A
study funded by the National Institute on Disability, Independent Living, and
Rehabilitation Research (NIDILRR).
A spinal cord injury (SCI) is damage anywhere
along the spinal cord from trauma. An SCI can occur in the upper part of the
spine (a cervical injury) or in the lower part of the spine (a non-cervical
injury), with cervical injuries having more severe impacts on mobility. Medical
improvements have made it possible for more people to survive after an SCI.
However, studies show that people with SCI still have shorter average life
expectancies than people without SCI. Some of the most common causes of death
in people with SCI include sepsis (a condition where infection spreads from the
skin or elsewhere into the bloodstream); lung infections such as pneumonia or
influenza; cancer; heart and blood vessel disease; and unintentional injury.
Certain lifestyle factors such as smoking, drinking, diet, and exercise can
affect a person’s risk of developing these and other health conditions. In a
recent NIDILRR-funded study, researchers looked at self-report assessments and
health records from a group of adults with SCI, including some who died during
the study period and others who survived. The researchers wanted to find out
which health and behavioral factors differed between the deceased and the
survivors. They also wanted to find out which factors were associated with
specific causes of death.
Researchers from a project Risk of Early
Mortality After Spinal Cord Injury looked at 2,979 adults with SCI who were
treated at a large city hospital. All of these individuals had SCI for at least
a year before filling out a self-report assessment about their health and
lifestyles. The individuals answered questions about their injury severity;
current age and age at injury; race/ethnicity; gender; and whether they were
underweight, about normal weight, or overweight for their height. The
individuals also answered questions about six types of lifestyle factors:
whether they took prescription medications for spasms, pain, depression, or
sleep; how often they drank alcohol; whether or not they smoked; how often they
ate fruits and vegetables; how often they ate unhealthy or “junk” foods; and
how much they exercised. One group of the individuals completed the survey
between 1997 and 1998, while a second group completed the survey between 2007
and 2009.
The researchers then looked at national death
records to find out which individuals had died before December 31, 2016. For
the deceased, the immediate cause of death was placed into one of six
categories: sepsis; pneumonia or influenza; cancer; heart/blood vessel
diseases; accidental injuries; and all other causes of death.
The researchers found that 27% of the individuals
had died by December 31, 2016. When the researchers compared the individuals
who died with those who survived, they found that:
·
The individuals with
cervical injuries were less likely to survive: Half of the deceased had
cervical injuries, while only 32% of the survivors did.
·
Age at injury and the
length of time an individual lived with the injury had an impact on survival:
On average, the deceased individuals were about 7.5 years older than the
survivors when they became injured, and they had been living with their
injuries for about 1.8 years longer at the time they completed the survey.
·
A higher percentage of
women survived than men.
·
A higher percentage of
the survivors were normal weight, while a higher percentage of the deceased
were under- or overweight.
·
Compared with the
deceased individuals, the survivors reported taking fewer prescription
medications to treat pain, sleep, spasticity, or depression (a composite
measure), smoking less, and exercising more. Drinking alcohol and diet were
unrelated to the likelihood of death.
When the researchers looked separately at each
cause of death, they found the following:
·
Factors associated
with death from sepsis were: having a cervical SCI, being older at injury and
living longer with an SCI, being overweight, and taking prescription
medications.
·
Factors associated
death from pneumonia or influenza were: having a cervical SCI and being older
at injury and living longer with an SCI.
·
Factors associated
with death from cancer were: being older at injury and living longer with an
SCI, being underweight, and smoking.
·
Factors associated
with death from heart or blood vessel diseases were: having a cervical SCI,
being older at injury and living longer with SCI, being male, smoking, and
exercising less often. The individuals who were underweight were less likely to
die from heart/blood vessel diseases than those who were normal weight or
overweight. Surprisingly, the individuals who reported eating more unhealthy
foods were also less likely to die from heart/blood vessel diseases.
·
Factors associated
with death from unintentional injury were: having a cervical SCI, taking more
prescription medications, and drinking more alcohol.
·
Factors associated
with death from other causes were: having a cervical SCI, being older at injury
and living longer with SCI, being male, being underweight, taking more
prescription medications, smoking, and exercising less.
The authors noted that different causes of
death after SCI may have different risk profiles. For example, in this study,
the individuals who smoked were more likely to die from cancer and heart
disease, while the individuals who drank more alcohol were more likely to die
from unintentional injury. The authors also noted an unexpected finding, as
there was an association between eating more unhealthy foods and a lower risk
of dying from heart and blood vessel diseases. According to the authors,
getting enough calories each day may be an important part of staying healthy
for people with SCI.
The authors also noted that screening
individuals with SCI to learn about their lifestyles may help inform
recommendations to improve their life expectancy. Physicians and rehabilitation
providers treating people with SCI may wish to inquire about lifestyle factors
such as smoking, alcohol use, exercise, and diet. Interventions such as
programs to help people quit smoking, physical therapy to provide access to
exercise, and nutritional counseling may help extend quantity and quality of
life for people with SCI.
To Learn More
The Model Systems Knowledge Translation Center
offers many
resources to learn about living with spinal cord injury including
videos and factsheets about exercise and fitness, respiratory health, and aging
with SCI.
Previous issues in the Research In Focus
Series have covered exercise and diet changes after SCI, exercise and respiratory health after SCI, the
connection between pressure injuries and pneumonia, the benefits
of alcohol counseling after SCI, mobility and
pain management, among many
other topics.
To Learn More About this Study
DiPiro, N.D., Cao, Y., Krause, J.S. (2019) A prospective study of health behaviors and risk of
all-cause and cause-specific mortality after spinal cord injury.
Spinal Cord 57, 933-941. This article is available from the NARIC Collection
under Accession Number J81804.
Date published: 2019-11-06
Keywords: spinal
cord injury, SCI, mortality,
life expectancy, research
in focus
Download this article in PDF format:
Research In Focus is a publication of the
National Rehabilitation Information Center (NARIC), a library and information
center focusing on disability and rehabilitation research, with a special focus
on the research funded by NIDILRR. NARIC provides information, referral, and
document delivery on a wide range of disability and rehabilitation topics. To
learn more about this study and the work of the greater NIDILRR grantee
community, visit NARIC at http://www.naric.com or call 800/346-2742 to
speak to an information specialist.
https://www.naric.com/?q=en/rif/Healthy%20Lifestyles%20May%20be%20Linked%20with%20Longer%20Life%20Expectancy%20for%20People%20with%20Spinal%20Cord%20Injuries
No comments:
Post a Comment