Mortality after spinal cord injury: an 11-year prospective study.

OBJECTIVE To identify the relative risk of mortality after spinal cord injury (SCI) as a function of level of psychosocial, vocational, and medical adjustment. DESIGN A prospective design was used: data on life adjustment was obtained at one time (1985), with subsequent survival status ascertained 11 years later (1996). Logistic regression was used to identify the relative risk of mortality given the level of adjustment on a number of predictor variables. SETTING All participants were selected from outpatient files of a Midwestern university hospital. PARTICIPANTS A total of 345 participants with SCI completed study materials in 1985 (a 78% response rate), 330 of whom could be definitively classified in 1996 as either survivor or deceased. Of these 330 participants, 84% were alive in 1996 (n = 278) and the other 16% were deceased (n = 52). MAIN OUTCOME MEASUREMENTS The Life Situation Questionnaire (LSQ) was used to measure nine primary predictors related to life adjustment after SCI, including employment status and eight predictor scales: Medical Instability, Adjustment, General Satisfaction, Emotional Distress, Dependency, and Poor Health. The LSQ was also used to generate data on 34 individual items that were used in exploratory predictive analyses. RESULTS All but one of the 8 primary adjustment predictors from 1985 significantly predicted 1996 mortality status. Dependency and low overall satisfaction were among the most significant predictors of mortality. CONCLUSIONS Overall quality of life is important to the longevity of people with SCI, and comprehensive rehabilitation programs are needed to promote a level of life adjustment that maximizes longevity after SCI.