Jonviea D Chamberlain1,2, Hans Peter Gmünder3, Kerstin Hug4, Xavier Jordan5, André Moser6,7, Martin Schubert8, Martin W G Brinkhof9,10. 1. Swiss Paraplegic Research, Nottwil, Switzerland. jonviea.chamberlain@paraplegie.ch. 2. University of Lucerne, Health Sciences and Health Policy, Luzern, Switzerland. jonviea.chamberlain@paraplegie.ch. 3. Swiss Paraplegic Center, Nottwil, Switzerland. 4. REHAB Basel, Basel, Switzerland. 5. Clinique Romande de Réadaptation, Sion, Switzerland. 6. Department of Geriatrics Bern, University Hospital, Spital Netz Bern Ziegler, University of Bern, Bern, Switzerland. 7. Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland. 8. Balgrist University Hospital, Zürich, Switzerland. 9. Swiss Paraplegic Research, Nottwil, Switzerland. 10. University of Lucerne, Health Sciences and Health Policy, Luzern, Switzerland.
Abstract
STUDY DESIGN: Observational cohort study. OBJECTIVES: To understand differentials in the force of mortality with increasing time since injury according to key spinal cord injury (SCI) characteristics. SETTING: Specialized rehabilitation centers within Switzerland. METHODS: Data from the Swiss Spinal Cord Injury (SwiSCI) cohort study were used to model mortality in relation to age, sex, and lesion characteristics. Hazard ratios (HRs) and adjusted survival curves were estimated using flexible parametric survival models of time since discharge from first rehabilitation to death or 30 September 2011, whichever came first. RESULTS: 2 421 persons were included that incurred a new TSCI between 1990 and 2011, contributing a total time-at-risk of 19,604 person-years and 376 deaths. Controlling for attained age, sex, decade, and etiology, there was more than a four-fold higher risk of mortality for complete tetraplegia compared to incomplete paraplegia (HR = 4.27; 95% CI 2.72 to 6.69). Survival estimates differed according to SCI characteristics, with differentials steadily increasing with time since injury. CONCLUSION: This study provides evidence of disparities in mortality and survival outcomes according to SCI characteristics that increases with increasing time since injury. These results lend support to the hypothesis of a progressive and disproportionate accumulation of allostatic load according to SCI characteristics. Future research should investigate cause-specific mortality for insight into potentially modifiable secondary health conditions contributing to these disparities.
STUDY DESIGN: Observational cohort study. OBJECTIVES: To understand differentials in the force of mortality with increasing time since injury according to key spinal cord injury (SCI) characteristics. SETTING: Specialized rehabilitation centers within Switzerland. METHODS: Data from the Swiss Spinal Cord Injury (SwiSCI) cohort study were used to model mortality in relation to age, sex, and lesion characteristics. Hazard ratios (HRs) and adjusted survival curves were estimated using flexible parametric survival models of time since discharge from first rehabilitation to death or 30 September 2011, whichever came first. RESULTS: 2 421 persons were included that incurred a new TSCI between 1990 and 2011, contributing a total time-at-risk of 19,604 person-years and 376 deaths. Controlling for attained age, sex, decade, and etiology, there was more than a four-fold higher risk of mortality for complete tetraplegia compared to incomplete paraplegia (HR = 4.27; 95% CI 2.72 to 6.69). Survival estimates differed according to SCI characteristics, with differentials steadily increasing with time since injury. CONCLUSION: This study provides evidence of disparities in mortality and survival outcomes according to SCI characteristics that increases with increasing time since injury. These results lend support to the hypothesis of a progressive and disproportionate accumulation of allostatic load according to SCI characteristics. Future research should investigate cause-specific mortality for insight into potentially modifiable secondary health conditions contributing to these disparities.
Authors: Jonviea D Chamberlain; Sonja Meier; Luzius Mader; Per M von Groote; Martin W G Brinkhof Journal: Neuroepidemiology Date: 2015-05-13 Impact factor: 3.282
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Authors: Martin W G Brinkhof; Christine Fekete; Jonviea D Chamberlain; Marcel W M Post; Armin Gemperli Journal: J Rehabil Med Date: 2016-02 Impact factor: 2.912
Authors: Marcel W M Post; Martin W G Brinkhof; Erik von Elm; Christine Boldt; Mirjam Brach; Christine Fekete; Inge Eriks-Hoogland; Armin Curt; Gerold Stucki Journal: Am J Phys Med Rehabil Date: 2011-11 Impact factor: 2.159
Authors: A Buzzell; J D Chamberlain; H P Gmünder; K Hug; X Jordan; M Schubert; M W G Brinkhof Journal: Spinal Cord Date: 2018-11-09 Impact factor: 2.772
Authors: Jonviea D Chamberlain; Inge E Eriks-Hoogland; Kerstin Hug; Xavier Jordan; Martin Schubert; Martin W G Brinkhof Journal: BMJ Open Date: 2020-07-09 Impact factor: 2.692