title: Long-term survival in spinal cord injury: a fifty year investigation.
abstract: The aims of this study were to examine long-term survival in a population-based sample of spinal cord injury (SCI) survivors in Great Britain, identify risk factors contributing to deaths and explore trends in cause of death over the decades following SCI. Current survival status was successfully identified in 92.3% of the study sample. Standardised mortality ratios (SMRs) were calculated and compared with a similar USA study. Relative risk ratio analysis showed that higher mortality risk was associated with higher neurologic level and completeness of spinal cord injury, older age at injury and earlier year of injury. For the entire fifty year time period, the leading cause of death was related to the respiratory system; urinary deaths ranked second followed by heart disease related deaths, but patterns in causes of death changed over time. In the early decades of injury, urinary deaths ranked first, heart disease deaths second and respiratory deaths third. In the last two decades of injury, respiratory deaths ranked first, heart related deaths were second, injury related deaths ranked third and urinary deaths fourth. This study also raises the question of examining alternative neurological groupings for future mortality risk analysis.
authors.affiliation: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK.
authors.forename: H L
authors.initials: HL
authors.lastname: Frankel
authors.forename: J R
authors.initials: JR
authors.lastname: Coll
authors.forename: S W
authors.initials: SW
authors.lastname: Charlifue
authors.forename: G G
authors.initials: GG
authors.lastname: Whiteneck
authors.forename: B P
authors.initials: BP
authors.lastname: Gardner
authors.forename: M A
authors.initials: MA
authors.lastname: Jamous
authors.forename: K R
authors.initials: KR
authors.lastname: Krishnan
authors.forename: I
authors.initials: I
authors.lastname: Nuseibeh
authors.forename: G
authors.initials: G
authors.lastname: Savic
authors.forename: P
authors.initials: P
authors.lastname: Sett
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011782:Quadriplegia / Q000401:mortality; D012016:Reference Values; D017678:Sex Distribution; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D016019:Survival Analysis; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology