Etiology-specific variation in survival following non-traumatic spinal cord injury: a causal inference approach using data from a population-based cohort.

Buzzell, Anne; Chamberlain, Jonviea D; Eriks-Hoogland, Inge; Jordan, Xavier; Schubert, Martin; Zwahlen, Marcel; Brinkhof, Martin W G (2020). Etiology-specific variation in survival following non-traumatic spinal cord injury: a causal inference approach using data from a population-based cohort. (In Press). Spinal cord Springer Nature 10.1038/s41393-020-00554-9

[img]
Preview
Text
Buzzell SpinalCord 2020_epub.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (828kB) | Preview

STUDY DESIGN

Observational, population-based cohort study.

OBJECTIVES

To evaluate the origin and contribution to excess of survival differences following non-traumatic spinal cord injury (NTSCI) using etiology as proxy for variation in underlying health condition.

SETTING

Specialized rehabilitation centers in Switzerland.

METHODS

Medical record data collected by the Swiss Spinal Cord Injury cohort (SwiSCI) study were linked with mortality information from the Swiss National Cohort. Considering contemporary theory and empirical evidence, a directed acyclic graph (DAG) was developed to formally evaluate causal differences among NTSCI etiologies, relative to traumatic SCI (TSCI). Statistical inference was contingent on hazard ratios (HRs) and marginal survival differences, derived using flexible parametric modeling.

RESULTS

3643 individuals (NTSCI = 1357; TSCI = 2286) diagnosed with SCI between 1990 and 2011 were included, contributing a cumulative 41,344 person-years and 1323 deaths. Test statistics confirmed DAG-dataset consistency. As compared to TSCI, mortality was elevated in all NTSCI etiological groups; malignant etiologies had the highest HRs (10; 95% CI, 8.0 to 14) followed by infection (2.6; 1.8 to 3.6) and vascular (2.5; 2.0 to 3.2) etiology groups. At the attained age of 55, the estimated reduction in survival among non-malignant etiologies was 9.4% (5.8 to 13) at 5 years and 17% (11 to 23) at 20 years.

CONCLUSIONS

Causal differences in survival among NTSCI etiological groups are likely a result of chronic variation in health conditions. This study supports the development of long-term interdisciplinary management and policy for individuals with NTSCI, specific to etiology.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Zwahlen, Marcel

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1476-5624

Publisher:

Springer Nature

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

24 Sep 2020 14:54

Last Modified:

14 Oct 2020 19:27

Publisher DOI:

10.1038/s41393-020-00554-9

PubMed ID:

32948845

BORIS DOI:

10.7892/boris.146621

URI:

https://boris.unibe.ch/id/eprint/146621

Actions (login required)

Edit item Edit item
Provide Feedback