Economic Factors and Longevity in Spinal Cord Injury: A Reappraisal

Abstract

Strauss D, DeVivo M, Shavelle R, Brooks J, Paculdo D. Economic factors and longevity in spinal cord injury: a reappraisal. Objective To review and reassess the findings of Krause and colleagues on the effect of economic and other risk factors on life expectancy after spinal cord injury, using an expanded and updated database. Design Pooled person-year analysis. Setting Model Spinal Cord Injury Systems hospitals. Participants A total of 7331 persons injured since 1973 who were enrolled in the National Spinal Cord Injury Database and received an evaluation between November 1995 and December 2005. Interventions Not applicable. Main Outcome Measures Mortality, determined by routine follow-up supplemented by information from the Social Security Death Index. Logistic regression models based on the predictor variables were developed to estimate the chance of dying in a given year. Results As in the Krause study, life expectancies of persons with the greatest handicap in economic self-sufficiency were substantially shorter than average. However, the positive effect of favorable economics was much less than previously reported, largely because having health insurance coverage through workers’ compensation was no longer a powerful (or statistically significant) predictor of survival. Conclusions The beneficial effect of favorable economics appears to be much less than previously reported. Further, the interpretation of the effects of modifiable factors (such as economics and social integration) is complicated by questions of cause and effect.