Mortality and Longevity after a Spinal Cord Injury: Systematic Review and Meta-Analysis

Abstract

Background/Aims: Mortality and longevity studies of spinal cord injury (SCI) are essential for informing healthcare systems and policies. This review evaluates the current evidence among people with SCIs worldwide in relation to the WHO region and country income level; demographic and lesion characteristics; and in comparison with the general population. Methods: A systematic review of relevant databases for original studies. Pooled estimates were derived using random effects meta-analysis, restricted to traumatic SCI. Results: Seventy-four studies were included. In-hospital mortality varied, with pooled estimates of 24.1% (95% confidence interval (CI) 14.1-38.0), 7.6% (95% CI 6.3-9.0), 7.0% (95% CI 1.5-27.4), and 2.1% (95% CI 0.9-5.0) in the WHO regions of Africa, the Americas, Europe and Western Pacific. The combined estimate for low- and middle-income countries was nearly three times higher than for high-income countries. Pooled estimates of first-year survival were 86.5% (95% CI 75.3-93.1), 95.6% (95% CI 81.0-99.1), and 94.0% (95% CI 93.3-94.6) in the Americas, Europe and Western Pacific. Pooled estimates of standardized mortality ratios in tetraplegics were 2.53 (2.00-3.21) and 2.07 (1.47-2.92) in paraplegics. Conclusion: This study found substantial variation in mortality and longevity within the SCI population, compared to the general population, and between WHO regions and country income level. Improved standardization and quality of reporting is needed to improve inferences regarding the extent to which mortality outcomes following an SCI are related to healthcare systems, services and policies.

Comparison of All-Cause and Cause-Specific Mortality of Persons with Traumatic Spinal Cord Injuries to the General Swiss Population: Results from a National Cohort Study

“…Mortality rates between 2-and 3-times that of the GP have been regularly reported in recent SCI literature [3]. Unfortunately, despite advances in medical technology and rehabilitation, a multitude of studies have found only limited or no improvement in long-term mortality [20,21].…”

“…Traumatic spinal cord injuries (TSCIs), comprised within the assemblage of neurological diseases, are a disabling condition associated with reduced functioning and quality of life, increased morbidity, and reductions in life expectancy. In comparison to the general population, persons with TSCI have a roughly 2.5 times greater risk of mortality (standardized mortality ratio [SMR] 2.5, 95% CI 1.9-3.2) [3]. This burden of mortality is similar to what has been estimated for other chronic neurological conditions such as multiple sclerosis (SMR 2.8, 95% CI 2.7-2.9) [4] or traumatic brain injury (SMR 2.3; 95% CI 2.1-2.4) [5].…”

“…Unfortunately, most research on long-term mortality risk post-SCI has found little to no improvements in recent decades [3], and although persons with SCI have the potential for a life expectancy similar to that of the general population, within-population and between-country discrepancies in mortality and survival estimates exist [3,6]. Importantly, these discrepancies reflect the influence of SCI characteristics and health systems on risk of mortality, and can thereby be exploited to identify targeted interventions and areas for innovation.…”

Strengthening Health Systems for Persons With Traumatic Spinal Cord Injury in South Africa and Sweden: A Protocol for a Longitudinal Study of Processes and Outcomes

“…Like many unforeseen medical emergencies, a TSCI could lead to early death in the absence of essential emergency and acute care (7, 8). Hence, the single most important indicator of the quality of medical care is reflected in short- and long-term mortality (9).…”

Study Protocol of the International Spinal Cord Injury (InSCI) Community Survey

“…1 SCI and associated health problems lead to premature mortality and increased risk for lower physical and mental health compared to the general population. 1,2 In interaction with environmental factors and personal resources, an SCI may lead to lower participation in social and economic activities. 3,4 As a result, the lived experience of persons with SCI has increasingly become the focus of research, going beyond the description of one's health state into domains of functioning and disability, as characterized by the WHO's International Classification of Functioning, Disability and Health (ICF) 5 and summarized in the International Perspectives on SCI (IPSCI) report.…”