Journal Article Details

Citation:
Krause, J.S., & Carter, R.E. (2009). Risk of mortality after spinal cord injury: relationship with social support, education and income. Spinal Cord, 47 592-596.
Title:
Risk of mortality after spinal cord injury: relationship with social support, education and income
Authors:
Krause, J.S., & Carter, R.E.
Year:
2009
Journal/Publication: 
Spinal Cord
Publisher:
International Spinal Cord Society
DOI:
Full text:
Peer-reviewed?
Yes
NIDILRR-funded? 
Yes

Structured abstract:

Background:
Risk of death is after Spinal Cord Injury (SCI) is highest the first year post injury and is greater for those with higher level or neurologically complete injuries and who are ventilator dependent. Previous research suggest that a general risk model is appropriate for guiding studies of risk of death. Other research points to the importance of insurance and income. Environmental factors are important to consider as they represent proxy variables for the availability of services. Research on social support in relation to mortality is scant.
Purpose:
The purpose of this prospective cohort study was to identify the association of social support and socioeconomic factors with early death among individuals with SCI. The research questions were as follows: When statistically controlling fro biographical and injury characteristics, will the environmental factors of social support and socioeconomic status indicators be associated with the hazard of mortality. When building an optimal risk model for mortality, will inclusion of social support and socioeconomic indicators substantially enhance the prediction of hazard for mortality above and beyond that of biographic and injury factors alone?
Setting:
The study participants were identified from a hospital in the southeastern United States.
Study sample:
The full sample was 1386 people who had died, among these 224 were observed deaths. Due to missing data the final sample was 188 participants. This included
Intervention:
There was no intervention.
Data collection & analysis:
Eight years after obtaining prospective data, mortality status was determined. Two death indexes were used to determine individuals who had died. A health survey was used to measure study variables. The Reciprocal Social Support Scale was developed to measure support given and received. A three stage hierarchical strategy to model building was used to identify the association between each health variable with death and define an set of environmental predictors of death. All model building was conducted using SAS System version 9.1.3. The validation of the proportional hazards assumption and estimation of the C-statistic were performend using STATA version 9.2.
Findings:
After controlling for biographic and injury related factors two environmental predictors remained: low income and general social support. Years of education and the upset scale, were eliminated from the final model. Social support and income were predictors of death after SCI. However, the overall relationships of environmental factors was less than health factors. It is also important to note that only a limited set of environmental factors were examined.
Conclusions:
Environmental factors are important predictors of death after SCI. Future research should address a wider range of predictors. Intervention studies are needed to identify individuals with SCI who are at risk for death and address the factors that place them at risk.
Disabilities served:
Spinal cord injury (SCI)
Populations served:
Gender: Female and Male
Race: Black / African American
Race: White / Caucasian