Mortality Beyond the First Year After Spinal Cord Injury: Does Body Mass Index Matter? |
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| Institution: | 1. Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL;2. Shirley Ryan AbilityLab, Chicago, Illinois;3. Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL;4. College of Health Professions, Medical University of South Carolina, Charleston, SC;5. TIRR Memorial Hermann, Houston, TX;6. Baylor College of Medicine, Houston, TX;7. University of Texas Health Science Center at Houston (UTHealth), Houston, TX;1. Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA;2. Departments of Physical Medicine and Rehabilitation;3. Bioengineering;4. Physical Therapy;5. Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA;6. University of Pittsburgh Medical Center Centers for Rehab Services, Pittsburgh, PA;7. Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL;8. Department of Human Performance and Sport Studies, Idaho State University, Pocatello, ID;1. From the Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA;2. Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA;3. Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA;4. Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA;5. Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Nova Scotia, Canada;6. Department of Physical Medicine & Rehabilitation, University of Alabama, Birmingham, AL;7. Kessler Foundation, West Orange, NJ;8. Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ;9. Kessler Institute for Rehabilitation, West Orange, NJ;10. Feinberg School of Medicine, Northwestern University, Chicago, IL;11. Shirley Ryan Ability Lab, Chicago, IL;1. Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA;2. Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA;3. Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA;4. Department of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA;5. Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA;6. Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA;7. Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA;1. Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA;2. Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA;3. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA;5. Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL;6. Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA;1. Research Department, Craig Hospital, Englewood, CO;2. Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN;3. Department of Psychology, University of Colorado, Denver, CO;4. Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical School, Aurora, CO;5. Rocky Mountain Regional VA Medical Center, Aurora, CO;6. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA;7. CNS Medical Group, Englewood CO;1. Sociology Department, Vrije Universiteit Amsterdam, Netherlands;2. College of Health Sciences, Marquette University, Milwaukee, Wisconsin;3. Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois;4. Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois;5. Craig Hospital, Englewood, Colorado;6. University of Colorado, Denver, Colorado;7. UT Health Science Center at Houston, Houston, Texas;8. Neurorecovery Research Center, TIRR Memorial Hermann, Houston, Texas;9. Shepherd Center, Atlanta, Georgia;10. Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia |
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| Abstract: | ObjectiveTo examine the association between body mass index (BMI calculated as weight in kilograms divided by height in meters squared]) and mortality after the first year post spinal cord injury (SCI) overall and across demographic and injury characteristics.DesignCohort study.SettingSixteen Spinal Cord Injury Model Systems (SCIMS) centers.ParticipantsSCIMS Database participants age 20 years or older and having a BMI assessment during the 2007-2011 wave of data collection.InterventionsNot applicable.Main Outcome MeasuresAll-cause mortality rate. Life table method and log-rank test were used to estimate and compare mortality rates across BMI groups and other factors. Cox proportional hazard regression model was conducted to estimate hazard ratio (HR) and 95% confidence interval (CI).ResultsA total of 2346 participants (N=2346) with SCI were classified into 1 of the 8 BMI groups: <18.5 (6.9%), 18.5-19.9 (7.3%), 20.0-22.49 (15.0%), 22.5-24.9 (18.8%), 25.0-27.49 (17.5%), 27.5-29.9 (13.2%), 30.0-34.9 (13.5%), and ≥35.0 (7.8%). Compared with people with BMI of 22.5-29.9, a higher mortality risk was observed among people with BMI<18.5 (HR, 1.76; 95% CI, 1.25-2.49), 18.5-19.9 (HR, 1.51; 95% CI, 1.06-2.15), and ≥35.0 (HR, 1.51; 95% CI, 1.11-2.07) after adjusting for confounding factors (sex, age at the time of BMI assessment, marital status, neurologic status). The U-shape BMI-mortality relationship varied by age, sex, neurologic status, and years since injury.ConclusionsTo improve life expectancy after SCI, health care professionals could focus on weight management among patients with relatively low and extremely high BMI, defined by demographic and injury-related characteristics. Future studies should explore factors that contribute to such a higher mortality after SCI, including pre-existing conditions, poor diet and/or nutrition, and cardiorespiratory fitness. |
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