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Early Risk of Mortality After Spinal Cord Injury.

Submitted to the National Institutes for Health.

The objective of this project is to conduct a prospective investigation of risk and protective factors for mortality after spinal cord injury (SCI) in order to identify individuals at risk for early mortality and to identify factors that may become the targets of prevention strategies.  Unlike the majority of existing studies that have focused almost exclusively on injury and biographic risk factors among people with SCI, we will investigate several sets of factors in relation to mortality, the selection of which will be guided by a general risk model.  We will identify risks of early mortality from five distinct sets of factors that include: (a) biological and injury related factors, (b) psychological traits, (c) environmental factors, (d) protective and risk health behaviors, and (e) health and secondary conditions.  This will be accomplished by comparing the relative contributions of each set of risk and protective factors to the prediction of mortality, comparing alternate statistical models from the most basic model that uses only demographic and injury characteristics to successively more sophisticated models that ultimately include all five sets of factors.  Because of the importance of assessing disparities in health outcomes, we will identify interactions in risk and protective factors for mortality as a function of gender and race/ethnicity. We will also classify causes of death and calculate cause-specific standardized mortality ratios (SMRs) of observed to expected deaths (based on the general population) in order to identify and compare cause-specific SMRs to previously published estimates in order to assess any improvement over time.  A prospective design will be utilized as preliminary data was collected from 1,391 participants in 1997 and we will use this to predict mortality status 10 years later.  In addition, we will collect a new set of prospective data from the existing cohort and from a new cohort with 2,281 projected total responses (cohort 1 after accounting for attrition = 906; cohort 2 = 1,375).  We have bolstered the assessment of environmental factors in the follow-up by adding a standardized measure of socio-economic status, a recently developed measure of environmental factors among persons with disabling conditions, and items from the Behavioral Risk Factor Surveillance System (BRFSS) related to availability of health care.  We have also strengthened measurement of behavioral factors by adding several content areas from the BRFSS, including immunizations, women’s health, hypertension and cholesterol awareness, cardiovascular screening, and binge drinking (individuals often prioritize prevention of SCI related complications such as pressure ulcers to the exclusion of general health maintenance).  By combining the mortality analyses with the new data collection, we will both contribute to the current state-of-the-art while laying a foundation for the next generation of research with the ultimate goal of establishing an empirical foundation to improve health and longevity among people with as SCI.

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