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

Short Title:
Model System:
SCI
Reference Type:
Journal Article
Accession No.:
Journal:
Archives of Physical Medicine and Rehabilitation
Year, Volume, Issue, Page(s):
2009, vol. 90, issue , pp 1708-1715
Publication Website:
Abstract:
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.
Author(s):
Krause, J.S.; Zhai, Y.; Saunders, L.L.; Carter, R.E.
Author Address(es):

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