Abstract
Objective
To identify trends in causes of death after spinal cord injury (SCI) that could enhance
understanding of why life expectancy after SCI has not improved in the last 3 decades.
Design
Cohort study.
Setting
Twenty-nine SCI Model Systems and 3 Shriners Hospitals.
Participants
Individuals with traumatic SCI (N=49,266) enrolled in the SCI Collaborative Survival
Study Database between 1973 and 2017.
Interventions
Not applicable.
Main Outcome Measures
Age-standardized cause-specific SCI mortality rates and 95% confidence intervals were
calculated for 5 time intervals (1960-1979, 1980-1989, 1990-1999, 2000-2009, and 2010-2017).
Results
A total of 17,249 deaths occurred in 797,226 person-years of follow-up. Since 2010,
the highest mortality rate was for respiratory diseases, followed by heart disease,
cancer, infective and parasitic diseases (primarily septicemia), and unintentional
injuries. Mortality rates for respiratory diseases, cancer, stroke, urinary diseases,
and digestive diseases, initially decreased significantly but remained relatively
stable since 1980, whereas essentially no progress occurred for infective and parasitic
diseases. Mortality rates for heart disease, pulmonary embolus, and suicide decreased
significantly throughout the entire study period, but were offset by increases in
mortality rates for endocrine (primarily diabetes), nutritional, and metabolic diseases,
as well as unintentional injuries. From 2010 to 2017, the overall age-standardized
mortality rate was 3 times higher for individuals with SCI than the general population,
ranging from 27% higher for cancer to 9 times higher for infective and parasitic diseases.
Conclusion
Improving life expectancy after SCI will require: (1) reducing mortality rates from
respiratory diseases and septicemia that have remained high, (2) reversing current
trends in diabetes and unintentional injury deaths, and (3) continuing to reduce mortality
from heart disease and other leading causes.
Keywords
List of abbreviations:
NDI (National Death Index), NSCID (National Spinal Cord Injury Database), NSSCID (National Shriners Spinal Cord Injury Database), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model Systems), 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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Article info
Publication history
Published online: November 17, 2021
Accepted:
September 2,
2021
Received in revised form:
August 30,
2021
Received:
June 11,
2021
Footnotes
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (grant no. 90DP0083). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, HHS, and endorsement by the federal government should not be assumed.
Disclosures: none.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
