Mortality Due to COVID-19 Among Persons With Traumatic Spinal Cord Injury in the United States: 2020-2022.
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OBJECTIVES: To quantify excess mortality due to COVID-19 among persons with traumatic spinal cord injury (TSCI). METHODS: This cohort study was conducted at 31 SCI Model Systems and 3 Shriners Hospitals SCI units. Participants were persons with TSCI (n = 22,800) enrolled in the SCI Collaborative Survival Study Database with follow-up between January 1, 2020, and December 31, 2022. Main outcome measures were age- and sex-specific standardized mortality ratios (SMR), and 95% confidence intervals (CI) were calculated by age group, sex, injury severity, and years since injury. RESULTS: There were 102 deaths in the TSCI study population due to COVID-19 among 1138 total deaths of known cause (9.0%) that occurred in 57,109 person-years of follow-up. COVID-19 deaths ranked fourth behind heart disease (17.4%), respiratory disease (16.0%), and cancer (12.2%). The overall COVID-19 SMR for TSCI was estimated to be 1.42 (95% CI 1.15-1.70). The SMR increased with increasing injury severity and was higher among persons who were younger than 60 years of age and who were at least 20 years post injury. CONCLUSION: Persons with TSCI had 42% greater risk of dying from COVID-19 than the general population of comparable age and sex. These findings emphasize the need for up-to-date COVID-19 vaccinations and prompt treatment with Paxlovid and/or other antiviral medications. Now that the latest COVID-19 variants are less lethal and effective vaccines and treatments are available, additional follow-up will be needed to determine whether COVID-19 and its long-term effects continue to have a significant negative impact on life expectancy among persons with TSCI.