1. ## #'s don't add up

I've read here a couple of times that approx 10% of us die each year from complications, suicides, etc. There are approx 10,000 new injuries each year. There are also somewhere between 250,000 and 450,000 of us. For the purposes of this model let's assume 250,000.

SO: if 10% are dying that means 25,000 - 45,000 die each year and only 10,000 new members join our wonderful "club".

here's what the #'s look like:

Year # Die New Inj. SCI Popuation

1 25,000 10,000 235,000
2 23,500 10,000 221,500
3 22,150 10,000 209,350
4 20,935 10,000 198,415
5 19,842 10,000 188,574
6 18,857 10,000 179,716
7 17,972 10,000 171,745
8 17,174 10,000 164,570
9 16,457 10,000 158,113
10 15,811 10,000 152,302
....
72 10,008 10,000 100,076

Does this make any sense? If the SCI popuation is NOT falling, then I don't believe 10% die each year.

2. MKowalski,

The assumption of 10% mortality rate per year is too high. What you may have read was the 10% of Vietnam war veterans with spinal cord injury committed suicide but this was over a period of many years. There is no simple mortality rate that can be applied ot the spinal cord injury population. For obvious reasons, mortality rate must age adjusted. The older the population, the more likely that the mortality rate will be higher. For example, a population of people over 75 years old will have a much higher mortality rate than a population of people at 25 years old.

Zeilig, et al. (2000) looked at long term morbidity and mortality in 20 people with SCI in Israel over a 50 year period. Ten (50%) of the people died over this period with an average age at death of 60 years. In short, if spread out over 50 years, approximately 1% of the population died over a 50 year period. Hartkopf, et al. (1998) followed 888 individuals with spinal cord injury over 39 years and found that 236 died over the period. If one divided 236 by 39, it suggests that 6 (0.676%) people died per year.

Strauss & Shavelle (1998) examined the life expectancy of people with chronic disabilities for insurance purposes. This analysis illustrates some of the difficulties of estimating life expectancy in people with spinal cord injury. I posted a link to a site that purported to show the life expectancy after spinal cord injury but think that the site is wrong. http://carecure.org/forum/showthread.php?t=10225

One measure of death rate is the number of patients in the population that died over a 5 year period. Rish, et al. (1997) published a report of mortality in Vietnam veterans. They found that although the 5-year death rate improved over time, it never quite reached the same level as the general population. However, we should note that the main cause of death was sepsis. This may very well have been true in the early 1970's and 1980's when treatment of urinary tract and other infections was not as good as it is today.

Note, however, as the spinal cord injury community ages, the mortality rate. Because the population of people with chronic spinal cord injury is definitely older now than it was 20 years ago, it is probably reasonable to assume a 1% per year mortality rate. If you apply a 1% mortality rate per year, that is only 2500 of 250,000 per year. The population of the spinal cord injury community is probably increasing at the rate of 7500 per year, if so.

The 250,000 prevalence of SCI was estimated based on 1990 numbers. If we assume that 75000 additional people were injured in the United States over the past 10 years, this would suggest that the current prevalence is in the range of 325,000 in 2000. It is not unreasonable to round this up to 340,000 in 2002.

Wise.

• Zeilig G, Dolev M, Weingarden H, Blumen N, Shemesh Y and Ohry A (2000). Long-term morbidity and mortality after spinal cord injury: 50 years of follow-up. Spinal Cord. 38 (9): 563-6. Summary: OBJECTIVE: To determine the long-term mortality rate and the types of morbidity among all people with spinal cord injuries (SCI) that occurred during the 1948 Israel War of Independence. METHOD: Chart review and telephone interviews for collecting demographic data, injury characteristics, marital status, physical activities, employment, morbidity and mortality. RESULTS: Twenty individuals with SCI (19 males, one female). There was no regular follow-up during the first 20 years post injury. The most frequent morbidities were genito-urinary, cardiovascular and decubiti. Ten (50%) had died during this overall follow-up interval. The average age at death was 60 years. The cause of death was cardiovascular in six, neoplastic disease in two, pneumonia in one, and one died from an unknown cause. CONCLUSIONS: The data analysis showed that those who died participated less in physical activity and fewer were employed as compared to the survivors. Department of Neurological Rehabilitation, Sheba Medical Center, Tel-Hashomer, Israel.

• Hartkopp PA, Bronnum-Hansen H, Seidenschnur AM and Biering-Sorensen F (1998). [Survival and cause of death after traumatic spinal cord injury. A long-term epidemiological study]. Ugeskr Laeger. 160 (43): 6207-10. Summary: Life expectancy among individuals with spinal cord injuries (SCI) has remained lower than normal, even with optimal medical management. But improvement has been achieved, as shown by this study of an unselected population of survivors of traumatic SCI, dead or still living. There has been complete follow-up over four decades. The survey included a total of 888 individuals who had survived the injury and were rehabilitated at the Centre for the Spinal Cord Injured, East-Denmark between 1.1.1953-31.12.1990. At the end of the follow-up, 31st of December 1992, 236 had died. The most common causes of death were lung diseases, ischaemic heart diseases and suicide. The Standardised Mortality Ratios (SMRs) were highest for septicaemia, uraemia and pneumonia. Likewise, except for pneumonia, suicide and ischaemic heart disease, a decrease over time in SMRs was seen for all causes of death. The patterns of causes of death in the study group begin to approximate those of the general population. Rigshospitalet, Neurocenteret, Kobenhavn.

• Strauss D and Shavelle R (1998). Life expectancy of persons with chronic disabilities. J Insur Med. 30 (2): 96-108. Summary: The life expectancy is an important summary measure of an individual's prognosis for survival. The life table is the preferred method for computing life expectancies, but it is not always feasible. We show that for several chronic disabilities, the logarithms of the age-specific mortality ratios (relative to the general population) decline linearly with age, reaching parity at age 85 or older. This, combined with a standard modeling of an individual's current mortality rate, yields a set of age-specific mortality rates that can be used to produce a "customized" life table. The life expectancy is then immediately available. In a series of empirical comparisons the method performed better than an assumption of constant excess death rate (EDR), and much better than one of constant mortality ratio (MR). The method may be useful for a variety of non-progressive disabilities, such as cerebral palsy and injuries of the brain or spinal cord. Department of Statistics, University of California, Riverside 92521, USA.

• Rish BL, Dilustro JF, Salazar AM, Schwab KA and Brown HR (1997). Spinal cord injury: a 25-year morbidity and mortality study. Mil Med. 162 (2): 141-8. Summary: The morbidity and mortality occurring during 25 years following spinal cord injury were analyzed. A cohort of 230 patients was selected from the Vietnam Head and Spinal Cord Injury Study Registry meeting the following criteria: (1) survival beyond triage (72 hours); (2) significant myelopathy; and (3) availability of medical records. The military and Veteran's Hospital medical records were compiled and reviewed. Additional death records were obtained from the Department of Veterans Affairs pension office. The major morbidity problems continue to be sepsis related to genitourinary and decubiti sequelae. Psychosocial maladjustment and substance abuse were prevalent and created heavy health care demand. The most frequent cause of death was sepsis. Suicide in the paraplegic group occurred at a rate exceeding by 10 times the frequency reported for uninjured peers. Survival after 5 years approached but never reached the rate established for uninjured peers. Department of Neurosurgery, Eastern Virginia Medical School, Norfolk, VA, USA.

3. The newest figures available have the number of SCIs per year going up as the population grows. See sources at the bottom. Sorry but I don't do death statistics.

posted May 18, 2002 11:01 PM
--------------------------------------------------------------------------------
Numbers used by Quest For Cure (2001)

SPINAL CORD INJURY STATISTICS

There are currently 450,000 Americans living with a spinal cord injury. (1)
(This comes to a prevalence rate of 1,600 per million not the 721 to 906 from the data collected in the 1970s by the model systems. I got this by working backwards--281.4 (millions) times 1600 = 450,240.)

Population of the 50 States and the District of Columbia for April 2000 was 281,421,906. (7)

The cost to maintain the health, accessibility to the community abilities and other direct costs associated with these chronic injuries is approximately \$25,213 (2) annually depending on level of injury. This yearly charge comes to \$11,345,850,000. This is solely for direct costs related to the injury of the people injured.

Another 13,064 people became injured during the last year that figures are available for--1997 (3). The average first year costs for those newly injured, to include initial hospitilization, rehabilitation, home modifications and durable medical equipment such as wheelchairs, is just over \$244,000 each(4). This adds another \$3,187,616,000 to the national aggregate bill. At this point we are at \$14,533,466,000. for one condition, one disability, spinal cord injury.

Indirect costs from loss of productive employment due to unemployment, reduced employment or variations in employment based on level or severity of injury average \$13,000 annually(5). Another astounding loss to the nation of \$5,850,000,000. is added to the above figures.

Without even addressing the loss of family cohesion, social contacts, loss of other family members' income for caring for the injured individuals, this nation is suffering a yearly drain of economic proportions equal to \$ 20,383,466,000. This is equal to the entire budget of the National Institutes of Health! (6)
________________________________

1 American Association of Neurological Surgeons. http://www.neurosurgery.org/health/p...?DisorderID=42. Copy write 1998-2001, inclusive.

2 Spinal Cord Injury-An Analysis of Medical and Social Costs. Berkowitz, et al.; Demos Medical Publishing, NYC NY, 10016. Page 107

3 HCUPnet, Health Care Cost and Utilization Project. Agency for Health Care Research and Quality, Rockville, MD. http://www.ahrq.gov/data/hcup/hcupnet.htm

4 Spinal Cord Injury-An Analysis of Medical and Social Costs. Berkowitz, et al.; Demos Medical Publishing, NYC NY, 10016. Page 107.

5 Spinal Cord Injury-An Analysis of Medical and Social Costs. Berkowitz, et al.; Demos Medical Publishing, NYC NY, 10016. Page 107.

6 The Scientist 15[2]:1, Jan. 22, 2001
http://www.the-scientist.com/yr2001/...p1_010122.html

7 Source: U.S. Department of Commerce, U.S. Census Bureau. Internet Release date: December 28, 2000. http://www.census.gov/population/cen2000/tab02.txt

#### Posting Permissions

• You may not post new threads
• You may not post replies
• You may not post attachments
• You may not edit your posts
•