Improvements in long-term survival after spinal cord injury?

Abstract

Objective: To investigate whether there have been improvements in long-term survival after spinal cord injury in recent decades.

Design: Survival analysis using time-varying covariates. The outcome variable was survival or mortality, and the explanatory variables were age, sex, level and grade of injury, and calendar year. The data were analyzed using the logistic regression model, Poisson regression model with comparison to the general population, and the computation of standardized mortality ratios for various groups.

Setting: National Spinal Cord Injury Model Systems facilities.

Participants: Persons (N=31,531) who survived 2 years postinjury, were older than 10 years, and who did not require ventilator support. These persons contributed 484,979 person-years of data, with 8536 deaths over the 1973 to 2012 study period.

Interventions: Not applicable.

Main outcome measures: Survival; survival relative to the general population; life expectancy.

Results: After adjustment for age, sex, race, etiology of injury, time since injury, and level and grade of injury, mortality in persons with spinal cord injury was higher in the 2005 to 2012 period than in 1990 to 2004 or 1980 to 1989, the odds ratios for these 3 periods were .857, .826, and .802 as compared with the 1970 to 1979 reference period.

Conclusions: There was no evidence of improvement. Long-term survival has not changed over the past 30 years.

Keywords: Life expectancy; Mortality; Rehabilitation; Survival; Trends.