Economic factors and longevity in spinal cord injury: a reappraisal.
OBJECTIVE
To review and reassess the findings of Krause and colleagues on the effect of economic and other risk factors on life expectancy after spinal cord injury, using an expanded and updated database.


METHODS
Pooled person-year analysis.


METHODS
Model Spinal Cord Injury Systems hospitals.


METHODS
A total of 7331 persons injured since 1973 who were enrolled in the National Spinal Cord Injury Database and received an evaluation between November 1995 and December 2005.


METHODS
Not applicable.


METHODS
Mortality, determined by routine follow-up supplemented by information from the Social Security Death Index. Logistic regression models based on the predictor variables were developed to estimate the chance of dying in a given year.


RESULTS
As in the Krause study, life expectancies of persons with the greatest handicap in economic self-sufficiency were substantially shorter than average. However, the positive effect of favorable economics was much less than previously reported, largely because having health insurance coverage through workers' compensation was no longer a powerful (or statistically significant) predictor of survival.


CONCLUSIONS
The beneficial effect of favorable economics appears to be much less than previously reported. Further, the interpretation of the effects of modifiable factors (such as economics and social integration) is complicated by questions of cause and effect.
Strauss
David
D
Life Expectancy Project, San Francisco, CA 94122-3402, USA.
DeVivo
Michael
M
Shavelle
Robert
R
Brooks
Jordan
J
Paculdo
David
D
D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D015601:Injury Severity Score; D008017:Life Expectancy / Q000639:trends; D008136:Longevity; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010264:Paraplegia / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation; D011237:Predictive Value of Tests; D011336:Probability; D011782:Quadriplegia / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000401:mortality* / Q000534:rehabilitation; D016019:Survival Analysis