1 Department of Surgery, Dalhousie University , Halifax, Nova Scotia, Canada .
2 Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada .
J Neurotrauma. 2017 Oct 15;34(20):2877-2882. doi: 10.1089/neu.2016.4931. Epub 2017 May 18.
There is worldwide geographic variation in the epidemiology of traumatic spinal cord injury (tSCI). The aim of this study was to determine whether environmental barriers, health status, and quality-of-life outcomes differ between patients with tSCI living in rural or urban settings, and whether patients move from rural to urban settings after tSCI. A cohort review of the Rick Hansen SCI Registry (RHSCIR) was undertaken from 2004 to 2012 for one province in Canada. Rural/urban setting was determined using postal codes. Outcomes data at 1 year in the community included the Short Form-36 Version 2 (SF36v2™), Life Satisfaction Questionnaire, Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF), Functional Independent Measure Instrument, and SCI Health Questionnaire. Statistical methodologies used were t test, Mann-Whitney U test, and Fisher's exact or χ test. In the analysis, 338 RHSCIR participants were included; 65 lived in a rural setting and 273 in an urban setting. Of the original patients residing in a rural area at discharge,10 moved to an urban area by 1 year. Those who moved from a rural to urban area reported a lower SF-36v2™ Mental Component Score (MCS; p = 0.04) and a higher incidence of depression at 1 year (p = 0.04). Urban patients also reported a higher incidence of depression (p = 0.02) and a lower CHIEF-SF total score (p = 0.01) indicating fewer environmental barriers. No significant differences were found in other outcomes. Results suggest that although the patient outcomes are similar, some patients move from rural to urban settings after tSCI. Future efforts should target screening mental health problems early, especially in urban settings.
创伤性脊髓损伤（tSCI）的流行病学在全球范围内存在地域差异。本研究旨在确定生活在农村或城市环境中的 tSCI 患者之间是否存在环境障碍、健康状况和生活质量结果的差异，以及患者在 tSCI 后是否从农村环境转移到城市环境。对加拿大一个省的 Rick Hansen SCI 注册中心（RHSCIR）进行了队列回顾研究，研究时间为 2004 年至 2012 年。使用邮政编码确定农村/城市环境。社区 1 年的结果数据包括 36 项简短健康调查简表第二版（SF36v2™）、生活满意度问卷、Craig 医院环境因素量表-短表（CHIEF-SF）、功能独立性测量量表和脊髓损伤健康问卷。使用的统计方法包括 t 检验、Mann-Whitney U 检验、Fisher 确切检验或 χ 检验。在分析中，纳入了 338 名 RHSCIR 参与者；65 人居住在农村环境，273 人居住在城市环境。在出院时居住在农村地区的原始患者中，有 10 人在 1 年内转移到城市地区。从农村到城市地区转移的患者报告 SF-36v2™ 心理成分评分（MCS；p=0.04）较低，1 年时抑郁发生率较高（p=0.04）。城市患者也报告抑郁发生率较高（p=0.02）和 CHIEF-SF 总分较低（p=0.01），表明环境障碍较少。在其他结果方面没有发现显著差异。结果表明，尽管患者的结果相似，但一些患者在 tSCI 后从农村环境转移到城市环境。未来的努力应针对早期筛查心理健康问题，尤其是在城市环境中。
