Abstract
Objective
To identify risk and protective factors for unintentional death related to drug poisoning
from prescription medications, including opioid-related deaths, and death due to all
other causes among participants with spinal cord injury (SCI).
Design
Prospective cohort study.
Setting
Large specialty hospital in the southeastern United States.
Participants
Two cohorts of SCI participants (N=3070) (>18y) with chronic (>1y) traumatic SCI.
Cohort 1 was enrolled in 1997-1998 (n=1386), and cohort 2 was enrolled in 2007-2009
(n=1684).
Interventions
N/A.
Main Outcome Measures
Participants completed self-report assessments including multiple behavioral variables
(alcohol, smoking, prescription medication), as well as the Zuckerman-Kuhlman Personality
Questionnaire (ZKPQ). The primary outcome is unintentional death related to drug poisoning.
Mortality status was determined as of December 31, 2014, using the National Death
Index. The Centers for Disease Control guidelines were used for classifying participants
into 3 groups: (1) unintentional death related to drug poisoning, (2) other death,
and (3) alive.
Results
There were 690 deaths (23%), including 24 unintentional deaths related to drug poisoning (11 from opioids). Binge drinking, medication usage total score, and impulsive-sensation
seeking were risk factors for unintentional death related to drug poisoning, whereas
the ZKPQ activity scale was protective. Risk factors for other causes of death included older age, greater injury severity, being nonambulatory,
regular smoker, medication use total score, and greater neuroticism-anxiety scale
scores.
Conclusions
Unintentional deaths related to prescription drug overdose are associated with a set
of risk factors that differs in meaningful ways from risk of death due to other causes
after SCI, and these differences hold the key to prevention strategies.
Keywords
List of abbreviations:
CDC (Centers for Disease Control), HR (hazard ratio), ICD (International Classification of Diseases), NDI (National Death Index), SCI (spinal cord injury), ZKPQ (Zuckerman-Kuhlman Personality Questionnaire)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 13, 2018
Footnotes
Supported by a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (grant no. 90IF0066). 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, HHS, and you should not assume endorsement by the Federal Government.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
