TY  - JOUR
PY  - 2009//
TI  - Risk of mortality after spinal cord injury: an 8-year prospective study
JO  - Archives of physical medicine and rehabilitation
A1  - Krause, James S.
A1  - Zhai, Yusheng
A1  - Saunders, Lee L.
A1  - Carter, R. E.
SP  - 1708
EP  - 1715
VL  - 90
IS  - 10
N2  - 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). DESIGN: 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.<p />  <p>Language: en</p>
LA  - en
SN  - 0003-9993
UR  - http://dx.doi.org/10.1016/j.apmr.2009.04.020
ID  - ref1
ER  -