Appropriate Specialized Healthcare Improves Quality of Life in Chronic Spinal Cord Injury

Mortality and Longevity after a Spinal Cord Injury: Systematic Review and Meta-Analysis Jonviea D. Chamberlain a, b Sonja Meier a Luzius Mader a, b Per M. von Groote a, b Martin W.G. Brinkhof a, b a Swiss Paraplegic Research, Nottwil , and b Department of Health Sciences and Health Policy, University of Lucerne, Lucerne , Switzerland Mortality and Longevity after a Spinal Cord Injury: Systematic Review and Meta-Analysis Jonviea D. Chamberlain a, b Sonja Meier a Luzius Mader a, b Per M. von Groote a, b Martin W.G. Brinkhof a, b a Swiss Paraplegic Research, Nottwil , and b Department of Health Sciences and Health Policy, University of Lucerne, Lucerne , Switzerland Abstract Background/Aims: Mortality and longevity studies of spinal cord injury (SCI) are essential for informing healthcare systems and policies. This review evaluates the current evidence among people with SCIs worldwide in relation to the WHO region and country income level; demographic and lesion characteristics; and in comparison with the general population. Methods: A systematic review of relevant databases for original studies. Pooled estimates were derived using random effects meta-analysis, restricted to traumatic SCI. Results: Seventy-four studies were included. In-hospital mortality varied, with pooled estimates of 24.1% (95% confidence interval (CI) 14.1-38.0), 7.6% (95% CI 6.3-9.0), 7.0% (95% CI 1.5-27.4), and 2.1% (95% CI 0.9-5.0) in the WHO regions of Africa, the Americas, Europe and Western Pacific. The combined estimate for low- and middle-income countries was nearly three times higher than for high-income countries. Pooled estimates of first-year survival were 86.5% (95% CI 75.3-93.1), 95.6% (95% CI 81.0-99.1), and 94.0% (95% CI 93.3-94.6) in the Americas, Europe and Western Pacific. Pooled estimates of standardized mortality ratios in tetraplegics were 2.53 (2.00-3.21) and 2.07 (1.47-2.92) in paraplegics. Conclusion: This study found substantial variation in mortality and longevity within the SCI population, compared to the general population, and between WHO regions and country income level. Improved standardization and quality of reporting is needed to improve inferences regarding the extent to which mortality outcomes following an SCI are related to healthcare systems, services and policies. © 2015 S. Karger AG, Basel