COVID-19 and mortality in the spinal cord injury population: examining the impact of sex, mental health, and injury etiology

Background/objective — The purpose of this study was to investigate the impact of the COVID-19 pandemic on mortality rates in a community-dwelling spinal cord injury (SCI) population in Ontario.

Methods — Using health administrative databases, monthly mortality rates were evaluated pre-pandemic, during the pandemic, and post-pandemic from March 2014 to May 2024. Data were stratified by sex, injury etiology, and mental health status. Group differences were evaluated using t-tests. Autoregressive integrated moving average (ARIMA) models evaluated the pandemic’s impact on mortality rates.

Results — A significant increase of 21.4% in mortality rates during the pandemic was found for the SCI cohort. With the exception of the traumatic group, all subgroups also experienced a significant increase in mortality rates (males: 13.9%, females: 31.9%, non-traumatic: 32.3%, mental health diagnoses: 19.6%, and mental health diagnoses: 29.4%). During the pandemic, females had a significantly higher mortality rate than males. The non-traumatic group had higher mortality rates than the traumatic group at all time periods. Individuals with mental health diagnoses had higher mortality rates than those without at the pre-pandemic and pandemic periods.

Conclusions — The variation in mortality rates across groups highlights inequitable access to medical care in the SCI population, with further research and interventions needed.