Abstract
Objective
To investigate the association of multiple sets of risk and protective factors (biographic
and injury, socioeconomic, health) with cause-specific mortality after spinal cord
injury (SCI).
Design
Retrospective analysis of a prospectively created cohort.
Setting
Spinal Cord Injury Model Systems facilities.
Participants
Adults (N=8157) with traumatic SCI who were enrolled in a model systems facility after
1973 and received follow-up evaluation that included all study covariates (between
November 1, 1995 and October 31, 2006).
Interventions
Not applicable.
Main Outcome Measures
All-cause mortality was determined using the Social Security Death Index as of January
1, 2014. Causes of death were obtained from the National Death Index and classified
as infective and parasitic diseases, neoplasms, respiratory system diseases, heart
and blood vessel diseases, external causes, and other causes. Competing risk analysis,
with time-dependent covariates, was performed with hazard ratios (HRs) for each cause
of death.
Results
The HRs for injury severity indicators were highest for deaths due to respiratory
system diseases (highest HR for injury level C1–4, 4.84) and infective and parasitic
diseases (highest HR for American Spinal Injury Association Impairment Scale grade
A, 5.70). In contrast, injury level and American Spinal Injury Association Impairment
Scale grade were relatively unrelated to death due to neoplasms and external causes.
Of the socioeconomic indicators, education and income were significantly predictive
of a number of causes of death. Pressure ulcers were the only 1 of 4 secondary health
condition indicators consistently related to cause of death.
Conclusions
Injury severity was related to mortality due to infective disease and respiratory
complications, suggesting that those with the most severe SCI should be targeted for
prevention of these causes. Socioeconomic and health factors were more broadly related
to a number of causes of death. Intervention strategies that enhance socioeconomic
status and health may also result in reduced mortality due to multiple causes.
Keywords
List of abbreviations:
AIS (American Spinal Injury Association Impairment Scale), CI (confidence interval), HR (hazard ratio), NSCISC (National Spinal Cord Injury Statistical Center), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model Systems), SSDI (Social Security Death Index)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 20, 2016
Footnotes
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (grant nos. 90IF0066, 90RT5003, 90SI5002, 90DP0011, and 90SI5005). NIDILRR is a center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this publication do not necessarily represent the policy of NIDILRR, ACL, and HHS, and you should not assume endorsement by the federal government.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
