Abstract
Study design
Prospective cohort study.
Objectives:
Identify the risk and protective factors of all-cause and cause-specific mortality among persons with traumatic spinal cord injury (SCI).
Setting
Rehabilitation specialty hospital in the Southeastern United States.
Methods
A prospective cohort study was conducted with 3070 adults with traumatic SCI who were a minimum of 1 year post-injury at assessment. Prospective data were collected in 1997–1998 and 2007–2010, with mortality determined as of 31 December, 2016. The deceased were classified into six categories based on underlying cause of death: septicemia, pneumonia and influenza, cancer, heart and blood vessel diseases, unintentional injuries, and all other causes. The competing risk analysis strategy applied to each of the specific causes.
Results
There were a total of 803 observed deaths among the 2979 final study sample. After controlling for demographic and injury characteristics, general health, pressure ulcer history, and symptoms of infections were significantly associated with all-cause mortality. Except for cancer, they were also related with at least one of the specific causes of death, whereas orthopedic complications and subsequent injuries were unrelated to any cause.
Conclusions
Three health domains, global health, pressure ulcers, and symptoms of illness or infection, were significantly associated with mortality after SCI, and the patterns of association varied as a function of specific cause of death.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
DeVivo MJ, Krause JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil. 1999;80:1411–9.
Strauss DJ, DeVivo MJ, Paculdo DR, Shavelle RM. Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil. 2006;87:1079–85.
NSCISC. Annual statistical report. Birmingham, AL: University of Alabama; 2017.
Chamberlain JD, Meier S, Mader L, von Groote PM, Brinkhof MW. Mortality and longevity after a spinal cord injury: systematic review and meta-analysis. Neuroepidemiology. 2015;44:182–98.
DeVivo MJ. Sir Ludwig Guttmann Lecture: trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973-2006. Spinal Cord. 2007;45:713–21.
Shavelle RM, DeVivo MJ, Brooks JC, Strauss DJ, Paculdo DR. Improvements in long-term survival after spinal cord injury? Arch Phys Med Rehabil. 2015;96:645–51.
Osterthun R, Post MW, van Asbeck FW, van Leeuwen CM, van Koppenhagen CF. Causes of death following spinal cord injury during inpatient rehabilitation and the first five years after discharge. A Dutch cohort study. Spinal Cord. 2014;52:483–8.
Savic G, DeVivo MJ, Frankel HL, Jamous MA, Soni BM, Charlifue S. Causes of death after traumatic spinal cord injury-a 70-year British study. Spinal Cord. 2017;55:891–7.
Leite VF, Souza DR, Imamura M, Battistella LR. Post-discharge mortality in patients with traumatic spinal cord injury in a Brazilian hospital: a retrospective cohort. Spinal Cord. 2018;57:134–40.
NSCISC. Spinal cord injury facts and figures at a glance. Birmingham, AL: University of Alabama; 2018.
Chamberlain JD, Gmunder HP, Hug K, Jordan X, Moser A, Schubert M, et al. Differential survival after traumatic spinal cord injury: evidence from a multi-center longitudinal cohort study in Switzerland. Spinal Cord. 2018;56:920–30.
McGrath R, Hall O, Peterson M, DeVivo M, Heinemann A, Kalpakjian C. The association between the etiology of a spinal cord injury and time to mortality in the United States: A 44-year investigation. J Spinal Cord Med. 2018:1–9. https://doi.org/10.1080/10790268.2018.1505311. [Epub ahead of print]
Krause JS. Secondary conditions and spinal cord injury: A model for prediction and prevention. Top Spinal Cord Inj Rehabil. 1996;2:217–27.
Krause JS, Saunders LL, DiPiro ND, Reed KS. Theoretical risk and prevention model for secondary health conditions and mortality: 15 years of research. Top Spinal Cord Inj Rehabil. 2013;19:15–24.
Krause JS, Cao Y, DeVivo MJ, DiPiro ND. Risk and protective factors for cause-specific mortality after spinal cord injury. Arch Phys Med Rehabil. 2016;97:1669–78.
Krause JS, Carter R, Zhai Y, Reed K. Psychologic factors and risk of mortality after spinal cord injury. Arch Phys Med Rehabil. 2009;90:628–33.
Krause JS, Carter RE. Risk of mortality after spinal cord injury: relationship with social support, education, and income. Spinal Cord. 2009;47:592–6.
Krause JS, Carter RE, Pickelsimer E. Behavioral risk factors of mortality after spinal cord injury. Arch Phys Med Rehabil. 2009;90:95–101.
Krause JS, Carter RE, Pickelsimer E, Wilson D. A prospective study of health and risk of mortality after spinal cord injury. Arch Phys Med Rehabil. 2008;89:1482–91.
Krause JS, DeVivo MJ, Jackson AB. Health status, community integration, and economic risk factors for mortality after spinal cord injury. Arch Phys Med Rehabil. 2004;85:1764–73.
Krause JS, Saunders LL. Risk of mortality and life expectancy after spinal cord injury: The role of health behaviors and participation. Top Spinal Cord Inj Rehabil. 2010;16:53–60.
Krause JS, Saunders LL. Health, secondary conditions, and life expectancy after spinal cord injury. Arch Phys Med Rehabil. 2011;92:1770–5.
Krause JS, Saunders LL. Do risk factors for mortality after spinal cord injury parallel those from the general USA population?, expanded abstract. Top Spinal Cord Inj Rehabil. 2012;18:113–7.
Krause JS, Saunders LL. Socioeconomic and behavioral risk factors for mortality: do risk factors observed after spinal cord injury parallel those from the general USA population? Spinal Cord. 2012;50:609–13.
Krause JS, Saunders LL, DeVivo MJ. Income and risk of mortality after spinal cord injury. Arch Phys Med Rehabil. 2011;92:339–45.
Krause JS, Saunders LL, Zhai Y. Stability of predictors of mortality after spinal cord injury. Spinal Cord. 2012;50:281–4.
Krause JS, Zhai Y, Saunders LL, Carter RE. Risk of mortality after spinal cord injury: an 8-year prospective study. Arch Phys Med Rehabil. 2009;90:1708–15.
Krause JS, Cao Y, DiPiro ND, Cuddy E. Personality, high-risk behaviors, and elevated risk of unintentional deaths related to drug poisoning among individuals with spinal cord injury. Arch Phys Med Rehabil. 2018;99:1941–8.
Krause JS, Reed KS, McArdle JJ. A structural analysis of health outcomes after spinal cord injury. J Spinal Cord Med. 2010;33:22–32.
CDC. National Death Index 2017. Available from: https://www.cdc.gov/nchs/ndi/index.htm.
SAS Institute Inc. SAS for Windows. 9.4 ed. Cary, NC: SAS Institute; 2015.
Allison PD. Survival analysis using the SAS system: a practical guide. Cary, NC: SAS Institute; 2010.
Austin PC, Lee DS, Fine JP. Introduction to the analysis of survival data in the presence of competing risks. Circulation. 2016;133:601–9.
Li C, DiPiro ND, Krause J. A latent structural equation model of risk behaviors and pressure ulcer outcomes among people with spinal cord injury. Spinal Cord. 2017;55:553–8.
Flattau A, Blank AE. Risk factors for 90-day and 180-day mortality in hospitalised patients with pressure ulcers. Int Wound J. 2014;11:14–20.
Cox J. Pressure injury risk factors in adult critical care patients: A review of the literature. Ostomy Wound Manag. 2017;63:30–43.
Margolis DJ, Knauss J, Bilker W, Baumgarten M. Medical conditions as risk factors for pressure ulcers in an outpatient setting. Age Ageing. 2003;32:259–64.
Li C, DiPiro ND, Cao Y, Szlachcic Y, Krause J. The association between metabolic syndrome and pressure ulcers among individuals living with spinal cord injury. Spinal Cord. 2016;54:967–72.
Funding
The contents of the publication were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90IF0066). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this publication do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.
Author information
Authors and Affiliations
Contributions
YC was responsible for research method, results, and conclusion sections. ND was responsible for literature search and introduction. JK was responsible for discussion.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of ethics
We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.
Additional information
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Cao, Y., DiPiro, N. & Krause, J.S. Health factors and spinal cord injury: a prospective study of risk of cause-specific mortality. Spinal Cord 57, 594–602 (2019). https://doi.org/10.1038/s41393-019-0264-6
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41393-019-0264-6
This article is cited by
-
Evaluating the modified spinal cord injury secondary conditions scale (SCI-SCS) combining severity and mortality-based weights
Spinal Cord (2026)
-
Longitudinal changes in employment, health, participation, and quality-of-life and the relationships with long-term survival after spinal cord injury
Spinal Cord (2023)
-
Development of a decision support tool to prevent community acquired pressure injuries for use in the spinal cord injury clinic using the delphi technique
Spinal Cord (2023)
-
Social participation as a mediator of the relationships of socioeconomic factors and longevity after traumatic spinal cord injury
Spinal Cord (2022)
-
A prospective study of health behaviors and risk of all-cause and cause-specific mortality after spinal cord injury
Spinal Cord (2019)
