Swiss Paraplegic Research, Nottwil, Switzerland
Centre INSERM U1219, CIC 1401-EC, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France.
BMJ Open. 2020 Jul 9;10(7):e035752. doi: 10.1136/bmjopen-2019-035752.
Study drop-out and attrition from treating clinics is common among persons with chronic health conditions. However, if attrition is associated with adverse health outcomes, it may bias or mislead inferences for health policy and resource allocation.
This retrospective cohort study uses data attained through the Swiss Spinal Cord Injury (SwiSCI) cohort study on persons with spinal cord injury (SCI). Vital status (VS) was ascertained either through clinic medical records (MRs) or through municipalities in a secondary tracing effort. Flexible parametric survival models were used to investigate risk factors for going lost to clinic (LTC) and the association of LTC with subsequent risk of mortality.
1924 individuals were included in the tracing study; for 1608 of these cases, contemporary VS was initially checked in the MRs. VS was ascertained for 704 cases of the 1608 cases initially checked in MRs; of the remaining cases (n=904), nearly 90% were identified in municipalities (n=804). LTC was associated with a nearly fourfold higher risk of mortality (HR=3.62; 95% CI 2.18 to 6.02) among persons with traumatic SCI. Extended driving time (ie, less than 30 min compared with 30 min and longer to reach the nearest specialised rehabilitation facility) was associated with an increased risk of mortality (HR=1.51, 95% CI 1.02 to 2.22) for individuals with non-traumatic SCI.
The differential risk of LTC according to sociodemographic and SCI lesion characteristics underscores the importance of accounting for attrition in cohort studies on chronic disease populations requiring long-term care. In addition, given the associated risk of mortality, LTC is an issue of concern to clinicians and policy makers aiming to optimise the long-term survival of community-dwelling individuals with traumatic SCI. Future studies are necessary to verify whether it is possible to improve survival prospects of individuals LTC through more persistent outreach and targeted care.
在患有慢性疾病的人群中，从治疗诊所辍学和流失是很常见的。然而，如果流失与不良健康结果有关，那么它可能会对卫生政策和资源分配产生偏差或误导。
这项回顾性队列研究使用了瑞士脊髓损伤（SwiSCI）队列研究中获得的数据，该研究对象为脊髓损伤（SCI）患者。通过诊所病历（MRs）或通过市政当局进行二次追踪来确定生存状态（VS）。使用灵活的参数生存模型来研究失去诊所联系（LTC）的风险因素，以及 LTC 与随后的死亡风险之间的关联。
共有 1924 人参加了追踪研究；其中 1608 例患者的初始 VS 在 MRs 中进行了检查。在最初检查 MRs 的 1608 例病例中，有 704 例确定了 VS；在其余病例（n=904）中，近 90%在市政当局中得到确认（n=804）。LTC 与创伤性 SCI 患者的死亡率几乎高出四倍相关（HR=3.62；95%CI 2.18 至 6.02）。对于非创伤性 SCI 患者，延长驾驶时间（即，到达最近的专门康复机构的时间少于 30 分钟与 30 分钟以上）与死亡风险增加相关（HR=1.51，95%CI 1.02 至 2.22）。
根据社会人口统计学和 SCI 损伤特征，LTC 的风险差异突出了在需要长期护理的慢性疾病人群的队列研究中考虑流失的重要性。此外，鉴于与死亡率相关，LTC 是临床医生和政策制定者关注的问题，他们旨在优化创伤性 SCI 社区居民的长期生存。未来的研究有必要验证通过更持久的外展和针对性护理，是否可以改善 LTC 个体的生存前景。
