To describe the epidemiology of traumatic spinal cord injury (tSCI) in Hawai‘i with a particular focus on identifying equity gaps affecting Native Hawaiian, Pacific Islander, and Filipino (NHPIF) patients. 

tSCI is a life-altering condition associated with high morbidity and long-term disability. Hawai?i reports approximately 117 tSCI cases per million residents annually, over twice the incidence observed in the continental United States (54 per million). National datasets often aggregate diverse Asian and Pacific Islander populations into large racial categories, which potentially masks injury characteristics and patterns that may be significant in underrepresented populations.

We conducted a single-center, retrospective study of tSCI admissions in Hawai‘i from 2014 to 2024. Patients hospitalized for tSCI were identified using ICD-9 codes 806.0–806.9 or 952.0–952.9, and ICD-10 codes S14xx, S24xx, or S34xx. Variables included race/ethnicity, age, sex, injury severity score (ISS), insurance, mechanism and level of injury, length of hospital stay, geographic location, discharge disposition, and mortality. Data was analyzed using Pearson’s chi-square tests and linear regression tests (p<0.05).

A total of 968 tSCI patients (25.5% female, 54.1 years, [SD 20.1]) were identified. Over 60% of patients identified as NHPIF or Asian. Injuries were concentrated on the island of O?ahu but occurred statewide. Falls were the leading mechanism overall, while water-related injuries were the most common among White patients. NHPIF patients were significantly younger at time of injury (16-45 years; p=0.004) and, along with Asian patients, had a threefold higher risk of in-hospital mortality compared to White patients (adjusted OR = 3.1). Cervical spine injuries predominated, representing 75.1% of all cases.

Disparities exist in tSCI outcomes and injury characteristics affecting NHPIF and Asian populations in Hawai‘i, indicating an urgent need for culturally informed tSCI prevention and care strategies.