Abstract
Objective
To investigate whether there have been improvements in long-term survival after spinal
cord injury in recent decades.
Design
Survival analysis using time-varying covariates. The outcome variable was survival
or mortality, and the explanatory variables were age, sex, level and grade of injury,
and calendar year. The data were analyzed using the logistic regression model, Poisson
regression model with comparison to the general population, and the computation of
standardized mortality ratios for various groups.
Setting
National Spinal Cord Injury Model Systems facilities.
Participants
Persons (N=31,531) who survived 2 years postinjury, were older than 10 years, and
who did not require ventilator support. These persons contributed 484,979 person-years
of data, with 8536 deaths over the 1973 to 2012 study period.
Interventions
Not applicable.
Main Outcome Measures
Survival; survival relative to the general population; life expectancy.
Results
After adjustment for age, sex, race, etiology of injury, time since injury, and level
and grade of injury, mortality in persons with spinal cord injury was higher in the
2005 to 2012 period than in 1990 to 2004 or 1980 to 1989, the odds ratios for these
3 periods were .857, .826, and .802 as compared with the 1970 to 1979 reference period.
Conclusions
There was no evidence of improvement. Long-term survival has not changed over the
past 30 years.
Keywords
List of abbreviations:
ASIA (American Spinal Injury Association), CI (confidence interval), NSCISC (National Spinal Cord Injury Statistical Center), OR (odds ratio), SCI (spinal cord injury), SMR (standardized mortality ratio), SSDI (Social Security Death Index)To read this article in full you will need to make a payment
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References
- Trends in life expectancy after spinal cord injury.Arch Phys Med Rehabil. 2006; 87: 1079-1085
- Recent trends in mortality and causes of death among persons with spinal cord injury.Arch Phys Med Rehabil. 1999; 80: 1411-1419
- Trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973-2006.Spinal Cord. 2007; 45: 713-721
- A prospective assessment of mortality in chronic spinal cord injury.Spinal Cord. 2005; 43: 408-416
- Mortality after traumatic spinal cord injury: 50 years of follow-up.J Neurol Neurosurg Psychiatry. 2010; 81: 368-373
- Health status, community integration, and economic risk factors for mortality after spinal cord injury.Arch Phys Med Rehabil. 2004; 85: 1764-1773
- A prospective study of health and risk of mortality after spinal cord injury.Arch Phys Med Rehabil. 2008; 89: 1482-1491
- Risk of mortality and life expectancy after spinal cord injury: the role of health behaviors and participation.Top Spinal Cord Inj Rehabil. 2010; 16: 53-60
- Mortality after spinal cord injury in Norway.J Rehabil Med. 2007; 39: 145-151
- Prognostic factors for 12-year survival after spinal cord injury [published erratum appears in Arch Phys Med Rehabil 1992;73:1146].Arch Phys Med Rehabil. 1992; 73: 156-162
- Accuracy of world-wide-web death searches for persons with traumatic brain injury.Brain Inj. 2004; 18: 1155-1162
- An analytic method for longitudinal mortality studies.J Insur Med. 2000; 32: 217-225
- Comparison of baseline and repeated measure covariate techniques in the Framingham Heart Study.Stat Med. 1998; 7: 205-218
- Long-term survival after childhood spinal cord injury.J Spinal Cord Med. 2007; 30: S48-S54
- Long-term survival of persons ventilator dependent after spinal cord injury.J Spinal Cord Med. 2006; 29: 511-519
- Applied logistic regression.2nd ed. Wiley, New York2000
- Rating the raters: evaluating the predictions from a life expectancy rating service.J Insur Med. 2009; 41: 178-190
- Poisson regression in epidemiology.in: Armitage P. Colton T. Encyclopedia of biostatistics. Wiley, Chichester (UK)2005
Human mortality database. Available from: http://www.mortality.org. Accessed July 17, 2013.
- Statistical methods in epidemiology.Oxford Univ Pr, Oxford1989: 207
Arias E. United States life tables, 2008 (updated). Hyattsville: National Center for Health Statistics; 2012. National Vital Statistics Reports, Vol 61, No. 3.
- Evaluating neurological group homogeneity in assessing the mortality risk for people with spinal cord injuries.Spinal Cord. 1998; 36: 275-279
- Long-term survival in spinal cord injury: a fifty year investigation.Spinal Cord. 1998; 36: 266-274
- Life expectancy after spinal cord injury: a 50-year study.Spinal Cord. 2012; 50: 803-811
- Discrepancies in the estimates of life expectancy after SCI.Spinal Cord. 2013; 51: 937
- Long-term survival and causes of death.in: Stover S.L. DeLisa J.A. Whiteneck G.G. Spinal cord injury: clinical outcomes from the Model Systems. Aspen, Gaithersburg1995 (p 298.)
- Trends in age-adjusted cause-specific mortality rates after spinal cord injury.Top Spinal Cord Inj Rehabil. 2012; 18 ([abstract]): 214
- Gains in life expectancy after SCI by preventing individual causes of death [abstract].Top Spinal Cord Inj Rehabil. 2011; 16: 38
Article info
Publication history
Published online: January 20, 2015
Footnotes
Supported in part by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, U.S. Department of Education, Washington, DC (grant no. H133A060039).
Disclosures: The authors consult on life expectancy, as expert witnesses and otherwise.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
