@article{ref1,
title="Mortality beyond the first year after spinal cord injury: does body mass index matter?",
journal="Archives of physical medicine and rehabilitation",
year="2021",
author="Wen, Huacong and Devivo, Michael J. and Heinemann, Allen W. and Krause, James S. and Robinson-Whelen, Susan and Chen, Yuying",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="OBJECTIVES: To examine the association between body mass index (BMI) and mortality after the first year post spinal cord injury (SCI) overall and across demographic and injury characteristics. <br><br>DESIGN: Cohort study. SETTING: Sixteen Spinal Cord Injury Model Systems (SCIMS) centers. PARTICIPANTS: SCIMS Database participants age ≥20 years and having a BMI assessment during the 2007-2011 wave of data collection. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: All-cause mortality rate. Life table method and log-rank test were used to estimate and compare mortality rates across BMI groups and other factors. Cox proportional hazard regression model was conducted to estimate hazard ratio (HR) and 95% confidence interval (CI). <br><br>RESULTS: 2,346 participants with SCI were classified into one of the eight BMI groups: <18.5 (6.9%), 18.5-19.9 (7.3%), 20.0-22.49 (15.0%), 22.5-24.9 (18.8%), 25.0-27.49 (17.5%), 27.5-29.9 (13.2%), 30.0-34.9 (13.5%) and ≥ 35.0 (7.8%). Compared with people with BMI 22.5-29.9, a higher mortality risk was observed among people with BMI <18.5 (HR, 1.76; 95% CI, 1.25, 2.49), 18.5-19.9 (HR, 1.51; 95% CI, 1.06, 2.15), and ≥ 35.0 (HR, 1.51; 95% CI, 1.11, 2.07), after adjusting for confounding factors (sex, age at the time of BMI assessment, marital status, and neurological status). The U-shape BMI-mortality relationship varied by age, sex, neurological status, and years since injury. <br><br>CONCLUSIONS: To improve life expectancy after SCI, health care professionals could focus on weight management among patients with relatively low and extremely high BMI, defined by demographic and injury-related characteristics. Future studies should explore factors that contribute to such a higher mortality after SCI, including pre-existing conditions, poor diet/nutrition, and cardiorespiratory fitness.<p /> <p>Language: en</p>",
language="en",
issn="0003-9993",
doi="10.1016/j.apmr.2021.08.026",
url="http://dx.doi.org/10.1016/j.apmr.2021.08.026"
}