Original article
Trends in Life Expectancy After Spinal Cord Injury

https://doi.org/10.1016/j.apmr.2006.04.022Get rights and content

Abstract

Strauss DJ, DeVivo MJ, Paculdo DR, Shavelle RM. Trends in life expectancy after spinal cord injury.

Objective

To investigate whether there have been improvements in survival after spinal cord injury (SCI) over time, both in the critical first 2 years after injury and in the longer term.

Design

Pooled repeated observations analysis of person-years. For each person-year, the outcome variable is survival and mortality, and the explanatory variables include age, level and grade of injury, and calendar year (the main focus of the analyses). The method can be viewed as a generalization of proportional hazards regression.

Setting

Model spinal cord injury systems and hospital SCI units across the United States.

Participants

Persons (N=30,822) admitted to a Spinal Cord Injury Model Systems facility a minimum of 1 day after injury. Only persons over 10 years of age and known not to be ventilator dependent were included. These persons contributed 323,618 person-years of data, with 4980 deaths, over the 1973 to 2004 study period.

Interventions

Not applicable.

Main Outcome Measure

Survival.

Results

Other factors being equal, over the last 3 decades there has been a 40% decline in mortality during the critical first 2 years after injury. However, the decline in mortality over time in the post–2-year period is small and not statistically significant.

Conclusions

The absence of a substantial decline in mortality after the first 2 years postinjury is contrary to widely held impressions. Nevertheless, the finding is based on a large database and sensitive analytic methods and is consistent with previous research. Improvements in critical care medicine after spinal cord injury may explain the marked decline in short-term mortality. In contrast, although there have no doubt been improvements in long-term rehabilitative care, their effect in enhancing the life span of persons with SCI appears to have been overstated.

Section snippets

Study Population

Data for the present study were collected through the Model Spinal Cord Injury Systems (MSCIS) program and submitted to the National Spinal Cord Injury Statistical Center (NSCISC). As many as 25 SCI centers located around the United States have contributed to this database at various times. Detailed descriptions of the history, eligibility criteria, data collection protocol, data quality control procedures, and current status of the NSCISC database have been published previously.20,21 This is

Results

The data were stratified into 3 time periods, as indicated in table 1: 1973 to 1979, 1980 to 1989, and 1990 to 2004. Table 1 shows how the subjects in each of the injury periods were distributed according to age, sex, injury level, and grade. It may be noted that the subjects in the late period were slightly more likely to be in the most severe group (C1-4), which may indicate a trend over time toward improved survival in this group until entry to the MSCIS. More strikingly, the percentage of

Discussion

The primary focus of this study was an investigation of improvements in survival in mortality after SCI since the 1970s. There were dramatic improvements for the first 2 postinjury years, which is consistent with previous reports. The principal findings, however, were that for the subsequent period there was at most a modest improvement since the 1970s and no evidence for any improvement after 1980.

Although these findings may appear to be inconsistent with previous research, this is not the

Conclusions

This study confirms the substantial progress that has occurred over the past 30 years in reducing the mortality rate during the first 2 years after SCI. As a result, life expectancy measured from the time of injury has also increased substantially. However, the study also shows that since 1980 there has been no substantial change in either annual mortality rates after the second postinjury year or in life expectancy as measured from the second anniversary of injury or later. However, the

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    Supported in part by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, U.S. Department of Education (grant no. H133A011201).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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