Abstract
Study design
Prospective cohort study
Objectives
Identify the association between health behaviors and risk of all-cause and cause-specific mortality in adults with chronic spinal cord injury (SCI)
Setting
A large rehabilitation hospital in the Southeastern United States.
Methods
Participants included 3070 adults (>18 years old) with chronic (>1-year) traumatic SCI. Behavioral data were collected by mail-in self report assessment between 1997–1998 and 2007–2010. Mortality status was determined using the National Death Index as of December 2016. We examined the associations between six behavioral domains (prescription medication usage, alcohol use, smoking, two nutrition factors, and fitness) and risk of all-cause and cause-specific mortality, including deaths due to sepsis (ICD-10-CM A40-A41), pneumonia and influenza (J09-J18), cancer (C00-D49), heart and blood vessel diseases (I00-I99), unintentional injuries (V01-X59, Y40-Y84, Y88), and all other causes.
Results
All health behaviors, except one nutrition factor, were associated with risk of all–cause mortality. Prescription medication usage was related to an increase in the risk of deaths caused by sepsis, unintentional injuries, and other causes of death. Alcohol usage was associated with an increased hazard of deaths due to unintentional injuries. Smoking was associated with increased risk of deaths due to cancer, heart and blood vessel diseases, and all other causes. Fitness level was protective from deaths due to heart and blood vessel diseases and other causes, as was the other nutrition factor.
Conclusions
The results identify relationships between health behaviors and specific causes of death and affirm their importance as targets for SCI rehabilitation research and intervention.
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Author contributions
ND was responsible for the literature search and introduction, and contributed to the discussion and overall development of the manuscript. YC was responsible for the analyses and research methods section and contributed to the results and conclusion sections. JK was the principal investigator and was responsible for the research design and contributed to the discussion and overall development and editing of the manuscript.
Funding
The contents of this publication were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers 90IF0066, 90SI5016, H133G090059, and H133N50022). 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.
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DiPiro, N.D., Cao, Y. & Krause, J.S. A prospective study of health behaviors and risk of all-cause and cause-specific mortality after spinal cord injury. Spinal Cord 57, 933–941 (2019). https://doi.org/10.1038/s41393-019-0298-9
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DOI: https://doi.org/10.1038/s41393-019-0298-9
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