Traumatic Spinal Cord Injury and Subsequent Risk of Developing Chronic Cardiovascular, Neurologic, Psychiatric, and Endocrine Disorders.

IMPORTANCE

While acute complications of traumatic spinal cord injury (TSCI) are well characterized, long-term systemic sequelae remain poorly understood, particularly in previously healthy individuals.

OBJECTIVE

To evaluate the long-term risk of neurologic, psychiatric, cardiovascular, and endocrine comorbidities and associated mortality in patients with TSCI compared with matched uninjured controls.

DESIGN, SETTING, AND

PARTICIPANTS

This retrospective cohort study analyzed longitudinal data from 2 large hospital-based registries (January 1996 to January 2024): Mass General Brigham (MGB) and the University of California (UC) Health System. Individuals with preexisting diagnoses of studied comorbidities were excluded. Uninjured controls were matched 3:1 by age, sex, and race. The data were analyzed in September to December 2024.

EXPOSURE: TSCI.

MAIN OUTCOMES AND MEASURES: Incidence of cardiovascular, endocrine, neurologic, and psychiatric conditions, as defined by International Classification of Diseases, Ninth Revision (ICD-9) or Tenth Revision (ICD-10). Associations between TSCI and comorbidities, and their association with all-cause mortality, were evaluated using multivariable Cox and logistic regression models.

RESULTS

A total of 1038 patients with TSCI in the MGB cohort (602 [58%] male; median [IQR] age, 44 [31-59] years) and 1711 in the UC cohort (1111 [65%] male; median [IQR] age, 45 [32-58] years) were matched with 3114 uninjured control participants in MGB (median [IQR] age, 43 [31-59] years) and 5133 uninjured control participants in UC (median [IQR] age, 45 [31-60] years). Compared with controls, patients with TSCI had significantly higher risk of hypertension (hazard ratio [HR], 1.6; 95% CI, 1.3-1.9), hyperlipidemia (HR, 1.5; 95% CI, 1.3-1.8), ischemic stroke (HR, 2.5; 95% CI, 1.7-3.7), coronary artery disease (HR, 1.8; 95%CI: 1.3-2.5), and diabetes (HR, 1.5; 95% CI, 1.1-2.1), along with other neurologic and psychiatric conditions. The risk of post-TSCI comorbidities was elevated across different age groups, including patients aged 18 to 45 years compared with age-matched controls, with higher rates of hypertension (HR 1.5, 95% CI 1.1-2.1) and ischemic stroke (HR 2.8, 95% CI 1.3-6.0) observed in the TSCI group. Similar findings were seen in a separate cohort of 1711 patients with TSCI from UC Health. Postinjury hypertension (odds ratio [OR], 2.0; 95% CI, 1.2-3.5), pituitary dysfunction (OR, 6.5; 95% CI, 1.1-33.2), adrenal insufficiency (OR, 5.0; 95% CI, 1.04-20.2), depression (OR, 2.9; 95% CI, 1.6-5.2), substance misuse (OR, 4.0; 95% CI, 1.5-9.8), seizures (OR, 6.4; 95% CI, 2.7-14.5), and dementia (OR, 4.8; 95% CI, 2.0-11.6) were associated with higher mortality.

CONCLUSIONS AND RELEVANCE: In this cohort study, TSCI was associated with increased long-term risk of multisystem morbidity and elevated mortality-even in previously healthy patients. These findings underscore the need for proactive, longitudinal, and multidisciplinary approaches to prevent complications and protect this high-risk population.