Original Article

Spinal Cord (2005) 43, 408–416. doi:10.1038/sj.sc.3101729 Published online 15 February 2005

A prospective assessment of mortality in chronic spinal cord injury

This work was supported by Health Services R&D, Cooperative Studies Program, Department of Veterans Affairs, and NIH/NICHD ROl HD42141 (Dr Garshick)

Presented in part in abstract form at the 2003 Spinal Cord Conference & Training, June 2003, Long Beach

E Garshick1, A Kelley2, S A Cohen3, A Garrison4, C G Tun5, D Gagnon3 and R Brown6

  1. 1Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
  2. 2Boston University School of Medicine, Boston, MA, USA
  3. 3Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston University School of Public Health, Boston, MA, USA
  4. 4Research Service, VA Boston Healthcare System, Boston, MA, USA
  5. 5Rehabilitation Medicine Service, VA Boston Healthcare System and Harvard Medical School, Boston, MA, USA
  6. 6Pulmonary and Critical Care Medicine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

Correspondence: E Garshick, Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA

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Abstract

Study design:

 

Prospective mortality study.

Objective:

 

To assess the relationship between comorbid medical conditions and other health-related factors to mortality in chronic spinal cord injury (SCI).

Setting:

 

Boston, MA, USA.

Methods:

 

Between 1994 and 2000, 361 males greater than or equal to1 year after injury completed a respiratory health questionnaire and underwent pulmonary function testing. Cause-specific mortality was assessed over a median of 55.6 months (range 0.33–74.4 months) through 12/31/2000 using the National Death Index.

Results:

 

At entry, mean (plusminusSD) age was 50.6plusminus15.0 years (range 23–87) and years since injury was 17.5plusminus12.8 years (range 1.0–56.5). Mortality was elevated (observed/expected deaths=37/25.1; SMR=1.47; 95% CI=1.04–2.03) compared to US rates. Risk factors for death were diabetes (RR=2.62; 95% CI=1.19–5.77), heart disease (RR=3.66; 95% CI=1.77–7.78), reduced pulmonary function, and smoking. The most common underlying and contributing causes of death were diseases of the circulatory system (ICD-9 390–459) in 40%, and of the respiratory system in 24% (ICD-9 460-519).

Conclusions:

 

These results suggest that much of the excess mortality in chronic SCI is related to potentially treatable factors. Recognition and treatment of cardiovascular disease, diabetes, and lung disease, together with smoking cessation may substantially reduce mortality in chronic SCI.

Keywords:

spinal cord injury (SCI), mortality, heart diseases, diabetes, smoking

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