Risk factors for mortality after spinal cord injury in the USA

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Study evaluated three sets of risk and protective factors in relation to mortality after spinal cord injury (SCI): basic demographic and injury severity variables, socio-environmental factors, and health and secondary conditions. Assessment of these variables enhances the ability to identify individuals at risk for excess mortality. A total of 8,183 adults with traumatic SCI who received at least one follow-up evaluation between November 1995 and October 2006 from one of the 20 SCI Model Systems of care in the United States were included in the study. There were 76,262 person-years and 1,381 deaths at the end of June 2011. Mortality status determined by National Death Index and Social Security Death Index searches. Three successive sets of risk factors were evaluated with a logistic regression model on person-year observations to estimate the chance of dying in any given year. Several biographic and injury, socio-environmental, and health factors were significantly related to the odds of mortality. A history of pneumonia or kidney calculus was associated with greater odds of mortality, whereas deep vein thrombosis was not. Poor general health, decline in health over the past year, hospitalization, and a grade 3 or 4 pressure ulcer were also related to mortality. Consistent with a mediating effect, odds ratios declined with the addition of each successive set of factors.

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