Self-reported secondary health conditions in relation to age and time living with spinal cord injury: Results from the second International Spinal Cord Injury Community Survey

Abstract

Objective: To describe the proportions of self-reported secondary health conditions, assess the overall health burden of these conditions, and examine their associations with age and time living with traumatic or nontraumatic spinal cord injury/disease (SCI/D) across participating countries in the second International Spinal Cord Injury (InSCI) survey.

Design: Cross-sectional, multi-national, observational cohort study conducted in 2022-2024.

Setting: Community setting with participants from 31 countries representing all six WHO regions.

Participants: Individuals with traumatic (n = 11 882) and nontraumatic (n = 3 194) SCI/D aged ≥18 years and living in the community.

Interventions: Not applicable.

Main outcome measures: Proportions of secondary health conditions. A comorbidity index, based on a multi-component approach - including the number of co-occurring health problems, their severity, and treatment status - was used as a proxy for overall health burden. Linear mixed model was conducted to examine the associations of age and time since injury with the comorbidity index.

Results: The most common secondary health problems worldwide were pain (81.5%), feeling depressed (79%), spasticity/muscle spasm (75.5%), and bowel dysfunction (70.5%). Higher comorbidity indices were observed with increasing age and duration of living with injury in individuals with traumatic SCI/D, but not in those with nontraumatic SCI/D.

Conclusions: Both individuals with traumatic and nontraumatic SCI/D worldwide experience high proportions of secondary health conditions. A significant association between overall health burden, increasing age, and time since injury was, however, observed only among those with traumatic injuries. This finding highlights the potential need for tailored interventions that account not only for the type of injury but also for the individual's age and duration of living with SCI/D.

Keywords: Ageing; Comorbidity; Spinal cord diseases; Time factors.