Disability is an independent predictor of mortality in patients with spinal cord injury

PURPOSE: To investigate the independent and combined effects of functional disability, chronic health conditions (CHCs), and neurological status on mortality after spinal cord injury (SCI). METHODS: This retrospective cohort study examined the records of 264 SCI patients aged ≥20 years who had completed the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) between 2012 and 2019. SCI category was based on their injuries' neurological levels and their scores on the American Spinal Injury Association Impairment Scale. Functional disability was assessed using WHODAS 2.0 score (range 0-100), and CHCs were quantified via the Charlson Comorbidity Index (CCI). RESULTS: During a median follow-up of 4.0 years, 95 deaths occurred. Multivariable Cox proportional hazards regression analysis identified three independent predictors of increased mortality: (1) greater functional disability (adjusted hazard ratio [HR], 1.02 per 1-point increase in WHODAS 2.0 score; 95% confidence interval [CI], 1.01-1.03; p = 0.0045); (2) a CCI score ≥4 (adjusted HR, 26.60; 95% CI, 6.14-115.25; p < 0.0001); and (3) non-traumatic SCI etiology (adjusted HR, 2.18; 95% CI, 1.28-3.70; p = 0.0039). Age, sex, SCI category, and time since SCI onset were not significantly associated with mortality. CONCLUSION: Functional disability independently contributes to mortality risk after SCI, highlighting the importance of comprehensive rehabilitation aimed at reducing disability to improve survival in this population.