Introduction: The need for long-term planning of health policy and health services for individuals with non-traumatic spinal cord injuries (NTSCI) is underscored by the rising incidence in aging populations and increasingly hampered by a deficit of estimates on the burden of mortality. As NTSCI is secondary to a heterogeneous group of diseases and pathologies, there is a particular need for etiology-specific estimates of all-cause and cause-specific mortality. Therefore, the objective of the present study is to evaluate all-cause and cause-specific mortality across NTSCI etiologies, with respect to the general population (GP) in Switzerland.

Methods: Longitudinal data from the Swiss Spinal Cord Injury (SwiSCI) medical records study were probabilistically linked with Swiss National Cohort data for cause of death (CoD) information. Standardized mortality ratios (SMRs) were used as relative estimates of all-cause (acSMR) and cause-specific mortality (csSMR) in comparison to the Swiss GP. A competing risk analysis was performed to estimate the marginal probability of death in the presence of competing CoD.

Results: 1,501 individuals were admitted to first rehabilitation for NTSCI between 1990-2011. CoD information was available for 454 individuals. The overall mortality rate was 1.6 times greater compared to the Swiss GP. Death from neoplasms (22%) and ischemic heart disease (12.5%) were most often reported. In cases of NTSCI due to a malignant tumor, the most common CoD was due to ‘neoplasms of the male genitalia’ (27%). The relative burden of mortality due to a digestive disease was greatest in individuals with an infection etiology (csSMR 5.1; 95% CI 1.3-20.3) and in those with a degenerative disc disorder (csSMR 3.9; 95% CI 1.9-8.2). Individuals with an NTSCI suffering from a vascular disorder were vulnerable to death due to infection (csSMR 5.4; 95% CI 3.1-9.2) and cardiovascular disease (csSMR 4.1; 95% CI 3.2-5.3). The marginal probability of death due to cardiovascular disease was particularly high in individuals with complete spinal cord lesions, especially within the first year after diagnosis.

Conclusions: Cause-specific SMRs varied according to NTSCI etiology, supporting the establishment of a differentiated clinical approach for this growing population. Cardiovascular disease, infection and gastrointestinal disease emerged as main causes of death following NTSCI, and are therefore promising targets for future research and health policy.

Introduction
Ensuring labor market participation (LMP) of persons with spinal cord injury (SCI) represents a major challenge and, at the same time, a key goal of SCI rehabilitation. In Switzerland, a recent study (Reinhardt et al. 2016, PlosOne) showed that 53.4% of individuals with SCI are involved in paid employment, which is around 30% points less compared to the general population, and that their LMP is mostly affected by low education and high lesion severity (i.e. tetraplegia). International literature underlines that LMP of persons with SCI is affected by a variety of modifiable and non-modifiable conditions, including socio-demographics, SCI-related factors, medical issues, function-related aspects as well as environmental and psychological personal factors. While most previous investigations focused on only one or a few determinants of LMP, it seems important to consider a broader range of factors, and especially conditions that are amenable to modification, such that findings can eventually inform medical and vocational integration practices, services and policies.
By taking such a broad perspective, our study aimed to identify associations between selected modifiable factors related to health, functional independence as well as the environment and LMP of persons with SCI living in Switzerland.

Methods
Cross-sectional study using data from the 2012 community survey of the Swiss Spinal Cord Injury Cohort Study. LMP (i.e. involvement in paid work or not) was determined for a sample of 966 persons with traumatic SCI who were of employable age at the time of the survey. Applying an exploratory approach, potential predictors of LMP were selected based on the literature and using a bidirectional stepwise variable selection approach. Descriptive statistics were calculated and bootstrapped multiple logistic regression was applied to describe the associations between the selected predictor variables and LMP, by controlling for socio-demographics (i.e. sex, age, education) and SCI-related characteristics (i.e. lesion severity, time since SCI).

Results
A total of 568 (58.8%) participants were involved in paid work at the time of the survey. From the 22 selected predictor and control variables, general functional independence and having a Swiss citizenship showed a positive and chronic pain, urinary tract infection and depression as well as SCI-related extra time needs for managing support a negative association with involvement in paid work.

Conclusions
Contrary to environmental factors, functional independence, health-related factors and nationality proved crucial for LMP of persons with SCI living in Switzerland. These factors should receive particular attention in medical and vocational strategies striving for a sustainable work integration of the affected persons.

Introduction: Survival following spinal cord injury (SCI) is a major problem in Bangladesh and other low- and middle-income countries (LMIC) with many people dying prematurely after they are discharged from hospital. However, there are no accurate estimates of the magnitude of the problem. Our study is unique because we followed a cohort for 5 years from a specialized hospital in Bangladesh from the time of discharge. The purpose of this study was to determine survival of people with SCI in Bangladesh 5 years after discharge from hospital and to develop a prediction model to identify those at risk of premature death.

Methods: Patients discharged from a hospital in Bangladesh in 2011 were identified using medical records. Participants or their family members were then contacted 5 years after discharge to determine vital status or date of death. Survival from time of discharge was estimated with Kaplan-Meier curves. Bootstrap variable selection was used to identify a simple set of predictors from 5 candidate predictors (age, sex, mobility, type of SCI, cause of SCI). The retained predictors were included in the final logistic model of the odds of death within 5 years of discharge. The model was internally validated.

Results: Three hundred and forty five people were identified from the medical records and discharged in 2011. Five years later, 342 (99%) were contacted. Of these, 74 (22%) had died (survival=78%; 95% CI 74% to 82%). Only two predictors were retained in the final prediction model (age and mobility). The odds of dying increased by a factor of 1.6 (95% CI, 1.3 to 2.0) with every decade of age and by a factor of 12.6 (95% CI, 4.8 to 32.9) if wheelchair-dependent. The final multivariate model included mobility at discharge and age as the predictors. The model had good calibration and discrimination.

Conclusion: The risk of dying after discharge from hospital with SCI in Bangladesh is high, especially amongst older and wheelchair-dependent people. A simple prediction model discriminates those at risk of death 5 years following discharge. This model can help healthcare providers prioritise care post discharge to those at most risk of dying: an important consideration for a country like Bangladesh where the healthcare dollar is scarce.

Introduction
An investigation was conducted to investigate the post-discharge mortality at the National Spinal Injuries Centre (NSIC) for patients requiring invasive ventilation and / or tracheostomy on discharge. This was a review in response to a high number of reported deaths soon after discharge which prompted further investigation.

Methods
A retrospective review of NSIC patients following their initial rehabilitation admission who were discharged between 1.1.12 and 1.11.18 were split into three groups based upon their ventilation requirements on discharge; patients requiring full time ventilation (FTV; more than 12hrs per day), patients requiring overnight ventilation (ONV; 12-8hrs per day) and patients requiring tracheostomy only with no ventilatory support, (TO).
Data was collected for each group regarding incidence of death and survival time before death, discharge destination (own home vs care home) and the relationship of this to death, and the provision of specialist ventilation and tracheostomy training to family members and the relationship of this to death.

Results
Within the study period 21 patients were found and allocated to the three groups (FTV n=8, ONV n=7, TO n=6). 52% (n= 11) of the patients had deceased with the lowest mortality found in the ONV group (27%) and joint highest mortality in the other groups (36%). The mean survival time before death was 257 days with the OVN group surviving almost double this at 503 days. An unexpectedly short time period between discharge and death was noted in all three groups with the shortest being 30 and 9 days in the OVN and TO groups respectively.
A home discharge compared to a care home was associated with a higher percentage of survival across all three groups; the FTV, OVN and TO groups showed a 75%, 33% and 50% higher survival percentage respectively. Furthermore, death occurred on average much quicker if the patient was discharged to a care home (58 days) compared to home (576 days).
A total of 10 patient’s families received ventilation and tracheostomy training. 60% of the patients alive at the end of the study period had family members trained.

Conclusion
This is the first known investigation internationally into post-discharge mortality of spinally injured patients related to discharge destination and family member training.
Spinal patients at the NSIC with a need for ventilation or a tracheostomy appear to have up to a 75% higher chance of survival, and can live for almost 9 times longer when discharged home compared to a care home. Patients who require overnight ventilation appear to be the most stable, with the lowest mortality and longest survival periods of the three groups investigated, and having a family member trained in ventilator and tracheostomy management carries a 60% higher chance of survival.
Further investigation is required to ascertain causes of death, age, and the contribution of co-morbidities. Care handover to care homes and follow up also warrant further focus.
This has led the author to consider prospective data collection and a review of the pathway of determining discharge destination for this patient group at the NSIC.

Objective: To investigate trends in the incidence and causes of traumatic SCI (TSCI) over a 10-year period.
Design, setting and participants: A retrospective cohort study of TSCI between 2007-2016 using data from the population-based Victorian State Trauma Registry. TSCI was defined as an injury to the spinal cord with an Abbreviated Injury Scale (AIS) score ≥ 4.
Main outcomes and measures: Temporal trends in population-based incidence rates.
Results: There were 706 cases of TSCI during the study period, which resulted mostly from transport events (38%) and low falls (28%). The overall incidence of TSCI was 1.26 cases per 100,000 population, and the incidence did not change over the study period (IRR = 1.01, 95% CI: 0.99,1.04; P=0.27). However, the incidence of TSCI resulting from low falls increased 9% per year (IRR = 1.09, 95% CI: 1.04,1.15; P=0.001). In line with this, the proportion of TSCI cases classified as incomplete tetraplegia increased from 41% in 2007 to 55% in 2016 (p<0.001). The overall in-hospital mortality rate was 15%.
Conclusions and Relevance: Given the often devastating consequences of TSCI, there is a need for enhanced primary prevention activities, particularly given an absence of a decline in the incidence of TSCI over a 10-year period. We noted a shift in the profile of TSCI to older adults sustaining incomplete cervical injuries often with central cord syndromes, which has implications for prevention, acute, and post-discharge care and support.
 
SIGNIFICANCE
The known
• Traumatic spinal cord injury (TSCI) is a serious public health issue with often debilitating and life-threatening effects.
The new
• We observed no change in the population-adjusted incidence of TSCI over the period of 2007-2016.
• However, the incidence in those aged 65 years and older increased 5% per year. In line with this, we observed a significant increase in the proportion of cases that were incomplete tetraplegia.
The implications
• An absence of a decline in the incidence of TSCI demonstrates the need for enhanced primary prevention activities.
• An increasing number of TSCI events in older adults has implications for prevention, acute, and post-discharge care and support.