Socioeconomic and behavioral risk factors for mortality: do risk factors observed after spinal cord injury parallel those from the general USA population?

Abstract

To evaluate the association of demographic, behavioral and socioeconomic factors with all-cause mortality while controlling for health status among a cohort of participants with severe disability related to spinal cord injury (SCI). Prospective cohort study. Data were analyzed at a major medical university in the Southeast United States of America. Participants included 1361 adults with traumatic SCI of at least 1-year duration who were recruited through a large specialty hospital in the Southeast United States of America. Three Cox proportional hazard models were generated relating the predictors to all-cause mortality. Age, disability, smoking and income were significant in the final model. Both current (hazard ratio (HR)=2.03, 95% confidence interval (CI)=1.46-2.82) and former smokers (HR=1.58, CI=1.16-2.16) were at elevated hazard of mortality, as were those with incomes below $10,000 (HR=2.29, CI=1.53-3.44) and between $10,000 and $35,000 (HR=1.47, CI=1.03-2.10). Even after controlling for health and severity of disability, the coefficients for smoking and income were significant, exceeding that reported previously within the general population. The importance of these factors may be magnified after severe disability, even though life expectancy is already greatly diminished in this population.