Dissertation for Medicine Doctoral degree at Sahlgrenska Academy, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Health outcomes after spinal cord injury. Epidemiology, secondary conditions and long-term consequences in Sweden
Opponent: Associate Professor Páll Ingvarson Department of Rehabilitation, University of Iceland, Reykjavik
Examining committee: Associate Professor Kliment Gatzinsky (chair), Associate Professor Sofie Jörgensen (LU) and Associate Professor Elisabet Åkesson (KI)
The disputation is held in Swedish
Chairperson of the disputation: Associate Professor Alba Corell
Spinal cord injury (SCI) is associated with a substantial burden of secondary health conditions affecting long-term health and quality of life. Respiratory complications, cardiopulmonary morbidity, and neurogenic bowel dysfunction are among the common challenges following SCI.
The aim of this thesis was to investigate epidemiology, complications, healthcare utilization, and long-term outcomes for individuals with a SCI in Sweden.
Four studies were conducted using Swedish registry data, clinical records, and patient-reported outcomes. Study I examined respiratory complications during primary inpatient rehabilitation and their association with rehabilitation outcomes and survival. Study II described the epidemiology of adult SCI in Sweden using national registry data from 2016–2020. Study III investigated cardiopulmonary readmissions and prescription patterns during the first year after injury. Study IV assessed longitudinal changes in neurogenic bowel dysfunction and health-related quality of life using linked registry and survey data.
Respiratory complications were common during primary inpatient rehabilitation and were associated with longer rehabilitation stays and poorer survival. Population-based analyses showed that traumatic injury remained the most common cause of SCI in Sweden and that the mean age at injury was 56 years. Cardiopulmonary readmissions during the first year after SCI were uncommon, although older age was associated with increased risk. Prescription data revealed increased medication use after SCI, particularly for antibiotics. Long-term follow-up demonstrated that neurogenic bowel dysfunction remained common and was associated with reduced quality of life.
SCI is associated with a substantial burden of secondary health conditions across the rehabilitation continuum. While severe cardiopulmonary events requiring hospitalization are relatively uncommon, ongoing morbidity and healthcare needs remain considerable, highlighting the importance of structured long-term follow-up and management after SCI.