All-cause and cause-specific mortality following non-traumatic spinal cord injury: evidence from a population-based cohort study in Switzerland

Abstract Study design Observational cohort study. Objective To benchmark all-cause and cause-specific mortality following NTSCI to the general population (GP). Setting Specialized rehabilitation centers in Switzerland. Methods Longitudinal data from the Swiss Spinal Cord Injury (SwiSCI) Medical Record study were probabilistically linked with cause of death (CoD) information from the Swiss National Cohort. Standardized mortality ratios (SMRs) were estimated for all-cause and cause-specific mortality. Competing risk frameworks were used to estimate the probability of death due to specific CoD. Results One thousand five hundred and one individuals were admitted for first rehabilitation with NTSCI between 1990–2011; CoD information was available for 454 individuals of the 525 individuals that died. Overall, the mortality rate for persons with NTSCI was 1.6 times greater than that of the GP. Deaths due to cardiovascular disease (39.8%), neoplasms (22%), and infection (9.9%) were most often reported. Individuals with an SCI due to a vascular etiology indicated the greatest burden of mortality from infection compared with the GP (SMR 5.4; 95% CI, 3.1 to 9.2). Conclusions Cause-specific SMRs varied according to etiology. This supports the need for targeted clinical care and follow-up. Cardiovascular disease, neoplasms, and infection, emerged as main causes of death following NTSCI and should thus be targets for future research and differential clinical management approaches.

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Excess burden of a chronic disabling condition: life lost due to traumatic spinal cord injury in a Swiss population-based cohort study

International Journal of Public Health ◽

10.1007/s00038-019-01265-6 ◽

2019 ◽

Vol 64 (7) ◽

pp. 1097-1105

Author(s):

Jonviea D. Chamberlain ◽

◽

Anne Buzzell ◽

Hans Peter Gmünder ◽

Kerstin Hug ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cohort Study ◽

Population Based ◽

Traumatic Spinal Cord Injury ◽

Excess Burden ◽

Cord Injury ◽

Swiss Population

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Prevalence of Prescribed Opioid Claims Among Persons With Traumatic Spinal Cord Injury in Ontario, Canada: A Population-Based Retrospective Cohort Study

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2020.06.020 ◽

2021 ◽

Vol 102 (1) ◽

pp. 35-43

Author(s):

Sara J.T. Guilcher ◽

Mary-Ellen Hogan ◽

Qi Guan ◽

Daniel McCormack ◽

Andrew Calzavara ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Population Based ◽

Traumatic Spinal Cord Injury ◽

Cord Injury

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Etiology-specific variation in survival following non-traumatic spinal cord injury: a causal inference approach using data from a population-based cohort

Spinal Cord ◽

10.1038/s41393-020-00554-9 ◽

2020 ◽

Author(s):

Anne Buzzell ◽

Jonviea D. Chamberlain ◽

Inge Eriks-Hoogland ◽

Xavier Jordan ◽

Martin Schubert ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Population Based ◽

Health Condition ◽

Parametric Modeling ◽

Interdisciplinary Management ◽

Traumatic Spinal Cord Injury ◽

Cord Injury ◽

National Cohort ◽

Survival Differences

Abstract Study design Observational, population-based cohort study. Objectives To evaluate the origin and contribution to excess of survival differences following non-traumatic spinal cord injury (NTSCI) using etiology as proxy for variation in underlying health condition. Setting Specialized rehabilitation centers in Switzerland. Methods Medical record data collected by the Swiss Spinal Cord Injury cohort (SwiSCI) study were linked with mortality information from the Swiss National Cohort. Considering contemporary theory and empirical evidence, a directed acyclic graph (DAG) was developed to formally evaluate causal differences among NTSCI etiologies, relative to traumatic SCI (TSCI). Statistical inference was contingent on hazard ratios (HRs) and marginal survival differences, derived using flexible parametric modeling. Results 3643 individuals (NTSCI = 1357; TSCI = 2286) diagnosed with SCI between 1990 and 2011 were included, contributing a cumulative 41,344 person-years and 1323 deaths. Test statistics confirmed DAG-dataset consistency. As compared to TSCI, mortality was elevated in all NTSCI etiological groups; malignant etiologies had the highest HRs (10; 95% CI, 8.0 to 14) followed by infection (2.6; 1.8 to 3.6) and vascular (2.5; 2.0 to 3.2) etiology groups. At the attained age of 55, the estimated reduction in survival among non-malignant etiologies was 9.4% (5.8 to 13) at 5 years and 17% (11 to 23) at 20 years. Conclusions Causal differences in survival among NTSCI etiological groups are likely a result of chronic variation in health conditions. This study supports the development of long-term interdisciplinary management and policy for individuals with NTSCI, specific to etiology.

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Health promotion and cardiovascular risk reduction in people with spinal cord injury: physical activity, healthy diet and maintenance after discharge— protocol for a prospective national cohort study and a preintervention- postintervention study

BMJ Open ◽

10.1136/bmjopen-2019-030310 ◽

2019 ◽

Vol 9 (12) ◽

pp. e030310 ◽

Cited By ~ 2

Author(s):

Nicolaj Jersild Holm ◽

Tom Møller ◽

Lis Adamsen ◽

Line Trine Dalsgaard ◽

Fin Biering-Sorensen ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Cohort Study ◽

Cardiovascular Risk ◽

Primary Study ◽

Cord Injury ◽

National Cohort ◽

Test Retest Reliability

IntroductionSpinal cord injury (SCI) predisposes those who suffer from it to physical inactivity and weight gain; consequently, death due to cardiovascular diseases is more frequent among people with SCI than in the general population. The literature documents a consensus about an interdisciplinary multimodal approach for the prevention and treatment of cardiovascular risk factors including overweight and obesity in people with SCI, focusing on diet, physical activity (PA) and behavioural interventions. This study will investigate implementation of recommendations from a recent clinical practice guideline for identification and management of cardiometabolic risk after SCI through multimodal patient education in a subacute clinical setting.Methods and analysisAll patients who are aged 18 years or older with an SCI within the previous 12 months and admitted to highly specialised rehabilitation are included, regardless of SCI aetiology or neurological level. A primary study designed as a controlled, pragmatic, preintervention- postintervention study with 6-month follow-up evaluates the effect of the clinical intervention; a prospective national cohort study on body mass index (BMI) serves as a historical control. The intervention consists of a standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet that begins at the outset of primary SCI rehabilitation and is integrated into existing settings and workflows. Outcome measures are collected at admission, discharge and 6 months after discharge and include peak oxygen uptake (VO2peak) (primary outcome), BMI, body composition, metabolic profile, neurological status, level of functioning, depression, quality of life, objective PA (accelerometry), self-reported PA, self-assessed PA ability, shared decision making, and dietary habits. Test–retest reliability of four VO2peak test protocols are investigated, as is test–retest reliability of a multisensor accelerometer in a rehabilitation setting.Ethics and disseminationThe project is approved by the Committees on Health Research Ethics in the Capital Region of Denmark on 10 July 2018 (Journal-nr.: H-18018325). The principal investigator obtains informed consent from all participants. The interventions in the project are closely related to existing rehabilitation care, and the risk of pain and discomfort is considered modest. Any unintended events related to the elements of the intervention are reported, according to existing regional procedures. Data are stored in a secure web-based database (Redcap). The primary study and prospective cohort study are registered at Clinicaltrials.gov. Positive and negative results will be submitted to relevant scientific journals related to SCI for publication. Important protocol modifications are reported to the Committees on Health Research Ethics in the Capital Region of Denmark.Trial registration numbersNCT03689023 and NCT03369080.

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