# Factors associated with long-term survival after traumatic and non-traumatic spinal cord injury: a 12-year population-based retrospective cohort study in Italy

## TL;DR

This study examines long-term survival and factors affecting mortality in individuals with spinal cord injuries in Italy over 12 years.

## Contribution

The study provides population-based insights into survival differences between traumatic and non-traumatic spinal cord injuries.

## Key findings

- Non-traumatic SCI had a higher case fatality rate (32.9%) compared to traumatic SCI (19.2%).
- Mortality risk increased with age and comorbidity burden, especially for traumatic SCI with CCI ≥ 3.
- Cancer was the leading cause of death in non-traumatic SCI, while circulatory diseases were common in both groups.

## Abstract

retrospective, population-based cohort study.

to evaluate long-term survival outcomes and factors affecting mortality in individuals with traumatic (TSCI) and non-traumatic spinal cord injury (NTSCI) in Italy.

Publicly funded rehabilitation units for SCI patients across Italy.

A total of 1070 individuals with confirmed TSCI (56.5%) or NTSCI, predominantly male (70.5%), residing in the Piedmont region, were identified through admission to specialized SCI rehabilitation units (2008–2020) using administrative data. Survival probabilities were estimated using Kaplan-Meier curves; Mortality risk was assessed using multivariate Cox regression models, and adjusted hazard ratios (HRs) were reported for sex, comorbidity burden (combined Charlson Comorbidity Index, CCI), and injury level (paraplegia/tetraplegia). Causes of death were retrieved from national mortality records.

The overall case fatality rate was 25.1%, higher in NTSCI (32.9%) than in TSCI (19.2%). Mortality increased with age and comorbidity burden. Among individuals with TSCI and CCI ≥ 3, mortality risk was significantly higher (HR 1.81; 95% CI 1.29–2.53). Sex (HR 1.05) and injury level (HR 1.10) were not significant predictors. Leading causes of death were cancer in NTSCI and circulatory diseases in both groups.

Age, comorbidities and injury type are the primary determinants of survival in SCI. The higher case fatality rate observed in NTSCI compared with TSCI underscores the prognostic relevance of etiology alongside frailty and multimorbidity. Our findings support early frailty screening, personalized comorbidity management, and the need for developing a dedicated national registry to inform long-term care strategies and improve outcomes in aging SCI populations.