Risk and Protective Factors for Cause-Specific Mortality After Spinal Cord Injury
Risk and Protective Factors for Cause-Specific Mortality After Spinal Cord Injury
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DOI：
10.1016/j.apmr.2016.07.001
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发表时间：
2016-10-01
影响因子：
4.3
通讯作者：
DiPiro, Nicole D.
中科院分区：
文献类型：
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作者：
Krause, James S.;Cao, Yue;DiPiro, Nicole D.
目的：研究多组危险和保护因素(传记和损伤、社会经济、健康)与脊髓损伤(SCI)后原因特异性死亡率的关系。设计：前瞻性队列分析。地点：脊髓损伤模型系统设施。参与者：1973年之后在模型系统设施登记的成人创伤性脊髓损伤患者(N=8157)，并接受包括所有研究协变量(1995年11月1日至2006年10月31日)的随访评估。干预：不适用。主要观察指标：使用截至2014年1月1日的社会保障死亡指数来确定全原因死亡率。死因从国家死亡指数中获得，归类为传染病和寄生虫病、肿瘤、呼吸系统疾病、心血管疾病、外部原因和其他原因。结果：呼吸系统疾病死亡的危险比最高(损伤级别为C1-4，4.84)，感染性和寄生虫病死亡的危险比最高(美国脊柱损伤协会损害评分A级，最高危险比为5.70)。相比之下，损伤程度和美国脊柱损伤协会损伤分级与肿瘤和外部原因导致的死亡相对无关。在社会经济指标中，受教育程度和收入对多种死亡原因有重要预测作用。在与死因相关的4项二级健康指标中，压疮是唯一的1项。结论：损伤严重程度与感染性疾病和呼吸道并发症的死亡率有关，提示脊髓损伤最严重者应作为预防这些原因的目标。社会经济和健康因素与一些死亡原因有更广泛的关系。提高社会经济地位和健康的干预战略也可能导致因多种原因造成的死亡率下降。(C)2016年度美国康复医学大会
Objective: To investigate the association of multiple sets of risk and protective factors (biographic and injury, socioeconomic, health) with cause specific mortality after spinal cord injury (SCI).Design: Retrospective analysis of a prospectively created cohort.Setting: Spinal Cord Injury Model Systems facilities.Participants: Adults (N=8157) with traumatic SCI who were enrolled in a model systems facility after 1973 and received follow-up evaluation that included all study covariates (between November 1, 1995 and October 31, 2006).Interventions: Not applicable.Main Outcome Measures: All-cause mortality was determined using the Social Security Death Index as of January 1, 2014. Causes of death were obtained from the National Death Index and classified as infective and parasitic diseases, neoplasms, respiratory system diseases, heart and blood vessel diseases, external causes, and other causes. Competing risk analysis, with time-dependent covariates, was performed with hazard ratios (HRs) for each cause of death.Results: The HRs for injury severity indicators were highest for deaths due to respiratory system diseases (highest HR for injury level C1-4, 4.84) and infective and parasitic diseases (highest HR for American Spinal Injury Association Impairment Scale grade A, 5.70). In contrast, injury level and American Spinal Injury Association Impairment Scale grade were relatively unrelated to death due to neoplasms and external causes. Of the socioeconomic indicators, education and income were significantly predictive of a number of causes of death. Pressure ulcers were the only 1 of 4 secondary health condition indicators consistently related to cause of death.Conclusions: Injury severity was related to mortality due to infective disease and respiratory complications, suggesting that those with the most severe SCI should be targeted for prevention of these causes. Socioeconomic and health factors were more broadly related to a number of causes of death. Intervention strategies that enhance socioeconomic status and health may also result in reduced mortality due to multiple causes. (C) 2016 by the American Congress of Rehabilitation Medicine