Long-Term Survival and Life Expectancy After Spinal Cord Injury in Salzburg, Austria: A Retrospective Population-Based Study.

BACKGROUND

Spinal cord injury (SCI) is associated with substantial morbidity, premature mortality, and reduced life expectancy. However, population-based survival data that include both traumatic and non-traumatic cases are limited.

METHODS

We retrospectively analyzed all 587 Salzburg residents diagnosed with SCI between 2013 and 2023. Cases were identified from hospital records and verified through the Austrian mortality registry. Crude mortality rates (CMRs) at 1-, 2-, and 5-year intervals, standardized mortality ratios (SMRs), and life expectancy (LE) differences compared with the general population were calculated by age, sex, and injury type. Causes of death were classified as natural or external.

RESULTS

Of 587 patients, 488 (83%) had non-traumatic and 99 (17%) traumatic SCI; median age at onset was 62 years. By January 2025, 138 patients (24%) had died, predominantly from cardiovascular and neoplastic causes. CMRs increased steeply with age, rising from 10.5 per 100,000 at 1 year to 19.4 at 5 years. SMRs were markedly elevated in younger patients (e.g., age 30-44: 71.7 at 1 year) and decreased with advancing age. Life expectancy was consistently lower than in the general population, with the greatest reductions in younger and middle-aged males with non-traumatic injuries (e.g., 50-year-old males: LE difference 3.4 years at 1 year).

CONCLUSIONS

SCI substantially reduces life expectancy, with younger individuals experiencing disproportionate relative mortality and older adults bearing the highest absolute risk. These findings highlight the need for tailored long-term strategies, including preventive measures for younger patients and comprehensive chronic disease management for older populations.