Risk and protective factors for cause-specific mortality after spinal cord injury

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Study investigated the association of multiple sets of risk and protective factors (biographic and injury, socioeconomic, health) with cause-specific mortality after spinal cord injury (SCI). Participants were 8,157 adults with traumatic SCI who were enrolled in a SCI Model Systems facility after 1973. All-cause mortality was determined using the Social Security Death Index. 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. 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 [AIS] grade A, 5.70). In contrast, injury level and AIS 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. Findings suggest that infective disease and respiratory causes of death are those that are most strongly tied with SCI severity, with respiratory causes most directly related to the neurologic level of injury and infective diseases most strongly related to the AIS grade.

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