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Abstract
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OBJECTIVES: To examine the association between body mass index (BMI) 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 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: 2,346 participants with SCI were classified into one of the eight 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 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, and neurological status). The U-shape BMI-mortality relationship varied by age, sex, neurological 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/nutrition, and cardiorespiratory fitness.
Language: en |