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

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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 factorsto the regression equation at a time) 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. Setting: A specialty hospital. 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 fo llow-up. Interventions: Not applicable. Main Outcome Measures: Mortality status was determined using the National Death Index and the Social Security Death
Index. 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, surgedes for pressure
ulcers, probable major depression). Conclusions: The results supported the major premise of the theoretical model that lisk factors are more important the more proximal they are in a tbeoretical chain of events leading to mortality.
According to this model, mortality results from declining health, precipitated by high-risk behav iors. These findings may be used to target those who are at high risk for early mortaiity as well as to direct intelventions to the particular risk factor.
Key Words: Health; Life expectancy; Mortality; Rehabilitation; Risk; Spinal cord injuries. © 2009 by the American Congress of Rehabilitation Medicine

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