Category: Spinal Cord Injury; Health Services Research
Individuals living with a spinal cord injury (SCI) are at heightened risk for a number of chronic health conditions such as secondary comorbidities, that may develop or be influenced by the injury, the presence of impairment and/or the process of aging. However, very little is known about the development of psychological morbidity and secondary chronic diseases among individuals living with SCIs. The objective of this study was to determine the prevalence of psychological and mental health disorders and chronic diseases among adults with SCIs, as compared to adults without SCIs.
Design : Retrospective cohort study.
Setting : Cohort of privately-insured beneficiaries.
Participants (or Animals, Specimens, Cadavers) : Data were from the Optum Clinformatics® Data Mart-a de-identified nationwide claims database of beneficiaries from a single private payer in the U.S. in the years 2001-2014. Beneficiaries were included if they had an International Classification of Diseases, Ninth Revision, Clinical Modification code for a diagnosis of a SCI (n= 6,847). Adults without SCIs were also included (n= 857,245).
Interventions : Interventions: Not applicable
Main Outcome Measure(s) : The incidence rates of 12 common psychological morbidities, 21 chronic conditions (modified Elixhauser Comorbidity Index), and multimorbidity were compared.
Adults with SCIs had a higher incidence of adjustment reaction, anxiety disorders, depressive disorders, drug dependence, episodic mood disorders, central pain syndrome, psychogenic pain, dementia, and psychological multimorbidity, as compared to adults with no SCIs (p<0.001). Adults with SCIs also had a significantly higher incidence of all except one chronic comorbidity (HIV/Aids), as compared to adults without SCIs. After propensity matching for age, education, race, gender, and the Elixhauser Comorbidity Index (n=5,884 matched pairs), there was still a higher incidence of adjustment reaction, depressive symptoms, central pain syndrome, psychogenic pain, drug dependence, and psychological multimorbidity among adults with NTSCIs, as compared to adults with no SCI (all p<0.001). Adults with SCI had a greater adjusted HRs for all the psychological disorders (HR: 1.16-3.17; p<0.001).
Conclusions : Adults with SCIs have an elevated prevalence of psychological morbidities and chronic diseases compared to adults without SCIs.
Mark Peterson– Associate Professor, University of Michigan, Ann Arbor, Michigan
Neil Kamdar– Statistician Expert, University of Michigan Medical School, Ann Arbor, Michigan
Denise Tate– Professor and Associate Chair for Research, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan