Krause J S, Carter R E
Department of Health Sciences and Research, Medical University of South Carolina, Charleston, 29425, USA.
Spinal Cord. 2009 Aug;47(8):592-6. doi: 10.1038/sc.2009.15. Epub 2009 Mar 3.
Prospective cohort study.
To identify the association of social support and socioeconomic factors with risk of early mortality among persons with spinal cord injury.
Participants were identified from a large specialty hospital in the Southeastern United States.
Data were collected by mailed survey, and mortality status was ascertained approximately 8 years later. The outcome was time from survey to mortality or censoring. Mortality status was determined using the National Death Index and the Social Security Death Index. There were 224 observed deaths (16.2%) in the full sample (n=1386). Because of missing data, the number of deaths used in the final analysis was 188 (out of 1249 participants).
Cox proportional hazards modeling was used to build a comprehensive predictive model. After controlling for biographic and injury-related factors, two of four environmental predictors were retained in the final model including low income and general social support. Years of education and the upsets scale, another aspect of social support, were not retained in the final model. Inclusion of these variables resulted in only modest improvement in the prediction of survival compared with biographic and injury variables alone, as the pseudo-R(2) increased from 0.121 to 0.134 and the concordance from 0.730 to 0.751.
Environmental factors are important predictors of mortality after spinal cord injury.
前瞻性队列研究。
确定社会支持和社会经济因素与脊髓损伤患者早期死亡风险之间的关联。
参与者来自美国东南部的一家大型专科医院。
通过邮寄调查问卷收集数据，并在大约8年后确定死亡状况。研究结果是从调查到死亡或被审查的时间。使用国家死亡指数和社会保障死亡指数确定死亡状况。在全部样本（n = 1386）中有224例观察到的死亡（16.2%）。由于数据缺失，最终分析中使用的死亡人数为188例（共1249名参与者）。
采用Cox比例风险模型建立综合预测模型。在控制了个人信息和损伤相关因素后，四个环境预测因素中的两个被保留在最终模型中，包括低收入和一般社会支持。教育年限和社会支持的另一个方面——困扰量表，未被保留在最终模型中。与仅考虑个人信息和损伤变量相比，纳入这些变量仅使生存预测有适度改善，因为伪R²从0.121增加到0.134，一致性从0.730增加到0.751。
环境因素是脊髓损伤后死亡率的重要预测因素。
