Abstract
Study design:
Longitudinal study with mortality follow-up.
Objective:
Identify predictive factors for long-term mortality following tetraplegic spinal cord injury (TSCI).
Setting:
The Tetrafigap survey is a multi-centre epidemiological survey on the long-term outcome of persons with TSCI, initiated in France in 1995 with the participation of 35 rehabilitation centres.
Methods:
The mortality follow-up involves 1241 persons with TSCI who were admitted to one of the study rehabilitation units at the initial phase and who completed the initial self-administered questionnaire. There were 226 observed deaths (18.2%) during an 11-year period. Logistic regression methods, with estimates of odds ratios (ORs), incorporating clinical, functional and social participation data were used to determine the factors related to mortality. This was followed by multivariate analysis to determine the best predictive factors for long-term mortality.
Results:
Risk of death increases significantly with age but not with the time elapsed since the accident. The risk of death is higher in men. Interestingly, clinical variables are not the best predictors of long-term mortality. Instead, the significant effect of poor social participation (being single, infrequent contact with friends) and functional limitations (full assistance required with dressing or eating) persists after adjustment for other variables.
Conclusion:
Once the medical situation becomes more stable, factors related to the long-term mortality of persons with TSCI are not exactly identical to those observed in the short acute-phase and during the first year after the accident. Social participation has a significant effect on mortality.
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References
Strauss D, DeVivo MJ, Paculdo D, Shavelle R . Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil 2006; 87: 1079–1085.
Frankel H, Coll J, Charlifue S, Whiteneck G, Gardner B, Jamous M et al. Long term survival in spinal cord injury: a fifty year investigation. Spinal Cord 1998; 36: 266–274.
McColl M, Walker J, Stirling P, Wilkins R, Corey P . Expectations of life and health among spinal cord injured adults. Spinal Cord 1997; 35: 818–828.
Yeo JD, Walsh J, Rutkowski S, Soden R, Craven M, Middleton J . Mortality following spinal cord injury. Spinal Cord 1998; 36: 329–336.
DeVivo MJ . Trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973–2006. Spinal Cord 2007; 45: 713–721.
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: 1411–1419.
Krause J, Sternberg M, Lottes S, Maides J . Mortality after spinal cord injury: an 11-year prospective study. Arch Phys Med Rehabil 1997; 78: 815–821.
O’Connor PJ . Survival after spinal cord injury in Australia. Arch Phys Med Rehabil 2005; 86: 37–47.
Lhéritier K, Ravaud J-F, Désert J-F, Pédelucq J-P, O’Hanna F, Daurès J-P . Survival of tetraplegic spinal cord injured persons after the first admission of a rehabilitation center and prognosis factors: a multicenter study of 697 subjects in French centers. Rev Epidemiol Sante Publique 2001; 49: 449–458.
Lidal I, Snekkevik H, Aamodt G, Hjeltnes N, Biering-Sørensen F, Stanghelle JK . Mortality after spinal cord injury in Norway. J Rehabil Med 2007; 39: 145–151.
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: 1764–1773.
Ravaud J-F, Désert J-F, Boulongne D, Delcey M, Peleducq J-P, Tramblay M et al. The Tetrafigap Survey on the long-term outcome of tetraplegic spinal cord injured individuals: part I Protocol and methodology. Spinal Cord 1998; 36: 117–124.
Ravaud J-F, Delcey M, Désert J-F . The Tetrafigap Survey on the long-term outcome of tetraplegic spinal cord injured persons: part II Demographic characteristics and initial cause of injury. Spinal Cord 2000; 38: 164–172.
Klotz R, Joseph P-A, Ravaud J-F, Wiart L, Barat M . The Tetrafigap Survey on the long-term outcome of tetraplegic spinal cord injured people: part III medical complications and associated factors. Spinal Cord 2002; 40: 45–67.
WHO. ICF International Classification of Functioning, Disability and Health. WHO: Geneva, 2001.
Krause JS, Carter RE, Pickelsimer EE, Wilson D . A prospective study of health and risk of mortality after spinal cord injury. Arch Phys Med Rehabil 2008; 89: 1482–1491.
Prioux F . Recent demographic developments in France: life expectancy still rising. Population-E 2008; 63: 375–413.
Meslé F . Recent improvements in life expectancy in France: men are starting to catch up. Population 2006; 61: 365–388.
Acknowledgements
We would like to thank all rehabilitation centres, which participated in the implementation of the second phase of the Tetrafigap Survey. We are particularly grateful to Aline Desesquelles of INED for her precious assistance in retrieving vital status data. We also thank Emily Divinagracia for her assistance with translation. This research was supported by IFR 25, French Federative Research Institute on Disability (with a grant of AFIGAP Association Francophone Internationale des Groupes d’Animation de la Paraplégie) and by INED.
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Espagnacq, M., Albert, T., Boyer, F. et al. Predictive factors of long-term mortality of persons with tetraplegic spinal cord injury: an 11-year French prospective study. Spinal Cord 49, 728–735 (2011). https://doi.org/10.1038/sc.2010.189
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DOI: https://doi.org/10.1038/sc.2010.189
