The association between secondary health conditions and indirect costs after spinal cord injury


Study design



Identify the association between secondary health conditions (SHC) and the indirect costs of traumatic spinal cord injury (SCI) based on the pre-injury and post-injury changes in employment and earnings.


Medical university in the southeastern United States (US).


A population-based cohort of 304 participants met the following eligibility criteria: received treatment for acute SCI within the state, residual effects resulting from traumatic SCI, at least 1-year post injury, age between 23 and 64 years at the time of injury onset, and younger than 65 years at the time of study measurement. The indirect costs estimate was measured by the annual forgone earnings and fringe benefits calculated as the difference in the sum of earnings and benefits between before injury and after injury adjusting for inflation in 2019 US dollars. We considered seven SHC in this study: bowel accidents, urine accidents, urinary tract infections, pressure sores, unintentional injury, severe pain, and depressive disorder. We used multivariate ordinary least squares regression models to examine their relationship controlling for age, sex, race/ethnicity, marital status, years of education, injury level, and ambulatory status.


The indirect costs were significantly associated with the total number of SHC and with the individual conditions of bowel accidents, urine accidents, pressure sores, and depressive disorder after controlling for age, sex, race/ethnicity, marital status, years of education, injury level, and ambulatory status.


Preventing SHC relates to better economic consequences for individuals, their families, and society, even after accounting for differences in severity of SCI.

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Data availability

The data sets generated and/or analyzed during the current study are not publicly available due to the privacy concerns of study participants and are not standardized to be in a publicly interpretable format.


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The contents of this publication were developed under grants from the South Carolina Spinal Cord Injury Research Fund (SCSCIRF) grants SCIRF 11-006, SCIRF 09-001, and SCIRF 2017 SI-02. However, those contents do not necessarily represent the policy of the SCSCIRF, and you should not assume endorsement by the state of SC.

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YC was the principal investigator and was responsible for the introduction, analyses, and research methods sections, as well as contributing to the results, discussion, and conclusion. JK was responsible for the discussion and contributed to the overall development and editing of the paper.

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Correspondence to Yue Cao.

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Cao, Y., Krause, J.S. The association between secondary health conditions and indirect costs after spinal cord injury. Spinal Cord (2020).

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