Article

OBJECTIVE: To test hypothesized relationships between multiple behavioral
indicators and mortality among persons with spinal cord injury (SCI), while
controlling for biographic and injury characteristics. DESIGN: Prospective cohort
study with behavioral data collected by mailed survey in late 1997 and early
1998. Mortality status was ascertained as of December 31, 2005. SETTING: A large
rehabilitation hospital in the southeastern United States. PARTICIPANTS: Adults
(N=1386) with traumatic SCI, at least 1 year postinjury. INTERVENTIONS: Not
applicable. MAIN OUTCOME MEASURES: Primary outcome was time from survey to
mortality or censoring. Mortality status was determined using the National Death
Index and the Social Security Death Index. There were 224 deaths (16.2%) in the
full sample, and due to missing data, 188 deaths were observed in the 1251
participants included in the final statistical model. RESULTS: Cox proportional
hazards modeling identified several significant behavioral predictors of
mortality. In the first set of analyses, the significance of a single behavioral
variable was assessed while controlling for biographic and injury predictors. We
subsequently built a comprehensive model based on an optimal group of behaviors.
The best set of behavioral predictors included: smoking, binge drinking (number
of episodes with 5 or more drinks), prescription medication use, and number of
hours out of bed per day. Inclusion of these variables improved prediction of
survival compared with biographic and injury variables alone, as the pseudo-R2
increased from .121 to .164 and the concordance from .730 to .769. CONCLUSIONS:
The results affirm the importance of avoiding basic risk behaviors, such as
smoking and alcohol misuse, and affirm their importance as targets of
intervention in association with SCI rehabilitation.

Langue : ANGLAIS