Article

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.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS