Mortality Due to COVID-19 Among Persons With Traumatic Spinal Cord Injury in the United States: 2020-2022

To quantify excess mortality due to COVID-19 among persons with traumatic spinal cord injury (TSCI).

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.

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.

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.