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Sex-Related Discrepancies in the Access to Optimal Care and Outcomes After Traumatic Spinal Cord Injury: A Retrospective Cohort Study Using Data From a Canadian Registry

  • Julio C. Furlan
    Correspondence
    Corresponding author Julio C. Furlan, MD, LLB, MBA, MSc, PhD, 520 Sutherland Drive, Room 206J, Toronto, Ontario, Canada M4G 3V9.
    Affiliations
    Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada

    KITE Research Institute, University Health Network, Toronto, Canada

    Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada

    Institute of Medical Science, University of Toronto, Toronto, Canada

    Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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  • Tian Shen
    Affiliations
    Praxis Spinal Cord Institute, Vancouver, Canada
    Search for articles by this author
  • Dilnur Kurban
    Affiliations
    Praxis Spinal Cord Institute, Vancouver, Canada
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Published:September 25, 2022DOI:https://doi.org/10.1016/j.apmr.2022.09.006

      Abstract

      Objective

      To compare males and females who were stratified into subgroups corresponding to premenopausal, perimenopausal, and postmenopausal ages, regarding access to optimal care and their outcomes after traumatic spinal cord injury (tSCI).

      Study Design

      Retrospective cohort study.

      Setting

      Eighteen acute care centers and 13 rehabilitation facilities across Canada.

      Participants

      This study included 5571 individuals with tSCI at C1-L2 who were enrolled in the Rick Hansen Spinal Cord Injury Registry from July 2004 to September 2019 (N=5571). Females were compared with males in the younger (aged ≤40 years), middle-aged (ages 41-50), and older (aged >50 years) subgroups.

      Intervention

      Not applicable.

      Main Outcome Measures

      Females were compared with males in each subgroup with regard to their demographic data, pre-existing comorbidities, injury characteristics, management choices, access to optimal care, and clinical, neurologic, and functional outcomes after tSCI.

      Results

      In the younger subgroups, females (n=408) were significantly younger, had a greater proportion of aboriginals and transportation-related tSCIs, underwent surgical treatment more often, and had a greater sensory score change than males (n=1613). In the middle-aged subgroups, females (n=174) had a greater proportion of high-thoracic tSCIs than males (n=666). In the older subgroups, females (n=660) were significantly older, had more fall-related and less severe tSCIs, had a shorter stay at the rehabilitation center, had less spasticity, and were discharged home less often than males (n=2050).

      Conclusions

      The results of this study suggest some sex-related differences in individuals’ demographics and injury characteristics, but fewer discrepancies between females and males regarding their access to optimal care and outcomes after tSCI. Overall, future clinical trials could consider inclusion of males and females of all age groups to enhance recruitment and augment generalizability.

      Keywords

      List of abbreviations:

      AIS (ASIA Impairment Scale), ASIA (American Spinal Injury Association), FIM (functional independence measure), ISNCSCI (International Standards for Neurological Classification of Spinal Cord Injury), NASCIS (National Spinal Cord Injury Study, OR, odds ratio), RHSCIR (Rick Hansen Spinal Cord Injury Registry), tSCI (traumatic spinal cord injury)
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