Objectives:To identify demographic and medical factors associated with changing bladder management method and document the reason for changing bladder management method among adults with spinal cord injury (SCI). Methods:This cohort study included 20 Spinal Cord Injury Model Systems (SCIMS) centers. Participants were individuals injured between 1972 and 2019 who completed 2 consecutive assessments of bladder management method within 5 years and identified the reason for changing bladder management method at the second assessment. Main outcome measures were change in bladder management method since first assessment (changed/not changed) and, if change occurred, reason for changing. Results:Of 10,769 persons included in the analysis, 10.6% reported change in bladder management at the second assessment. After adjusting for covariates, higher odds of changing bladder management was observed among people who completed first assessment at discharge from initial rehabilitation and those who (a) used nonvolitional voiding for bladder management, (b) were older than 44 years of age, (c) had less than high school education, and (d) resided in a hospital or nursing home. The most reported reason for changing bladder management was medical-related factors (48.2%), followed by functional improvement (28.5%) and personal factors (19.6%). Conclusion:Understanding the patterns and predictors of bladder management transitions can help clinicians anticipate potential changes, provide proactive education and support, and implement strategies to minimize secondary complications.

Objectives:To quantify excess mortality due to COVID-19 among persons with traumatic spinal cord injury (TSCI). Methods:This cohort study was conducted at 31 SCI Model Systems and 3 Shriners Hospitals SCI units. Participants were persons with TSCI (n = 22,800) enrolled in the SCI Collaborative Survival Study Database with follow-up between January 1, 2020, and December 31, 2022. Main outcome measures were age- and sex-specific standardized mortality ratios (SMR), and 95% confidence intervals (CI) were calculated by age group, sex, injury severity, and years since injury. Results:There were 102 deaths in the TSCI study population due to COVID-19 among 1138 total deaths of known cause (9.0%) that occurred in 57,109 person-years of follow-up. COVID-19 deaths ranked fourth behind heart disease (17.4%), respiratory disease (16.0%), and cancer (12.2%). The overall COVID-19 SMR for TSCI was estimated to be 1.42 (95% CI 1.15-1.70). The SMR increased with increasing injury severity and was higher among persons who were younger than 60 years of age and who were at least 20 years post injury. Conclusion:Persons with TSCI had 42% greater risk of dying from COVID-19 than the general population of comparable age and sex. These findings emphasize the need for up-to-date COVID-19 vaccinations and prompt treatment with Paxlovid and/or other antiviral medications. Now that the latest COVID-19 variants are less lethal and effective vaccines and treatments are available, additional follow-up will be needed to determine whether COVID-19 and its long-term effects continue to have a significant negative impact on life expectancy among persons with TSCI.

ImportancePressure ulcers (PUs) are (1) prevalent secondary complications after spinal cord injury (SCI), (2) present with elevated systemic inflammatory tone, and (3) may interfere with healing processes underlying neurological recovery (disrepair). ObjectiveTo investigate whether PUs acquired during initial hospitalization are associated with neurological and functional long-term outcome and survival after SCI. Design, Setting, and ParticipantsMulticenter cohort study at 20 centers of the prospective SCI Model Systems (SCIMS) Database (Birmingham, AL). Patients with acute traumatic cervical SCI with relevant motor impairment (ie, American Spinal Injury Association [ASIA] impairment scale [AIS] A, B, and C) were enrolled from January 1996 to September 2006 and followed up until June 2016. Data were analyzed from April 2021 to September 2024. ExposuresPUs acquired during surgical or first rehabilitative SCI care. Main outcomes and measuresThe change in the ASIA motor score at 1 year after SCI was the primary end point. Secondary end points included the recovery of functional independence measure (FIM) motor score at 1 year after SCI and mortality up to 10 years. ASIA and FIM motor score were analyzed applying linear mixed models with random intercept adjusted for baseline neurological level, AIS, and sociodemographic factors. Mortality was analyzed using Cox regression. ResultsThe study included 1282 patients with a mean (SD) age of 38.0 (15.7) years and consisted of 1028 (80.2%) male patients. Regarding race and ethnicity, 349 of 1249 (27.9%) were African American patients, 1139 of 1273 (89.5%) were non-Hispanic patients, and 834 of 1249 (66.8%) were White patients. During initial hospitalization, 594 patients (45.7%) acquired PUs. Exposure to PUs was associated with impaired motor recovery 1 year after SCI compared with unexposed patients (-9.1 ASIA motor score points; 95% CI, -12.3 to -6.0; P < .001). In addition, PUs were associated with lower recovery of physical independence 1 year after SCI (-8.3 FIM motor score points; 95% CI: -11.1 to -5.5; P < .001). Cox regression confirmed PUs as a risk marker for death up to 10 years after SCI (hazard ratio, 1.41; 95% CI, 1.09 to 1.82; P = .01). Conclusions and RelevanceIn this cohort study, PUs acquired during initial hospitalization after SCI were independently associated with poor long-term neurofunctional outcome. PUs constitute a modifiable factor associated with risk for worse long-term disability (recovery confounder) and elevated mortality.

BACKGROUND: Long-term survival after spinal cord injury (SCI) has been extensively studied in the US and UK. OBJECTIVE: To compare SCI epidemiology and survival results between the US and UK for the same time period and patient groups. METHODS: We restricted attention to persons injured at ages 18 and older who had survived at least 2 years post injury and were not ventilator dependent. We performed survival analysis using logistic regression on person-year data with time-dependent covariates. The resulting mortality rates were used to construct life tables in order to obtain life expectancies. RESULTS: The average age at injury, percentage male, and level/grade of injury were rather similar between the two countries. After adjustment for risk factors, UK mortality was 85% of that in the US (95% c.i. 80% to 91%, p < 0.0001). Mortality increased by 0.3% per year over the 1980 to 2012 study period (HR = 1.003); this was not statistically significant (p = 0.44). The US and UK life expectancies are nearly the same percentage of their respective general population values, differing by at most 2%. CONCLUSION: Long-term mortality after SCI in the UK is roughly 15% lower than that in the US. The general population mortality in the UK is also approximately 15% lower, however, and thus the percentages of normal life expectancy in the two countries prove to be strikingly similar.

OBJECTIVE:To evaluate the impact of bladder management method, specifically chronic indwelling catheter (IndC), on survival in patients with spinal cord injury (SCI) in Spinal Cord Injury Model System database. METHODS:Spinal Cord Injury Model System is a multicenter longitudinal database since 1970 with >40,000 patients with SCI. Adult patients (>18 at the time of injury) were screened. Patients who died within 1 year of injury and had 2 or more changes in method of bladder management, or reported normal volitional void were excluded. Outcome of interest was death from nonpulmonary, nonwound related sepsis (NPNWS). Left truncation cox regression method using age as the time-scale was used to calculate hazard ratios. RESULTS:A total of 13,616 patients were included. Comparison was performed between "IndC" group (n = 4872; 36.1%) vs "Other" (n = 8744; 63.9%). After adjusting for age and change in bladder management method, "IndC" is associated with elevated NPNWS mortality (2.10; 95% confidence interval 1.72-2.56, P < .001). Multivariable analysis, adjusting for age at injury, gender, race, education, insurance status, etiology of SCI, injury level, neurologic impairment level, and change in bladder management method, showed IndC was associated with significantly higher risk of death from NPNWS compared to other methods of bladder management. CONCLUSION:In a large cohort of SCI patients, bladder management with IndC is predictive of significantly propagated NPNWS related mortality compared to other methods of bladder management. While identifying IndC is an independent mortality risk factor, a better understanding of the underlying mechanisms could inform strategies to improve neurourological care and survival after SCI.

"Update on the long-term survival of persons who are ventilator dependent after spinal cord injury." The Journal of Spinal Cord Medicine, ahead-of-print(ahead-of-print), pp. 1–2 Disclosure statementNo potential conflict of interest was reported by the author(s).Additional informationFundingNone.

Objective: To identify trends in causes of death after spinal cord injury (SCI) that could enhance understanding of why life expectancy after SCI has not improved in the last 3 decades.Design: Cohort study.Setting: Twenty-nine SCI Model Systems and 3 Shriners Hospitals.Participants: Individuals with traumatic SCI (N=49,266) enrolled in the SCI Collaborative Survival Study Database between 1973 and 2017.Interventions: Not applicable.Main Outcome Measures: Age-standardized cause-specific SCI mortality rates and 95% confidence intervals were calculated for 5 time intervals (1960-1979, 1980-1989, 1990-1999, 2000-2009, and 2010-2017).Results: A total of 17,249 deaths occurred in 797,226 person-years of follow-up. Since 2010, the highest mortality rate was for respiratory diseases, followed by heart disease, cancer, infective and parasitic diseases (primarily septicemia), and unintentional injuries. Mortality rates for respiratory diseases, cancer, stroke, urinary diseases, and digestive diseases, initially decreased significantly but remained relatively stable since 1980, whereas essentially no progress occurred for infective and parasitic diseases. Mortality rates for heart disease, pulmonary embolus, and suicide decreased significantly throughout the entire study period, but were offset by increases in mortality rates for endocrine (primarily diabetes), nutritional, and metabolic diseases, as well as unintentional injuries. From 2010 to 2017, the overall age-standardized mortality rate was 3 times higher for individuals with SCI than the general population, ranging from 27% higher for cancer to 9 times higher for infective and parasitic diseases.Conclusion: Improving life expectancy after SCI will require: (1) reducing mortality rates from respiratory diseases and septicemia that have remained high, (2) reversing current trends in diabetes and unintentional injury deaths, and (3) continuing to reduce mortality from heart disease and other leading causes. Archives of Physical Medicine and Rehabilitation 2022;103:634-41 (c) 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Objective To estimate the population profile of people living with traumatic spinal cord injury (TSCI) to help evaluate health care needs of this aging population. Design Cross-sectional study. Setting SCI Model Systems (SCIMS) centers in the United States. Participants Individuals (N=20,437) who: (1) incurred a TSCI between 1972 and 2019, (2) were initially treated at one of the SCIMS centers, and (3) were alive during the period from 2015 to 2019. Interventions Not applicable. Main Outcome Measures Demographics, injury characteristics, health conditions, and social participation, as compared with previous estimates in 2008 and general population statistics in 2017. Results People living with TSCI during the period from 2015-2019 (mean years since injury, 18y; 79.4% male, and 62.5% White) were older (51.6 vs 45.0y) and had a higher percentage of C1-C4 (21.9% vs 17.0%) and American Spinal Injury Association Impairment Scale D injuries (31.5% vs 26.0%) compared with the 2008 TSCI population profile. Although the proportion of people with a bachelor's degree or higher was similar between the TSCI and general US populations (30.7% vs 32.0%), the employment rate was lower in the TSCI population (24.0% vs 59.5%). People are affected by various medical problems over time post TSCI. The prevalence of pain and urinary tract infection remained high over postinjury years, at 86.1% and 52.6%, respectively. Rehospitalization and depression were most common during the first year (34.9% and 22.3%, respectively), and pressure injury was more common among those 20 years or more postinjury (>30.0%). Health conditions declined with advanced age, including self-perceived health, diabetes, and institutional residence. People who survived TSCI for years, however, had relatively good degrees of independence and social participation. Conclusion Study findings highlight the need for greater involvement of primary care providers and geriatricians in the continuity of care for SCI to promote healthy aging. Improvement in employment should also be the target in promoting social participation and quality of life.

OBJECTIVE:To examine the association between body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) and mortality after the first year post spinal cord injury (SCI) overall and across demographic and injury characteristics.DESIGN:Cohort study.SETTING:Sixteen Spinal Cord Injury Model Systems (SCIMS) centers.PARTICIPANTS:SCIMS Database participants age 20 years or older and having a BMI assessment during the 2007-2011 wave of data collection.INTERVENTIONS:Not applicable.MAIN OUTCOME MEASURES:All-cause mortality rate. Life table method and log-rank test were used to estimate and compare mortality rates across BMI groups and other factors. Cox proportional hazard regression model was conducted to estimate hazard ratio (HR) and 95% confidence interval (CI).RESULTS:A total of 2346 participants (N=2346) with SCI were classified into 1 of the 8 BMI groups: <18.5 (6.9%), 18.5-19.9 (7.3%), 20.0-22.49 (15.0%), 22.5-24.9 (18.8%), 25.0-27.49 (17.5%), 27.5-29.9 (13.2%), 30.0-34.9 (13.5%), and ≥35.0 (7.8%). Compared with people with BMI of 22.5-29.9, a higher mortality risk was observed among people with BMI<18.5 (HR, 1.76; 95% CI, 1.25-2.49), 18.5-19.9 (HR, 1.51; 95% CI, 1.06-2.15), and ≥35.0 (HR, 1.51; 95% CI, 1.11-2.07) after adjusting for confounding factors (sex, age at the time of BMI assessment, marital status, neurologic status). The U-shape BMI-mortality relationship varied by age, sex, neurologic status, and years since injury.CONCLUSIONS:To improve life expectancy after SCI, health care professionals could focus on weight management among patients with relatively low and extremely high BMI, defined by demographic and injury-related characteristics. Future studies should explore factors that contribute to such a higher mortality after SCI, including pre-existing conditions, poor diet and/or nutrition, and cardiorespiratory fitness.

Context:Colorectal cancer (CRC) is the second leading cause of cancer related deaths in the US. There is paucity of data regarding CRC and the spinal cord injury (SCI) community. Persons with SCI have suboptimal rates of colonoscopies and face extensive barriers to care. The aim of our study was to compare CRC mortality in persons with SCI to CRC mortality in the general population. Design:A prospective follow-up study. Setting:Analysis of the National SCI database. Participants:54,965 persons with SCI. Interventions:Not applicable. Outcome Measures:Current survival status and causes of death were determined. The expected number of CRC deaths was calculated for the general US population, using ICD-10 codes. Standardized mortality ratios (SMR) were calculated as the ratio of observed to expected CRC deaths stratified by current age, sex, race, time post-injury and neurologic group. Results:The CRC mortality was 146 persons out of 54,965 persons with SCI. The overall SMR was determined to be 1.11 (95% CI [0.94, 1.31]). Among subgroups, one finding was significant and this was for patients with injury level C1-4 with an American Spinal Injury Association Impairment Scale Grade of A, B or C with an SMR of 1.68 ([95% CI [1.03-2.61]). Conclusion:Although persons with SCI receive suboptimal rates of preventative care screenings and report extensive barriers to care, overall, they are not at an increased risk of CRC mortality. The current recommendations for CRC screening should be continued for these individuals while reducing barriers to care.

Objective: Evaluate the association between body mass index (BMI, kg/m2) and one-year mortality among people who survived the first 90 days after spinal cord injury (SCI).Design: Cohort study.Setting: Eighteen SCI Model Systems centers throughout the United States.Participants: 6640 participants (men, 79.6%; mean age, 42.8 ± 17.7y; Whites, 62.3%) who had an SCI between October 2006 and March 2017.Interventions: Not applicable.Outcome Measures: All-cause mortality and causes of death. Life table method was used to estimate mortality rates, while Cox proportional hazard model was conducted to assess the impact of BMI on mortality after adjusting for demographic and injury-related factors.Results: Based on BMI obtained during initial rehabilitation, participants were classified into underweight (4.2%), normal weight (41.2%), overweight (30.9%) and obese (23.8%) groups, and their corresponding one-year mortality rates were 2.6%, 1.8%, 3.1%, 3.5%, respectively (P = 0.002). After adjusting for potential confounding factors, people with obesity had a higher mortality risk than those with normal weight (hazard ratio, 1.51; 95% confidence interval, 1.00-2.28). The most frequent causes of death for people with obesity were infective and parasitic diseases and respiratory diseases, while respiratory diseases were the most frequent for people with other BMI statuses.Conclusion: People with obesity who incur an SCI need special attention to prevent early mortality. Future studies should explore factors that contribute to such a higher mortality after SCI, such as preexisting conditions and comorbidities. The effects of BMI on long-term mortality also deserve further investigation.

Objective: To determine the association between spinal cord injury (SCI) etiology categories and mortality, and examine the association between etiology sub-categories and mortality. Design: Prospective cohort study. Setting: Model Systems and Shriners Hospital SCI units. Participants: Data were analyzed from 42,627 cases in the SCI Model System Collaborative Survival Study Database from 1973 to 2017. Those with SCI etiologies categorized as vehicular, violent, sports, falls, pedestrian, and medical were included. Interventions: Not applicable. Outcome Measure: Time to mortality after SCI. Results: Relative to the sports related etiology category, those with medical, pedestrian, violence, falls, and vehicular related SCIs had a 2.00 (95% confidence intervals (CIs): 1.79-2.24), 1.57 (CIs: 1.34-1.83), 1.54 (CIs: 1.41-1.68), 1.35 (CIs: 1.25-1.45), and 1.26 (CIs: 1.17-1.35) higher hazard for mortality, respectfully. Persons with SCIs from automobile crashes had a 1.38 (CIs: 1.23-1.56) higher hazard for mortality, whereas those with SCIs from motorcycle crashes had a 1.21 (CIs: 1.04-1.39) higher hazard for mortality, relative to other etiologies within the vehicular category. Those with SCIs from diving had a 1.37 (CIs: 1.18-1.59) higher hazard for mortality relative to other etiologies within the sports category. Conclusions: Injury etiology categories and certain sub-categories were associated with a higher risk for early mortality. Understanding how additional factors such as socioeconomic status, co-occurring injuries, medical co-morbidities, and environmental aspects interact with SCI etiologies may provide insights for how etiology of injury impacts survival. These findings may serve as a development for extending long-term life expectancy by informing SCI prevention programs and care post-injury.

Observational studies investigating large real-life datasets are a valuable resource in clinical research. Understanding the imperfect nature of clinical data, statistical approaches factoring in known confounders are instrumental for rigorously addressing bias.1 Our recent work identifying pneumonia and postoperative wound infections (Pn/Wi) as risk markers for impaired long-term functional recovery and survival after spinal cord injury (SCI)2 was considered as a strong statistical analysis.3 However, some unexplored putative confounders in terms of nonrandom loss to follow-up, temporal changes in clinical practice, and exclusion criteria were discussed.3 In order to evaluate and objectivize for the probability of attrition and temporal and selection bias, we apply and discuss an array of analytical tools extending beyond the format of the original publication.2

Objective: To quantify the burden of traumatic spinal cord injury (SCI) as defined by nonfatal health loss and premature mortality among a large sample of participants over a 44-year period, and estimate the national burden of SCI in the United States for the year 2010. Design: Longitudinal. Setting: National SCI Model Systems and Shriners Hospitals. Participants: Individuals (N=51,226) were categorized by neurologic level of injury as cervical (n=28,178) or thoracic and below (n=23,048). Main Outcome Measures: The burden of SCI was calculated in years lost due to premature mortality (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY). Results: For those with cervical level injuries, the overall YLLs and YLDs were 253,745 and 445,709, respectively, for an estimated total of 699,454 DALYs. For those with thoracic and below level injuries, the overall YLLs and YLDs were 153,885 and 213,160, respectively, for an estimated total of 367,045 DALYs. Proportionally adjusted DALYs attributable to SCI in 2010 were 445,911. Conclusions: SCIs accounted for over 1 million years of healthy life lost in a national sample over a 44-year span. We estimated that 445,911 DALYs resulted from SCIs in the US in 2010 alone, placing the national burden of SCIs above other impactful conditions such as human immunodeficiency virus/acquired immune deficiency syndrome. Future investigations may employ DALYs to monitor trends in SCI burden in response to innovations in SCI care and identify subgroups of persons with SCIs for whom tailored interventions might improve DALYs. (C) 2018 by the American Congress of Rehabilitation Medicine

Background: Among people with spinal cord injury (SCI), minorities experience a disproportionately higher burden of diseases. Knowledge of data quality by race/ethnicity will help better design racial health disparity research and understand potential errors/biases. Objective: To investigate racial/ethnic differences in response completeness in a longitudinal SCI database. Methods: This study included 7,507 participants (5,483 non-Hispanic whites, 1,414 non-Hispanic blacks, and 610 Hispanics) enrolled in the National SCI Database who returned for follow-up between 2001 and 2006 and were aged ≥18 years at follow-up. Missing data were defined as any missing, unknown, or refusal response to interview items. Results: The overall missing rate was 29.7%, 9.5%, 9.7%, 10.7%, 12.0%, and 9.8% for the Craig Handicap Assessment and Reporting Technique-Short Form (CHART) economic self-sufficiency subscale, CAGE questionnaire, drug use, Diener's Satisfaction with Life Scale, Patient Health Questionnaire, and pain severity, respectively. The missing rate for the CHART measure was significantly higher among non-Hispanic blacks and Hispanics than among non-Hispanic whites, after controlling for demographics, injury factors, mode of data collection, and study sites. The missing data in the other outcome measures examined were also significantly higher among non-Hispanic blacks than among non-Hispanic whites but were not significantly different between Hispanics and non-Hispanic whites. Conclusion: Our study highlights the importance of research methodology designed to improve non-response or response incompleteness, particularly in non-Hispanic blacks, as we move to reduce racial/ethnic disparities and strive to explain how and why disparities occur in the SCI population.

Objective: To describe the impact of an education program to prevent falls in full-time manual wheelchair users (MWU) living with Spinal Cord Injury (SCI).Design: Pre/post.At baseline, participants reported the frequency of falls over the past six months and completed the Community Participation Indicators(CPI) and the World Health Organization Quality of Life (short version -WHO-QOL BREF) assessment.Transfer quality to and from a mat table was assessed using the Transfer Assessment Instrument (TAI) and boundaries of seated stability were evaluated using standardized procedures.After baseline testing, a structured education program designed to decrease fall frequency was implemented.After the intervention, participants were asked to prospectively track fall frequency for 12 weeks.After 12 weeks, the assessment, as described above, was repeated.Participant/methods: 18 fulltime MWUs with SCI participated in the study.Participants were an average of 35.78 ± 13.89 y.o. and lived with their SCI for an average of 17 ± 15 years.The majority of participants were female (n = 11, 61.1%).Level of injury ranged from C4-L3, AIS A-C.To examine the differences in outcomes pre and post exposure to the education program, seated stability was evaluated using a paired t-test.Nonparametric Wilcoxon tests were used to evaluate all other variables due to the ordinal or non-normally distributed nature of the data.Results: After exposure to the intervention, fall frequency significantly decreased, (Pre: 1.37 ± 1.62 falls per month, Post: 0.67 ± 0.82, p = 0.047).A trend in the data indicated improvements in seated stability (Pre: 1.22 ± .26,Post: 1.35 ± .26,p = 0.06).Finally, significant improvements were found in the Post: 75.61 ± 16.38 p = 0.05) and Psychological (Pre: 69.06 ± 14.67, Post: 76.17 ± 17.62, p = 0.040) domains.No significant differences were found among TAI or CPI scores. Conclusion:The structured fall prevention education program specifically designed for MWUs living with SCI appears to have potential to reduce fall frequency and improve quality of life.Additional research in the form of a large-scale, controlled investigation of the program is needed to further assess program effectiveness.

This cross-sectional analysis of longitudinal data was conducted to document demographic and clinical characteristics of newly injured and prevalent population with spinal cord injury (SCI) in the United States. 32.727 people with traumatic SCI who received initial hospital care from one of the 30 SCI Model Systems Centers since the early 1970s were included in the analyses with data on demographic, injury and medical characteristics, and psychosocial wellbeing obtained during the initial hospitalization and at year 1, 5, and every 5 years after injury through 2017. Age at injury has increased from 29 years in the 1970s to 42 years currently. This aging phenomenon was noted for all sexes, races, and etiologies except acts of violence. Although vehicular crashes continue to be the leading cause of SCI overall, injuries due to falls have increased over time particularly among those aged 46 years and older. Injuries resulting in tetraplegia are increasing while neurologically complete injuries are decreasing. Lengths of stay in the acute hospital and rehabilitation unit have declined. About 30% of persons with SCI are re-hospitalized during any given year following injury. Diseases of the genitourinary system are the leading cause of re-hospitalization. Mortality rates are significantly higher during the first year after injury. The life expectancy has improved but remain significantly below life expectancies of persons without SCI. The causes of death that have the greatest impact on reduced life expectancy over the last 5 decades are pneumonia and septicemia. Study findings call for geriatrics expertise in the care for SCI and also highlights the need for a multi-dimensional risk assessment and intervention to reduce falls and SCI in older adults. Within the prevalent population, those who survive many years typically will have less severe injuries, high levels of independence and overall good health.

STUDY DESIGN:Retrospective observational.OBJECTIVES:To compare results of several different methods for calculating life expectancy in the same sample of people with spinal cord injury (SCI), and critically assess their advantages and disadvantages.SETTING:Two spinal centres in Great Britain.METHODS:Survival status of persons with traumatic SCI injured between 1943 and 2010 with follow-up to 2015 was determined. Standardised mortality ratios (SMRs) were calculated using age at injury and current (attained) age, and compared. Life expectancy was then estimated using the SMR methods and compared with the results of a method based on multivariate logistic regression of a person-year dataset. Life expectancy estimates calculated by applying SMRs based on current age to general population period (current) and cohort (projected) life tables were also compared.RESULTS:The estimated life expectancies were significantly higher when the SMRs were based on age at injury. They were also higher when a general population cohort life table was used, particularly for younger ages. With the exception of the ventilator-dependent group, the life expectancy estimates derived from logistic regression were slightly lower than those derived from SMRs based on current age and a general population period life table.CONCLUSIONS:The multivariate logistic regression of person-years method offers several advantages compared to the SMR method for calculating life expectancy after SCI, the main ones being: greater statistical power and precision with smaller sample sizes, the ability to include more predictive factors and to distinguish the otherwise confounded effects of current age, time post-injury, and calendar time.