard to age at injury, pre-injury employment and aetiology, highlighting that individuals in the private sector were older than those in the government sector, that most were employed prior to the injury, and that their injuries were chiefly transport related, as opposed to assault in the government sector. Conclusions. Two cohorts with TSCI from the sampling population differed with regard to incidence, aetiology and sociodemographic characteristics. The findings suggest the need for more than one high-priority primary prevention programme, stratified by healthcare system. These programmes should inclusively emphasise road safety and the consequences of interpersonal violence among men.