Risk of mortality after spinal cord injury: an 8-year prospective study.

To evaluate a theoretical model for mortality after spinal cord injury (SCI) by sequentially analyzing 4 sets of risk factors in relation to mortality (i.e., adding 1 set of factors to the regression equation at a time). Prospective cohort study of data collected in late 1997 and early 1998 with mortality status ascertained in December 2005. We evaluated the significance of 4 successive sets of predictors (biographic and injury, psychologic and environmental, behavioral, health and secondary conditions) using Cox proportional hazards modeling and built a full model based on the optimal predictors. A specialty hospital. 1,386 adults with traumatic SCI, at least 1 year post-injury, participated. There were 224 deaths. After eliminating cases with missing data, there were 1,209 participants, with 179 deceased at follow-up. N/A. Mortality status was determined using the National Death Index and the Social Security Death Index. The final model included one environmental variable (poverty), 2 behavioral factors (prescription medication use, binge drinking), and 4 health factors or secondary conditions (hospitalizations, fractures/amputations, surgeries for pressure ulcers, probable major depression). The results supported the major premise of the theoretical model that risk factors are more important the more proximal they are in a theoretical chain of events leading to mortality. According to this model, mortality results from declining health, precipitated by high-risk behaviors. These findings may be used to target individuals who are at high risk for early mortality as well as directing interventions to the particular risk factor.

通过依次分析与死亡率相关的4组风险因素（即每次在回归方程中增加一组因素）来评估脊髓损伤（SCI）后死亡率的理论模型。 对1997年末和1998年初收集的数据进行前瞻性队列研究，并于2005年12月确定死亡率状况。我们使用Cox比例风险模型评估了连续4组预测因素（人口统计学和损伤、心理和环境、行为、健康和继发性疾病）的重要性，并基于最佳预测因素建立了一个完整模型。 一家专科医院。 1386名创伤性脊髓损伤的成年人参与研究，受伤至少1年。其中有224人死亡。在剔除数据缺失的病例后，有1209名参与者，随访时有179人死亡。 不适用。 使用国家死亡指数和社会保障死亡指数确定死亡率状况。 最终模型包括一个环境变量（贫困）、2个行为因素（处方药使用、酗酒）以及4个健康因素或继发性疾病（住院、骨折/截肢、压疮手术、可能的重度抑郁症）。 结果支持了理论模型的主要前提，即风险因素在导致死亡的理论事件链中越接近，就越重要。根据该模型，死亡是由高危行为引发的健康状况下降导致的。这些发现可用于确定早期死亡高风险个体，并针对特定风险因素进行干预。