Risk of mortality after spinal cord injury: An 8-year prospective study
Archives of Physical Medicine and Rehabilitation
Year, Volume, Issue, Page(s):
2009, vol. 90, issue , pp 1708-1715
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)<br /><br />.
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.<br /><br />
SETTING: A specialty hospital.<br /><br />
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.<br /><br />
INTERVENTIONS: Not applicable.<br /><br />
MAIN OUTCOME MEASURES: Mortality status was determined using the National Death Index and the Social Security Death Index.<br /><br />
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).<br /><br />
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.
Krause, J.S.; Zhai, Y.; Saunders, L.L.; Carter, R.E.
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