rends in Life Expectancy After Spinal Cord Injury avid

Objective: To investigate whether there have been improveents in survival after spinal cord injury (SCI) over time, both n the critical first 2 years after injury and in the longer term. Design: Pooled repeated observations analysis of personears. For each person-year, the outcome variable is survival nd mortality, and the explanatory variables include age, level nd grade of injury, and calendar year (the main focus of the nalyses). The method can be viewed as a generalization of roportional hazards regression. Setting: Model spinal cord injury systems and hospital SCI nits across the United States. Participants: Persons (N 30,822) admitted to a Spinal ord Injury Model Systems facility a minimum of 1 day after njury. Only persons over 10 years of age and known not to be entilator dependent were included. These persons contributed 23,618 person-years of data, with 4980 deaths, over the 1973 o 2004 study period. Interventions: Not applicable. Main Outcome Measure: Survival. Results: Other factors being equal, over the last 3 decades here has been a 40% decline in mortality during the critical rst 2 years after injury. However, the decline in mortality over ime in the post–2-year period is small and not statistically ignificant. Conclusions: The absence of a substantial decline in morality after the first 2 years postinjury is contrary to widely held mpressions. Nevertheless, the finding is based on a large atabase and sensitive analytic methods and is consistent with revious research. Improvements in critical care medicine after pinal cord injury may explain the marked decline in short-term ortality. In contrast, although there have no doubt been imrovements in long-term rehabilitative care, their effect in nhancing the life span of persons with SCI appears to have een overstated.