All-cause and cause-specific mortality following non-traumatic spinal cord injury: evidence from a population-based cohort study in Switzerland

Buzzell, Anne; Chamberlain, Jonviea D; Eriks‐Hoogland, Inge; Hug, Kerstin; Jordan, Xavier; Schubert, Martin; Zwahlen, Marcel; Brinkhof, Martin W. G.

doi:10.1038/s41393-019-0361-6

Cited by 20 publications

(20 citation statements)

References 32 publications

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“…In persons with SCI, the prevalence of heart disease is 17.1 % (ages 65-69 years) compared with 4.9 % (ages 65-69 years) for individuals without SCI, while the odds of heart disease or stroke are more than two and three-folds greater in individuals with SCI in comparison to individuals without SCI, respectively. [7,8] Cardiovascular complications are, therefore, among the leading causes of death in persons with SCI and an important determinant of longevity and quality of life in this vulnerable population [9][10][11]. Thus, there is an emerging need to improve research in this area.…”

Section: Cardiometabolic Risk Following the Spinal Cord Injurymentioning

confidence: 99%

Sex and gender gap in spinal cord injury research: Focus on cardiometabolic diseases. A mini review

2021

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Cardiometabolic disease (CMD) is among the leading causes of morbidity and mortality in people with a spinal cord injury (SCI). Despite well-acknowledged sex and gender differences in CMD in the general population, they remain insufficiently studied in persons with SCI. To describe the landscape of sex and gender in SCI research, we searched the literature for systematic reviews on cardiometabolic health in this population. Out of 15 systematic reviews identified, only 9 provided meaningful information on sex. Although one-quarter to one-fifth of the SCI population is female, women comprised only one-eighth to a quarter of study participants. A number of clinical studies purposively excluded women, to make the study population more homogenous. For those studies which included both sexes, in general, no sex-specific analyses were performed due to small sample sizes. All these reasons have contributed to the underrepresentation of females in the current body of evidence. Therefore, future studies should adopt a more sex-and gender-sensitive research framework to address cardiometabolic risk in SCI. Novel and advanced epidemiological methods should also be used, considering small sample sizes. Finally, collaborative research (through consortia and multi-center studies) should be encouraged to include more females. More inclusive research will ensure that everyone will benefit from scientific advancements, regardless of sex and gender.

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Section: Cardiometabolic Risk Following the Spinal Cord Injurymentioning

confidence: 99%

Sex and gender gap in spinal cord injury research: Focus on cardiometabolic diseases. A mini review

2021

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“…The index was computed as the sum of the 15-health problems (

, weighted by their estimated mortality risk

( Buzzell et al, 2020 ; Cao et al, 2019 ; DiPiro et al, 2019 ; Frankel et al, 1998 ; Garshick et al, 2005 ; Lidal et al, 2007 ; Minaire et al, 1983 ; Neumann et al, 2009 ; Osterthun et al, 2014 ; Sabre et al, 2013 ; Savic et al, 2017 ; Soden et al, 2000 ; World Health Organization, 2016 ), times the reported severity

(see appendix). The severity was ranked as “chronic” (value 2), mild or moderate (value 1), and no problem (value 0).…”

Section: Methodsmentioning

confidence: 99%

“…We use data from the International Spinal Cord Injury Survey [InSCI], which provides for the first-time comparable data on the living situation of persons with SCI from all six WHO regions ( Fekete et al, 2017 ). Due to the lack of mortality data, we use two alternative health measures: (a) the number of years a person has lived with the injury and (b) a co-morbidity index ( Buzzell et al, 2020 ; DiPiro et al, 2019 ; Krause et al, 2011 ; Quan et al, 2011 ). To allow the comparison between countries, a relative personal income was estimated according to the socio-economic position in the country of residence of each respondent.…”

Section: Introductionmentioning

confidence: 99%

Health inequalities and income for people with spinal cord injury. A comparison between and within countries

Oña

Strøm

Lee

et al. 2021

SSM - Population Health

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Income and health are related in a bi-directional manner, whereby level of income affects health and vice versa. People in poorer households tend to experience worse health status and higher mortality rates than people in wealthier households, and, at the same time, having poor health could restrict workability leading to less income. This gap exists in almost every country, and it is more pronounced in more unequal countries and in vulnerable populations, such as people experiencing disability. The goal of this paper is to estimate the health-income gap in people with a Spinal Cord Injury (SCI), which is a chronic health condition often associated with multiple comorbidities that leads to disability. As data on mortality is inexistent, to estimate the health-income gap for persons with SCI, this paper uses two health outcomes: the number of years a person has lived with the injury, and a comorbidity index. Data was obtained from the International Spinal Cord Injury survey (InSCI), which is the first worldwide survey on community-dwelling persons with SCI. To compare across countries, the health outcomes were adjusted through hierarchical models, accounting for country fixed-effects, individual characteristics such as age and gender, and injury characteristics (cause, type and degree). Our results suggest that for the years living with SCI, the gap varies from 1 to 6 years between the lowest and the highest income groups. The main driver of such a difference is the cause of injury, where injuries caused by work accidents showed the biggest gap. Similarly, for the comorbidity index, persons with SCI in poorer deciles reported significantly more comorbidities, forty times more, than people in richer deciles.

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“…This DAG therefore also hypothesizes that SCI etiology indirectly impacts mortality through SCI severity. This should be interpreted to mean that the NTSCI etiology, itself causes the SCI severity, which in turn has an impact on survival [ 5 , 18 , 19 ].…”

Section: Methodsmentioning

confidence: 99%

“…The reasoning for inclusion of these demographic factors as confounders is based on previous research in the field of SCI [ 7 , 20 ]. ‘Calendar period’ defines a further potential confounding pathway, given that health survey and survival data from the Swiss general population indicate that the survival has steadily increased with calendar period, in addition to the declining risk of death following NTSCI [ 3 , 19 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

Etiology-specific variation in survival following non-traumatic spinal cord injury: a causal inference approach using data from a population-based cohort

et al. 2020

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Study design Observational, population-based cohort study. Objectives To evaluate the origin and contribution to excess of survival differences following non-traumatic spinal cord injury (NTSCI) using etiology as proxy for variation in underlying health condition. Setting Specialized rehabilitation centers in Switzerland. Methods Medical record data collected by the Swiss Spinal Cord Injury cohort (SwiSCI) study were linked with mortality information from the Swiss National Cohort. Considering contemporary theory and empirical evidence, a directed acyclic graph (DAG) was developed to formally evaluate causal differences among NTSCI etiologies, relative to traumatic SCI (TSCI). Statistical inference was contingent on hazard ratios (HRs) and marginal survival differences, derived using flexible parametric modeling. Results 3643 individuals (NTSCI = 1357; TSCI = 2286) diagnosed with SCI between 1990 and 2011 were included, contributing a cumulative 41,344 person-years and 1323 deaths. Test statistics confirmed DAG-dataset consistency. As compared to TSCI, mortality was elevated in all NTSCI etiological groups; malignant etiologies had the highest HRs (10; 95% CI, 8.0 to 14) followed by infection (2.6; 1.8 to 3.6) and vascular (2.5; 2.0 to 3.2) etiology groups. At the attained age of 55, the estimated reduction in survival among non-malignant etiologies was 9.4% (5.8 to 13) at 5 years and 17% (11 to 23) at 20 years. Conclusions Causal differences in survival among NTSCI etiological groups are likely a result of chronic variation in health conditions. This study supports the development of long-term interdisciplinary management and policy for individuals with NTSCI, specific to etiology.

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All-cause and cause-specific mortality following non-traumatic spinal cord injury: evidence from a population-based cohort study in Switzerland

Cited by 20 publications

References 32 publications

Sex and gender gap in spinal cord injury research: Focus on cardiometabolic diseases. A mini review

Sex and gender gap in spinal cord injury research: Focus on cardiometabolic diseases. A mini review

Health inequalities and income for people with spinal cord injury. A comparison between and within countries

Etiology-specific variation in survival following non-traumatic spinal cord injury: a causal inference approach using data from a population-based cohort

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