Article

Risk of mortality after spinal cord
injury: an 8-year prospective study. OBJECTIVE: To evaluate a theoretical model
for mortality after spinal cord injury (SCI) by sequentially analyzing 4 sets of
risk factors in relation to mortality (ie, adding 1 set of factors to the
regression equation at a time). Prospective cohort study of data
collected in late 1997 and early 1998 with mortality status ascertained in
December 2005. We evaluated the significance of 4 successive sets of predictors
(biographic and injury, psychologic and environmental, behavioral, health and
secondary conditions) using Cox proportional hazards modeling and built a full
model based on the optimal predictors. SETTING: A specialty hospital.
PARTICIPANTS: Adults (N=1386) with traumatic SCI, at least 1 year postinjury,
participated. There were 224 deaths. After eliminating cases with missing data,
there were 1209 participants, with 179 deceased at follow-up. INTERVENTIONS: Not
applicable. MAIN OUTCOME MEASURES: Mortality status was determined using the
National Death Index and the Social Security Death Index.
RESULTS: The final
model included 1 environmental variable (poverty), 2 behavioral factors
(prescription medication use, binge drinking), and 4 health factors or secondary
conditions (hospitalizations, fractures/amputations, surgeries for pressure
ulcers, probable major depression). CONCLUSIONS: The results supported the major
premise of the theoretical model that risk factors are more important the more
proximal they are in a theoretical chain of events leading to mortality.
According to this model, mortality results from declining health, precipitated by
high-risk behaviors. These findings may be used to target those who are at high
risk for early mortality as well as to direct interventions to the particular
risk factor.

Langue : ANGLAIS