title: A prospective assessment of mortality in chronic spinal cord injury.
abstract: METHODS
  Prospective mortality study.
  
  
  OBJECTIVE
  To assess the relationship between comorbid medical conditions and other health-related factors to mortality in chronic spinal cord injury (SCI).
  
  
  METHODS
  Boston, MA, USA.
  
  
  METHODS
  Between 1994 and 2000, 361 males >/=1 year after injury completed a respiratory health questionnaire and underwent pulmonary function testing. Cause-specific mortality was assessed over a median of 55.6 months (range 0.33-74.4 months) through 12/31/2000 using the National Death Index.
  
  
  RESULTS
  At entry, mean (+/-SD) age was 50.6+/-15.0 years (range 23-87) and years since injury was 17.5+/-12.8 years (range 1.0-56.5). Mortality was elevated (observed/expected deaths=37/25.1; SMR=1.47; 95% CI=1.04-2.03) compared to US rates. Risk factors for death were diabetes (RR=2.62; 95% CI=1.19-5.77), heart disease (RR=3.66; 95% CI=1.77-7.78), reduced pulmonary function, and smoking. The most common underlying and contributing causes of death were diseases of the circulatory system (ICD-9 390-459) in 40%, and of the respiratory system in 24% (ICD-9 460-519).
  
  
  CONCLUSIONS
  These results suggest that much of the excess mortality in chronic SCI is related to potentially treatable factors. Recognition and treatment of cardiovascular disease, diabetes, and lung disease, together with smoking cessation may substantially reduce mortality in chronic SCI.
authors.affiliation: Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Garshick
authors.forename: A
authors.initials: A
authors.lastname: Kelley
authors.forename: S A
authors.initials: SA
authors.lastname: Cohen
authors.forename: A
authors.initials: A
authors.lastname: Garrison
authors.forename: C G
authors.initials: CG
authors.lastname: Tun
authors.forename: D
authors.initials: D
authors.lastname: Gagnon
authors.forename: R
authors.initials: R
authors.lastname: Brown
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002423:Cause of Death; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012120:Respiration Disorders / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012907:Smoking / Q000401:mortality*; D013119:Spinal Cord Injuries / Q000401:mortality*; D016019:Survival Analysis