TY - JOUR
T1 - A prospective study of health and risk of mortality after spinal cord injury
AU - Krause, James S.
AU - Carter, Rickey E.
AU - Pickelsimer, E. Elisabeth
AU - Wilson, Dulaney
N1 - Funding Information:
Supported by the National Institute for Disability and Rehabilitation Research (grant no. H133G030117), Model Spinal Cord Injury Systems (grant no. H133N000005), and the National Institutes of Health (grant no. 1R01 NS 48117-01 A1).
PY - 2008/8
Y1 - 2008/8
N2 - Objective: To test hypothesized relationships between multiple health parameters and mortality among persons with spinal cord injury (SCI) while controlling for variations in biographical and injury characteristics. Design: Prospective cohort study with health data collected in late 1997 and early 1998 and mortality status ascertained in December 2005. Setting: A large rehabilitation hospital in the Southeastern United States. Participants: A total of 1389 adults with traumatic SCI, at least 1 year postinjury. Interventions: Not applicable. Main Outcome Measures: The primary outcome was time from survey to mortality (or time of censoring). Mortality status was determined using the National Death Index and the Social Security Death Index. There were 225 deaths (16.2%) by December 31, 2005. Results: Cox proportional hazards modeling identified several significant health predictors of mortality status, while controlling for biographic and injury factors. Two sets of analyses were conducted - the first identifying the significance of a single variable of interest and the second analysis building a comprehensive model based on an optimal group of variables. Multiple types of health conditions were associated with mortality. The best set of health predictors included probable major depression, surgeries to repair pressure ulcers, fractures and/or amputations, symptoms of infections, and days hospitalized. Inclusion of these variables, along with a general health rating, improved prediction of survival compared with biographic and injury variables alone, because the pseudo R2 increased from .12 to .18 and the concordance from .730 to .776. Conclusions: In addition to secondary conditions that have been the traditional focus of prevention efforts (eg, pressure ulcers, urinary tract infections), amputations, fractures, and depressive symptoms were associated with higher risk for mortality; however, further research is needed to identify the association of specific conditions with causes of death and to determine whether interventions can modify these conditions and ultimately improve survival.
AB - Objective: To test hypothesized relationships between multiple health parameters and mortality among persons with spinal cord injury (SCI) while controlling for variations in biographical and injury characteristics. Design: Prospective cohort study with health data collected in late 1997 and early 1998 and mortality status ascertained in December 2005. Setting: A large rehabilitation hospital in the Southeastern United States. Participants: A total of 1389 adults with traumatic SCI, at least 1 year postinjury. Interventions: Not applicable. Main Outcome Measures: The primary outcome was time from survey to mortality (or time of censoring). Mortality status was determined using the National Death Index and the Social Security Death Index. There were 225 deaths (16.2%) by December 31, 2005. Results: Cox proportional hazards modeling identified several significant health predictors of mortality status, while controlling for biographic and injury factors. Two sets of analyses were conducted - the first identifying the significance of a single variable of interest and the second analysis building a comprehensive model based on an optimal group of variables. Multiple types of health conditions were associated with mortality. The best set of health predictors included probable major depression, surgeries to repair pressure ulcers, fractures and/or amputations, symptoms of infections, and days hospitalized. Inclusion of these variables, along with a general health rating, improved prediction of survival compared with biographic and injury variables alone, because the pseudo R2 increased from .12 to .18 and the concordance from .730 to .776. Conclusions: In addition to secondary conditions that have been the traditional focus of prevention efforts (eg, pressure ulcers, urinary tract infections), amputations, fractures, and depressive symptoms were associated with higher risk for mortality; however, further research is needed to identify the association of specific conditions with causes of death and to determine whether interventions can modify these conditions and ultimately improve survival.
KW - Mortality
KW - Outcome assessment (health care)
KW - Rehabilitation
KW - Risk
KW - Spinal cord injuries
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U2 - 10.1016/j.apmr.2007.11.062
DO - 10.1016/j.apmr.2007.11.062
M3 - Article
C2 - 18674984
AN - SCOPUS:48649086352
SN - 0003-9993
VL - 89
SP - 1482
EP - 1491
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 8
ER -