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Multimorbidity in persons with non-traumatic spinal cord injury and its impact on healthcare utilization and health outcomes


Study design

Cross-sectional survey in Canada.


To explore multimorbidity (the coexistence of two/more health conditions) in persons with non-traumatic spinal cord injury (NTSCI) and evaluate its impact on healthcare utilization (HCU) and health outcomes.


Community-dwelling persons.


Data from the Spinal Cord Injury Community Survey (SCICS) was used. A multimorbidity index (MMI) consisting of 30 secondary health conditions (SHCs), the 7-item HCU questionnaire, the Short Form-12 (SF-12), Life Satisfaction-11 first question, and single-item Quality of Life (QoL) measure were administered. Additionally, participants were grouped as “felt needed healthcare was received” (Group 1, n = 322) or “felt needed healthcare was not received” (Group 2, n = 89) using the HCU question. Associations among these variables were assessed using multivariable analysis.


408 of 412 (99%) participants with NTSCI reported multimorbidity. Constipation, spasticity, and fatigue were the most prevalent self-reported SHCs. Group 1 had a higher MMI score compared to Group 2 (p < 0.001). A higher MMI score correlated with the feeling of not receiving needed care (OR 1.4, 95% CI 1.08–1.21), lower SF-12 (physical/mental component summary scores), being unsatisfied with life, and lower QoL (all p < 0.001). Additionally, Group 1 had more females (p < 0.001), non-Caucasians (p = 0.034), and lower personal annual income (p = 0.025).


Persons with NTSCI have multimorbidity, and the MMI score was associated with increased HCU and worse health outcomes. This work emphasizes the critical need for improved healthcare and monitoring. Future work determining specific thresholds for the MMI could be helpful for triage screening to identify persons at higher risk of poor outcomes.

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Fig. 1: Type and frequency of secondary health conditions (SHC a) reported by participants with non-traumatic SCI (NTSCI, n = 412).

Data availability

The data are not publicly available as participants did not provide informed consent to share them.


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We express thanks to all participants who participated in the 2011–2012 SCI Community Survey (SCICS), and the Praxis Spinal Cord Institute (grant number: 2010-03), and the Ontario Neurotrauma Foundation (grant number: 2010-RHI-SURVEY-812) who supported the survey. We acknowledge Dr. Frédéric S. Dumont, Dr. Jean Leblond, and Dr. Luc Noreau from the Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) and Université Laval, Quebec City, Canada, as well as Mr. John Cobb from Vancouver General Hospital, Vancouver, British Columbia, Canada for their contributions to the development, design and implementation of the SCICS.


This study was supported by Praxis Spinal Cord Institute, Health Canada, and Western Economic Diversification Canada.

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Authors and Affiliations



All authors participated in the study design and provided feedback on the manuscript. HH, DW, SH, JP, NF, CC and VN analyzed the data, interpreted the results and HH wrote the manuscript. VN and NF were the principal investigators and directors of the study.

Corresponding author

Correspondence to Vanessa K. Noonan.

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Competing interests

The authors declare that we are employees of the Praxis Spinal Cord Institute.

Ethics approval and consent to participate

Ethics was obtained from an independent ethics board (Institutional Research Board Services), the Research Ethics Board of Université Laval (project #2009-179), and from local research ethics boards to recruit participants from SCI centers across Canada. We further certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research and that informed consent was obtained from all subjects.

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Hong, H.A., Fallah, N., Wang, D. et al. Multimorbidity in persons with non-traumatic spinal cord injury and its impact on healthcare utilization and health outcomes. Spinal Cord 61, 483–491 (2023).

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