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Differential survival after traumatic spinal cord injury: evidence from a multi-center longitudinal cohort study in Switzerland.
Chamberlain, Jonviea D; Gmünder, Hans Peter; Hug, Kerstin; Jordan, Xavier; Moser, André; Schubert, Martin; Brinkhof, Martin W G.
Afiliación
  • Chamberlain JD; Swiss Paraplegic Research, Nottwil, Switzerland. jonviea.chamberlain@paraplegie.ch.
  • Gmünder HP; University of Lucerne, Health Sciences and Health Policy, Luzern, Switzerland. jonviea.chamberlain@paraplegie.ch.
  • Hug K; Swiss Paraplegic Center, Nottwil, Switzerland.
  • Jordan X; REHAB Basel, Basel, Switzerland.
  • Moser A; Clinique Romande de Réadaptation, Sion, Switzerland.
  • Schubert M; Department of Geriatrics Bern, University Hospital, Spital Netz Bern Ziegler, University of Bern, Bern, Switzerland.
  • Brinkhof MWG; Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland.
Spinal Cord ; 56(10): 920-930, 2018 Oct.
Article en En | MEDLINE | ID: mdl-29895883
STUDY DESIGN: Observational cohort study. OBJECTIVES: To understand differentials in the force of mortality with increasing time since injury according to key spinal cord injury (SCI) characteristics. SETTING: Specialized rehabilitation centers within Switzerland. METHODS: Data from the Swiss Spinal Cord Injury (SwiSCI) cohort study were used to model mortality in relation to age, sex, and lesion characteristics. Hazard ratios (HRs) and adjusted survival curves were estimated using flexible parametric survival models of time since discharge from first rehabilitation to death or 30 September 2011, whichever came first. RESULTS: 2 421 persons were included that incurred a new TSCI between 1990 and 2011, contributing a total time-at-risk of 19,604 person-years and 376 deaths. Controlling for attained age, sex, decade, and etiology, there was more than a four-fold higher risk of mortality for complete tetraplegia compared to incomplete paraplegia (HR = 4.27; 95% CI 2.72 to 6.69). Survival estimates differed according to SCI characteristics, with differentials steadily increasing with time since injury. CONCLUSION: This study provides evidence of disparities in mortality and survival outcomes according to SCI characteristics that increases with increasing time since injury. These results lend support to the hypothesis of a progressive and disproportionate accumulation of allostatic load according to SCI characteristics. Future research should investigate cause-specific mortality for insight into potentially modifiable secondary health conditions contributing to these disparities.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traumatismos de la Médula Espinal Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Spinal Cord Asunto de la revista: NEUROLOGIA Año: 2018 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traumatismos de la Médula Espinal Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Spinal Cord Asunto de la revista: NEUROLOGIA Año: 2018 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Reino Unido