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Mortality Beyond the First Year After Spinal Cord Injury: Does Body Mass Index Matter?

Published:November 17, 2021DOI:https://doi.org/10.1016/j.apmr.2021.08.026

      Abstract

      Objective

      To examine the association between body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) and mortality after the first year post spinal cord injury (SCI) overall and across demographic and injury characteristics.

      Design

      Cohort study.

      Setting

      Sixteen Spinal Cord Injury Model Systems (SCIMS) centers.

      Participants

      SCIMS Database participants age 20 years or older and having a BMI assessment during the 2007-2011 wave of data collection.

      Interventions

      Not applicable.

      Main Outcome Measures

      All-cause mortality rate. Life table method and log-rank test were used to estimate and compare mortality rates across BMI groups and other factors. Cox proportional hazard regression model was conducted to estimate hazard ratio (HR) and 95% confidence interval (CI).

      Results

      A total of 2346 participants (N=2346) with SCI were classified into 1 of the 8 BMI groups: <18.5 (6.9%), 18.5-19.9 (7.3%), 20.0-22.49 (15.0%), 22.5-24.9 (18.8%), 25.0-27.49 (17.5%), 27.5-29.9 (13.2%), 30.0-34.9 (13.5%), and ≥35.0 (7.8%). Compared with people with BMI of 22.5-29.9, a higher mortality risk was observed among people with BMI<18.5 (HR, 1.76; 95% CI, 1.25-2.49), 18.5-19.9 (HR, 1.51; 95% CI, 1.06-2.15), and ≥35.0 (HR, 1.51; 95% CI, 1.11-2.07) after adjusting for confounding factors (sex, age at the time of BMI assessment, marital status, neurologic status). The U-shape BMI-mortality relationship varied by age, sex, neurologic status, and years since injury.

      Conclusions

      To improve life expectancy after SCI, health care professionals could focus on weight management among patients with relatively low and extremely high BMI, defined by demographic and injury-related characteristics. Future studies should explore factors that contribute to such a higher mortality after SCI, including pre-existing conditions, poor diet and/or nutrition, and cardiorespiratory fitness.

      Keywords

      List of abbreviations:

      AIS (American Spinal Injury Association Impairment Scale), BMI (body mass index), HR (hazard ratio), NDI (National Death Index), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model Systems)
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