Etiologies, incidence, and demographics of lumbar vertebral fractures in U.S. emergency departments

Background: Lumbar vertebral fractures are debilitating injuries widely associated with significant patient deformity, disability, pain, and potentially neurological deficit. This cross-sectional database study investigates the most frequent annual etiologies of lumbar vertebral fractures presented to emergency departments throughout the United States (U.S.) from 2010–2018. Methods: The National Electronic Injury Surveillance System (NEISS) database was used to identify all patients who visited participating emergency departments between 2010–2018 and were diagnosed with a lumbar spine fracture. Population estimates by age (18+) were obtained from annual U.S. Census estimates and used to calculate annual incidence rates of lumbar fractures per 100,000 people. Results: The annual incidence rate of total lumbar fractures in the U.S. increased from 14.6 to 22.5 per 100,000 people from 2010–2018 (54%). From 2010–2018, there were 382,914 [95% confidence interval (CI): 382,855–382,973] lumbar fractures in the U.S. This increased from 34,328 (95% CI: 34,277–34,379) in 2010 to 57,098 (95% CI: 57,044–57,152) in 2018 (66.3%). Men composed 40.2% and women made up 59.8% of patients. Mean patient age increased by 2.96 years from 65.5 (95% CI: 65.38–65.62) years in 2010 to 68.4 (95% CI: 68.32–68.48) years in 2018 (4.5%). From 2010–2018, floors, stairs/steps, and ladders were the most common etiologies of lumbar fractures. Estimated sum of floor-related fractures was 80,054 (95% CI: 79,986–80,122), stair/step-related fractures was 48,274 (95% CI: 48,209–48,339), and ladder-related fractures was 31,053 (95% CI: 30,987–31,119). The increase in these three etiologies accounted for 48% of the total increase of all-cause lumbar fractures between 2010 and 2018. Conclusions: The volume of lumbar vertebral fracture has increased over the last near decade (66.3%), and approximately half (48%) of these fractures can be attributed to accidents caused by flooring, stairs/steps, and ladder-related injuries. The increasing mean patient age, as well as accidents involving ladders, were found to be statistically correlated with the rise in total lumbar fracture volume.