title: Mortality after traumatic spinal cord injury: 50 years of follow-up.
abstract: OBJECTIVE
  To study mortality and causes of death in an unselected geographically defined cohort of patients with traumatic spinal cord injury (TSCI), 1952-2001.
  
  
  METHODS
  Patients were identified from hospital records. The date of death was obtained from the National Population Register, and causes of death recorded by linkage to the Norwegian Cause of Death Registry. Patient mortality was compared with mortality in the Norwegian population using standardised mortality ratios (SMR) adjusted for age and gender.
  
  
  RESULTS
  401 patients (70 women and 331 men) were identified. By 31 August 2008, 173 were dead. Median survival time in deceased patients was 7.4 years; 6.9 years for patients with cervical injuries and 8.2 years for patients with thoracolumbosacral injuries (TLS). TSCI patients had an increased mortality (SMR 1.85) compared with the Norwegian population. SMR did not change during the observation period. SMR was significantly higher for women than for men (2.88 vs 1.72), and higher in patients with complete TSCI compared with patients with incomplete TSCI (4.23 vs 1.25). SMR was 6.70 for patients with complete cervical injuries and 3.07 for patients with complete TLS injuries. Cause specific SMR were 1.96 for respiratory disease, and for suicide including accidental poisoning 3.70 for men and 37.59 for women.
  
  
  CONCLUSIONS
  Patients with a TSCI, and especially women, have an increased mortality despite modern treatment and care. Special attention should be paid to respiratory dysfunction and pulmonary infections, and to prevent suicide and accidental poisoning.
authors.affiliation: Department of Neurology, Haukeland University Hospital, Jonas Lies vei 65, N-5021 Bergen, Norway. ellen.merete.hagen@helse-bergen.no
authors.forename: Ellen Merete
authors.initials: EM
authors.lastname: Hagen
authors.forename: Stein Atle
authors.initials: SA
authors.lastname: Lie
authors.forename: Tiina
authors.initials: T
authors.lastname: Rekand
authors.forename: Nils Erik
authors.initials: NE
authors.lastname: Gilhus
authors.forename: Marit
authors.initials: M
authors.lastname: Gronning
mesh_terms: D000328:Adult; D000368:Aged; D002391:Catchment Area, Health; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008161:Lumbosacral Region / Q000294:innervation / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D012447:Sacrum / Q000294:innervation / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000401:mortality* / Q000503:physiopathology; D015996:Survival Rate; D013909:Thorax / Q000294:innervation / Q000503:physiopathology; D013997:Time Factors