Traumatic spinal cord injury was linked to markedly increased long-term risks of cardiovascular, neurologic, psychiatric, and endocrine disorders in a two-cohort analysis published in JAMA Network Open.
Adults with traumatic spinal cord injury (TSCI) developed hypertension, coronary artery disease, ischemic stroke, hyperlipidemia, dementia, seizures, depression, and substance misuse at significantly higher rates than matched uninjured individuals, reported Ahmad Mashlah, MBBS, of the Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, and colleagues.
Central findings included higher risks of hypertension and hyperlipidemia, coronary artery disease, ischemic stroke, dementia, seizure disorder, depression, and opioid misuse. Elevated risks persisted across both health systems and were evident even in adults aged 18 to 45 years, underscoring that the systemic disease burden following TSCI affects younger populations.
The researchers analyzed 1,038 adults with TSCI from Mass General Brigham and 1,711 from the University of California Health System, each matched 3:1 with uninjured controls by age, sex, and race. All participants with any preexisting comorbidity were excluded, meaning all measured conditions represented new-onset disease. Using electronic health records from 1996 to 2024, the researchers assessed 21 outcomes across multiple organ systems. Comorbidities emerged a median of 8 years following injury in the Mass General Brigham cohort and developed earlier in adults with TSCI than in matched controls.
Injury-level analyses showed that both cervical and thoracolumbar injuries carried increased risks across cardiovascular, neurologic, and psychiatric domains. Several conditions—including hypertension, adrenal insufficiency, pituitary dysfunction, depression, seizures, dementia, and substance misuse—were each associated with higher mortality among adults with TSCI. Findings remained consistent after adjusting for concomitant traumatic brain injury and were not explained by greater postinjury health care utilization.
Study limitations included reliance on ICD-coded diagnoses within two academic health systems, which may not fully capture disease severity or care received outside these networks. The exclusion of individuals with any preexisting comorbidities may have produced a particularly healthy cohort, potentially limiting generalizability, and some outcomes were based on small case numbers. Injury severity and trauma burden were not quantified, and mortality data were available only in one cohort, restricting cross-system comparisons.
"These findings underscore the need for proactive, longitudinal, and multidisciplinary approaches to prevent complications and protect this high-risk population," the researchers concluded.
Research funding and industry relationships outside the submitted work as detailed in the article.
Source: JAMA Network Open
