Intentional and Unintentional Injuries after Spinal Cord Injury: Mortality Risk and Trends

Abstract

To assess: 1) whether intentional and unintentional injury deaths are increased in persons with spinal cord injury (SCI) and 2) whether injury deaths after SCI have changed over the last 4 decades. Cohort study 28 SCI Model Systems and 3 Shriners SCI programs throughout the United States 45,489 persons with traumatic SCI injured since 1936 (99.5% injured after 1972) Not applicable Vital status and causes of death determined by chart reviews, routine follow-up, and searches of the Social Security Death Index, National Death Index, and death certificates. Mortality experience of study participants, as of December 2009, was compared to the general population by using standardized mortality ratio (SMR). Trends in annual age-adjusted cause-specific mortality rates after SCI were also calculated by decade. Of total 10,575 deaths over 576,698 person-years of follow-up, 1231 deaths (11.6%) were known to be caused by external cause (n=666, 359, 106, and 100 for unintentional injuries, suicide, homicide, and undetermined). Had persons with SCI had the same injury mortality as the general population, the expected number of injury deaths would have been 446 (SMR=2.8). The increased mortality was noted for unintentional injuries (SMR=2.7), suicide (SMR=3.5), homicide (SMR=1.3), and undetermined cause (SMR=7.4), particularly among females and those younger than 60 years and with American Spinal Injury Association Impairment Scale A, B, and C injuries. Unintentional injury and homicide deaths have increased, while suicide deaths have decreased over the last 40 years. Our study findings highlight the need of the prevention of secondary injuries after SCI to improve life expectancy