Traumatic Spinal Cord Injury and Subsequent Risk of Developing Chronic Cardiovascular, Neurologic, Psychiatric, and Endocrine Disorders

Importance: While acute complications of traumatic spinal cord injury (TSCI) are well characterized, long-term systemic sequelae remain poorly understood, particularly in previously healthy individuals. Objective: To evaluate the long-term risk of neurologic, psychiatric, cardiovascular, and endocrine comorbidities and associated mortality in patients with TSCI compared with matched uninjured controls. Design, Setting, and Participants: This retrospective cohort study analyzed longitudinal data from 2 large hospital-based registries (January 1996 to January 2024): Mass General Brigham (MGB) and the University of California (UC) Health System. Individuals with preexisting diagnoses of studied comorbidities were excluded. Uninjured controls were matched 3:1 by age, sex, and race. The data were analyzed in September to December 2024. Exposure: TSCI. Main Outcomes and Measures: Incidence of cardiovascular, endocrine, neurologic, and psychiatric conditions, as defined by International Classification of Diseases, Ninth Revision (ICD-9) or Tenth Revision (ICD-10). Associations between TSCI and comorbidities, and their association with all-cause mortality, were evaluated using multivariable Cox and logistic regression models. Results: A total of 1038 patients with TSCI in the MGB cohort (602 [58%] male; median [IQR] age, 44 [31-59] years) and 1711 in the UC cohort (1111 [65%] male; median [IQR] age, 45 [32-58] years) were matched with 3114 uninjured control participants in MGB (median [IQR] age, 43 [31-59] years) and 5133 uninjured control participants in UC (median [IQR] age, 45 [31-60] years). Compared with controls, patients with TSCI had significantly higher risk of hypertension (hazard ratio [HR], 1.6; 95% CI, 1.3-1.9), hyperlipidemia (HR, 1.5; 95% CI, 1.3-1.8), ischemic stroke (HR, 2.5; 95% CI, 1.7-3.7), coronary artery disease (HR, 1.8; 95%CI: 1.3-2.5), and diabetes (HR, 1.5; 95% CI, 1.1-2.1), along with other neurologic and psychiatric conditions. The risk of post-TSCI comorbidities was elevated across different age groups, including patients aged 18 to 45 years compared with age-matched controls, with higher rates of hypertension (HR 1.5, 95% CI 1.1-2.1) and ischemic stroke (HR 2.8, 95% CI 1.3-6.0) observed in the TSCI group. Similar findings were seen in a separate cohort of 1711 patients with TSCI from UC Health. Postinjury hypertension (odds ratio [OR], 2.0; 95% CI, 1.2-3.5), pituitary dysfunction (OR, 6.5; 95% CI, 1.1-33.2), adrenal insufficiency (OR, 5.0; 95% CI, 1.04-20.2), depression (OR, 2.9; 95% CI, 1.6-5.2), substance misuse (OR, 4.0; 95% CI, 1.5-9.8), seizures (OR, 6.4; 95% CI, 2.7-14.5), and dementia (OR, 4.8; 95% CI, 2.0-11.6) were associated with higher mortality. Conclusions and Relevance: In this cohort study, TSCI was associated with increased long-term risk of multisystem morbidity and elevated mortality-even in previously healthy patients. These findings underscore the need for proactive, longitudinal, and multidisciplinary approaches to prevent complications and protect this high-risk population.