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. 2009 Oct;90(10):1708-15.
doi: 10.1016/j.apmr.2009.04.020.

Risk of mortality after spinal cord injury: an 8-year prospective study

James S Krause  1 , Yusheng Zhai, Lee L Saunders, Rickey E Carter
Affiliations

Risk of mortality after spinal cord injury: an 8-year prospective study

James S Krause et al. Arch Phys Med Rehabil. 2009 Oct.

Abstract

Krause JS, Zhai Y, Saunders LL, Carter RE. Risk of mortality after spinal cord injury: an 8-year prospective study.

Objective: To evaluate a theoretical model for mortality after spinal cord injury (SCI) by sequentially analyzing 4 sets of risk factors in relation to mortality (ie, adding 1 set of factors to the regression equation at a time).

Design: Prospective cohort study of data collected in late 1997 and early 1998 with mortality status ascertained in December 2005. We evaluated the significance of 4 successive sets of predictors (biographic and injury, psychologic and environmental, behavioral, health and secondary conditions) using Cox proportional hazards modeling and built a full model based on the optimal predictors.

Setting: A specialty hospital.

Participants: Adults (N=1386) with traumatic SCI, at least 1 year postinjury, participated. There were 224 deaths. After eliminating cases with missing data, there were 1209 participants, with 179 deceased at follow-up.

Interventions: Not applicable.

Main outcome measures: Mortality status was determined using the National Death Index and the Social Security Death Index.

Results: The final model included 1 environmental variable (poverty), 2 behavioral factors (prescription medication use, binge drinking), and 4 health factors or secondary conditions (hospitalizations, fractures/amputations, surgeries for pressure ulcers, probable major depression).

Conclusions: The results supported the major premise of the theoretical model that risk factors are more important the more proximal they are in a theoretical chain of events leading to mortality. According to this model, mortality results from declining health, precipitated by high-risk behaviors. These findings may be used to target those who are at high risk for early mortality as well as to direct interventions to the particular risk factor.

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Conflict of interest statement

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

References

    1. National Spinal Cord Injury Statistical Center (NSCISC) Annual Statistical Report. Birmingham, AL: University of Alabama; 2006. Jun,
    1. DeVivo MJ, Krause JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil. 1999;80(11):1411–9. - PubMed
    1. Strauss DJ, DeVivo MJ, Paculdo DR, Shavelle RM. Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil. 2006;87:1079–85. - PubMed
    1. Krause JS. Secondary conditions and spinal cord injury: A model for prediction and prevention. Topics SCI Rehab. 1996;2(2):217–27.
    1. Krause JS, Carter RE, Pickelsimer E. Behavioral risk factors for mortality after spinal cord injury. Arch Phys Med Rehabil. 2009;90(1):95–101. - PMC - PubMed

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