Health-related quality of life and healthcare systems in people with spinal cord injury: A cross-country comparison from the second InSCI community survey.

Abstract

People with spinal cord injury/disease (SCI/D) have high healthcare needs. Using data from the second International Spinal Cord Injury (InSCI) community survey, the objective of this study is to determine the performance of healthcare systems for people with SCI/D. Specifically, health utilities for people with SCI/D and the country's healthcare system performance relative to other countries with comparable economic profiles will be examined. A cross-sectional, multi-national, observational cohort study. Community setting with participants from 31 countries across six World Health Organization regions. Of the 15,051 participants completing the survey between May 2022 and October 2024, 72% were male with a median age of 54 years, 55% having an incomplete injury and 64% having paraplegia. Not applicable MAIN OUTCOME MEASURES: Health-related quality of life was assessed by reporting health utilities using the EQ-5D-5L. Sixteen healthcare system performance indicators for five domains were derived by mapping the InSCI survey items to the Commonwealth Fund domains. Health utility values ranged from 0.75 for Finland, a high-income country, to -0.01 for Iran, an upper-middle income country. All 31 countries have strengths and areas for improvement across sixteen indicators. High-income countries generally had higher health utility ratings and better rankings for their healthcare system performance. However, the healthcare systems in many of the upper-middle and lower-middle-income countries performed well, and efficiently utilized limited resources. To optimize health and participation in the community, the healthcare system must be responsive and meet the needs for people living with SCI/D. Results from this study provide evidence on the link between healthcare policies, resources and health outcomes for people with SCI, which can inform policy change.