Behavioral Risk Factors of Mortality After Spinal Cord Injury
Behavioral Risk Factors of Mortality After Spinal Cord Injury
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DOI：
10.1016/j.apmr.2008.07.012
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发表时间：
2009-01-01
影响因子：
4.3
通讯作者：
Pickelsimer, Elisabeth
中科院分区：
文献类型：
--
作者：
Krause, James S.;Carter, Rickey E.;Pickelsimer, Elisabeth
目的：为了测试多个行为指标和死亡率之间的假设关系的人与脊髓损伤（SCI），同时控制传记和损伤characteristics.Design：前瞻性队列研究，在1997年底和1998年初通过邮寄调查收集的行为数据。死亡情况于2005年12月31日确定。地点：美国东南部的一家大型康复医院。参与者：创伤性SCI成人（N = 1386），伤后至少1年。干预：不适用。主要结果测量：主要结果是从调查到死亡或删失的时间。使用国家死亡指数和社会保障死亡指数确定死亡率状况。有224例死亡（16.2%），在整个样本中，由于缺失的数据，188例死亡被观察到的1251名参与者包括在最终的统计model.Results：考克斯比例风险模型确定了几个显着的行为预测死亡率。在第一组分析中，在控制传记和伤害预测因素的同时，评估了单个行为变量的显著性。随后，我们建立了一个基于最优行为组的综合模型。最好的行为预测因素包括：吸烟、酗酒（5杯或更多的酒）、处方药的使用和每天下床的时间。与单独的传记和损伤变量相比，纳入这些变量改善了对生存率的预测，因为伪R-2从.121增加到.164，一致性从.730增加到.769。结论：结果肯定了避免基本危险行为的重要性，如吸烟和酗酒，并肯定了它们作为SCI康复干预目标的重要性。
Objective: To test hypothesized relationships between multiple behavioral indicators and mortality among persons with spinal cord injury (SCI), while controlling for biographic and injury characteristics.Design: Prospective cohort study with behavioral data collected by mailed survey in late 1997 and early 1998. Mortality status was ascertained as of December 31, 2005.Setting: A large rehabilitation hospital in the southeastern United States.Participants: Adults (N = 1386) with traumatic SCI, at least 1 year postinjury.Interventions: Not applicable.Main Outcome Measures: Primary outcome was time from survey to mortality or censoring. Mortality status was determined using the National Death Index and the Social Security Death Index. There were 224 deaths (16.2%) in the full sample, and due to missing data, 188 deaths were observed in the 1251 participants included in the final statistical model.Results: Cox proportional hazards modeling identified several significant behavioral predictors of mortality. In the first set of analyses, the significance of a single behavioral variable was assessed while controlling for biographic and injury predictors. We Subsequently built a comprehensive model based on an optimal group of behaviors. The best set of behavioral predictors included: smoking, binge drinking (number of episodes with 5 or more drinks), prescription medication use, and number of hours out of bed per day. Inclusion of these variables improved prediction of survival compared with biographic and injury variables alone, as the pseudo-R-2 increased from .121 to .164 and the concordance from .730 to .769.Conclusions: The results affirm the importance of avoiding basic risk behaviors, such as smoking and alcohol misuse, and affirm their importance as targets of intervention in association with SCI rehabilitation.