Attrition from specialised rehabilitation associated with an elevated mortality risk: results from a vital status tracing study in Swiss spinal cord injured patients
Autor: | Xavier Jordan, Martin Schubert, Martin W. G. Brinkhof, Inge Eriks-Hoogland, Kerstin Hug, Jonviea D Chamberlain |
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Přispěvatelé: | Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lucerne (UNILU) |
Rok vydání: | 2020 |
Předmět: |
Adult
Male medicine.medical_specialty Adolescent Epidemiology medicine.medical_treatment statistics & research methods spine Medical Records Cohort Studies 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Risk of mortality Humans 030212 general & internal medicine Mortality Spinal cord injury Survival analysis Spinal Cord Injuries Aged Retrospective Studies Rehabilitation business.industry Vital Signs Medical record rehabilitation medicine Retrospective cohort study General Medicine Middle Aged medicine.disease neurological injury 3. Good health Emergency medicine [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie Female business 030217 neurology & neurosurgery Switzerland Cohort study |
Zdroj: | BMJ Open BMJ Open, BMJ Publishing Group, 2020, 10 (7), pp.e035752. ⟨10.1136/bmjopen-2019-035752⟩ |
ISSN: | 2044-6055 |
Popis: | IntroductionStudy drop-out and attrition from treating clinics is common among persons with chronic health conditions. However, if attrition is associated with adverse health outcomes, it may bias or mislead inferences for health policy and resource allocation.MethodsThis retrospective cohort study uses data attained through the Swiss Spinal Cord Injury (SwiSCI) cohort study on persons with spinal cord injury (SCI). Vital status (VS) was ascertained either through clinic medical records (MRs) or through municipalities in a secondary tracing effort. Flexible parametric survival models were used to investigate risk factors for going lost to clinic (LTC) and the association of LTC with subsequent risk of mortality.Results1924 individuals were included in the tracing study; for 1608 of these cases, contemporary VS was initially checked in the MRs. VS was ascertained for 704 cases of the 1608 cases initially checked in MRs; of the remaining cases (n=904), nearly 90% were identified in municipalities (n=804). LTC was associated with a nearly fourfold higher risk of mortality (HR=3.62; 95% CI 2.18 to 6.02) among persons with traumatic SCI. Extended driving time (ie, less than 30 min compared with 30 min and longer to reach the nearest specialised rehabilitation facility) was associated with an increased risk of mortality (HR=1.51, 95% CI 1.02 to 2.22) for individuals with non-traumatic SCI.ConclusionThe differential risk of LTC according to sociodemographic and SCI lesion characteristics underscores the importance of accounting for attrition in cohort studies on chronic disease populations requiring long-term care. In addition, given the associated risk of mortality, LTC is an issue of concern to clinicians and policy makers aiming to optimise the long-term survival of community-dwelling individuals with traumatic SCI. Future studies are necessary to verify whether it is possible to improve survival prospects of individuals LTC through more persistent outreach and targeted care. |
Databáze: | OpenAIRE |
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