418 Spinal Cord Injury
the “rst national model system of care to persons with SCI.
To foster systematic research that could inform clinical care,
a coordinated collaborative database (the National Spinal
Cord Injury Data Research Center, NSCIDRC) was estab-
lished in 1975 at the Arizona site to gather and archive
demographic and medical information from the SCI Model
Systems. Transferred in 1983 to the University of Alabama
at Birmingham, the NSCIDRC has yielded more than
1,000 published research reports (Stover, Hall, DeLisa, &
Donovan, 1995). Initially, the SCI model systems project em-
phasized collection of demographic and medical information
pertinent to the clinical management of SCI and associated
complications. Much of the literature concerning SCI has
emanated from this database or from centers that have partic-
ipated in the model systems project.
According to the National Spinal Cord Injury Statistical
Center, there are approximately 10,000 new SCIs per year,
and it is estimated that between 183,000 and 230,000 persons
live with SCI in the United States (Stover, Whiteneck, &
DeLisa, 1995). Over the years, studies from the archived
database have revealed a reduction in the incidence of com-
plete cord lesions (which are associated with more neurolog-
ical impairment) among persons admitted for care, and an
increase in the number of persons with incomplete lesions
(indicating some sparing of neurological function below the
lesion site). This trend is attributed, in part, to improved
emergency service techniques at these sites that minimize
further damage to the cord (Stover, Hall, et al., 1995).
Secondary complications (particularly the development of
pressure-related skin sores) compromise personal health and
quality of life, and are associated with increased costs to the
person, the health care delivery system, and society. Treat-
ment at a model system center has been associated with a de-
creased likelihood of a severe pressure ulcer during acute
care and at long-term follow-up (Stover, Whiteneck, et al.,
1995). This trend may be due to improved assessment, inter-
vention, education, and health promotion methods. De-
creased rehospitalizations and improved survival rates have
been observed among persons with SCI who were treated in
these centers (Stover, Hall, et al., 1995).
Age
SCI occurs mainly in persons between the ages of 16 and 30
years. Almost 80% of all SCIs documented by the NSCIDRC
were among individuals 16 to 45 years of age, with an aver-
age age of 30.7 years. Women tend to be somewhat older at
the time of injury, with a mean age of 32.2 years compared to
men whose average age is 30.3 years. A trend identi“ed by
the NSCIDRC is the increase in individuals over the age of
61 years at the time of injury. This “nding likely re”ects the
increase in the median age of the national population.GenderMen have a higher observed incidence of SCI in the
NSCIDRC data set (82.2%). General population-based sam-
ples re”ect a range of 69% to 81% of SCI•s occurring in
males vs. females. However, while this disproportionate rep-
resentation of men may re”ect the greater likelihood of high-
risk activities among men in general, it is comparable to those
“gures re”ecting unintentional mortality rates in the popula-
tion at large (Go, DeVivo, & Richards, 1995).EthnicityThe NSCIDRC reports a change in the ethnic distribution of
persons with SCI since 1990. During this period, the percent-
age of Caucasians with SCI in the model systems database
dropped to 58.1% from 77.5% observed between 1973 and- Similarly, a 1.6% decrease in SCI among American
Indians was observed. A more disturbing trend is seen during
the same time period, with spinal cord injuries to African
Americans, Hispanics, and Asians increasing from 13.5% to
28%, 5.7% to 8.4%, and .8% to 2.1%, respectively. It is pos-
sible that the geographic locations of the model systems may
contribute to an overrepresentation of the ethnic minorities
with SCIs compared to the general population. Differences
in ethnic distribution of persons with SCI and the population
at large may also be explained by the proportionate decrease
in the Caucasian population along with the concomitant in-
crease in African American, Asian, and Hispanic populations.
Finally, referral patterns to the model systems centers may
also account for some of the observed variations.
Educational and Occupational StatusBecause the median age of the SCI population is 26 years, it
is encouraging to see that approximately 59% of these indi-
viduals have received a high school education. The observed
tendency toward increased age at time of injury increases the
likelihood of possession of a high school diploma or its
equivalent, which can affect postinjury employment. Almost
80% of persons with SCI are employed at the time of their in-
jury. Unfortunately, 14.3% are unemployed and are likely to
remain that way despite a much lower national unemploy-
ment average. Interestingly, but perhaps not surprisingly,
level of education is inversely related to likelihood of injury
due to violence.