Abstract
Study design
Observational cohort study.
Objective
To investigate survival and life expectancy after NTSCI in Switzerland according to etiology.
Setting
Specialized rehabilitation centers in Switzerland.
Methods
Longitudinal data from the Swiss Spinal Cord Injury (SwiSCI) medical records study were used. Adjusted hazard ratios (HRs) and life expectancies were estimated using flexible parametric survival modeling.
Results
One thousand four hundred and fifty individuals were admitted to first rehabilitation for NTSCI between 1990 and 2011, contributing 6137 cumulative person-years at risk and 528 deaths. With reference to persons with a degenerative disc disorder, the HR for mortality in individuals with NTSCIs from infections was 1.42 (95% CI 0.99–2.04), while risk in those with NTSCIs from vascular disorders was 1.28 (95% CI 0.97–1.68). Mortality risk was most pronounced in individuals with NTSCIs from malignant neoplasms (HR 6.32, 95% CI 4.79–8.34). Exemplified for males with an attained age of 60 years, a malignant etiology was associated with 1.7 life years remaining (LYR), as compared to 10.1 LYR for non-malignant etiologies. Males with an attained age of 60 years and a degenerative disc etiology were estimated to have 12.9 LYR.
Conclusions
This study contributes an evidence base for risk factors of mortality after NTSCI, reducing a considerable knowledge gap in survival after NTSCI. Survival and life expectancy estimates were highly differential between etiological groups, indicating a need for a heterogeneous clinical approach and dynamic health-care provisions for this growing population.
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Acknowledgements
This study has been financed in the framework of the Swiss Spinal Cord Injury Cohort Study (SwiSCI, www.swisci.ch), supported by the Swiss Paraplegic Foundation. The members of the SwiSCI Steering Committee are: Xavier Jordan, Bertrand Léger (Clinique Romande de Réadaptation, Sion); Michael Baumberger, Hans Peter Gmünder (Swiss Paraplegic Center, Nottwil); Armin Curt, Martin Schubert (University Clinic Balgrist, Zürich); Margret Hund-Georgiadis, Kerstin Hug (REHAB Basel, Basel); Thomas Troger (Swiss Paraplegic Association, Nottwil); Daniel Joggi (Swiss Paraplegic Foundation, Nottwil); Hardy Landolt (Representative of persons with SCI, Glarus); Nadja Münzel (Parahelp, Nottwil); Mirjam Brach, Gerold Stucki (Swiss Paraplegic Research, Nottwil); Christine Fekete (SwiSCI Coordination Group at Swiss Paraplegic Research, Nottwil). JDC was supported by a grant from the Swiss National Science Foundation (Grant #166603 - http://p3.snf.ch/project-166603).
Author contributions
AB and MWGB were responsible for designing and planning the conceptual framework of the present study. MWGP and JDC further provided statistical support in addition to contributing critical feedback on the manuscript. HPG, KH, XJ, and MS provided clinical support, feedback on the manuscript, and support in data collection at their respective clinics. AB was responsible for data analysis, interpretation, and development of the present manuscript.
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Buzzell, A., Chamberlain, J.D., Gmünder, H.P. et al. Survival after non-traumatic spinal cord injury: evidence from a population-based rehabilitation cohort in Switzerland. Spinal Cord 57, 267–275 (2019). https://doi.org/10.1038/s41393-018-0212-x
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DOI: https://doi.org/10.1038/s41393-018-0212-x
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