The US Department of Veterans Affairs (VA) is the largest system of care for individuals with spinal cord injury/disorder (SCI/D) in the world. This article compares demographics, utilization, diagnoses, and associated costs between veterans with traumatic and nontraumatic SCI/D. Regression analyses were used to predict the effect of injury etiology on patient utilization and cost after controlling for covariates. Veterans with a nontraumatic SCI/D were significantly older with a greater number of comorbidities and outpatient utilization; however, there was no difference in health care costs between groups, and injury etiology was not a significant predictor of cost. Recommendations for future research based on these findings are offered.
Office of Public Affairs Media Relations. Fact sheet: VA and spinal cord injury. 2009. Washington, DC, Department of Veterans Affairs. May 19, 2010. http://www1.va.gov/opa/publications/factsheets/fs_spinal_cord_injury.pdf. Accessed November 10, 2010. http://www1.va.gov/opa/publications/factsheets/fs_spinal_cord_injury.pdf
Harvey C, Wilson SE, Greene CG, Berkowitz M, Stripling TE. New estimates of the direct costs of traumatic spinal cord injuries: results of a nationwide survey. Paraplegia. 1992;30(12):834-850.
,
New estimates of the direct costs of traumatic spinal cord injuries: results of a nationwide survey
, Paraplegia.
, vol. 30
(pg. 834
-850
) Dryden DM, Saunders LD, Jacobs P, et al. Direct health care costs after traumatic spinal cord injury. J Trauma. 2005;59(2):443-449.
,
Direct health care costs after traumatic spinal cord injury
, J Trauma.
, vol. 59
(pg. 443
-449
) Johnson RL, Brooks CA, Whiteneck GG. Cost of traumatic spinal cord injury in a population-based registry. Spinal Cord. 1996;34(8):470-480.
,
Cost of traumatic spinal cord injury in a population-based registry
, Spinal Cord.
, vol. 34
(pg. 470
-480
) Munce SE, Guilcher SJ, Couris CM, et al. Physician utilization among adults with traumatic spinal cord injury in Ontario: a population-based study. Spinal Cord. 2009;47(6):470-476.
,
Physician utilization among adults with traumatic spinal cord injury in Ontario: a population-based study
, Spinal Cord.
, vol. 47
(pg. 470
-476
) Guilcher SJ, Munce SE, Couris CM, et al. Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study. Spinal Cord. 2010;48(1):45-50.
,
Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study
, Spinal Cord.
, vol. 48
(pg. 45
-50
) Cosar SN, Yemisci OU, Oztop P, et al. Demographic characteristics after traumatic and non-traumatic spinal cord injury: a retrospective comparison study. Spinal Cord. 2010;48(12):862-866.
,
Demographic characteristics after traumatic and non-traumatic spinal cord injury: a retrospective comparison study
, Spinal Cord.
, vol. 48
(pg. 862
-866
) New PW, Sundararajan V. Incidence of non-traumatic spinal cord injury in Victoria, Australia: a population-based study and literature review. Spinal Cord. 2008;46(6):406-411.
,
Incidence of non-traumatic spinal cord injury in Victoria, Australia: a population-based study and literature review
, Spinal Cord.
, vol. 46
(pg. 406
-411
) Hagen EM, Rekand T, Gilhus NE, Gronning M. Diagnostic coding accuracy for traumatic spinal cord injuries. Spinal Cord. 2009;47(5):367-371.
,
Diagnostic coding accuracy for traumatic spinal cord injuries
, Spinal Cord.
, vol. 47
(pg. 367
-371
) Thurman D, Sniezek J, Johnson D, Greenspan A, Smith S. Guidelines for Surveillance of Central Nervous System Injury. Atlanta: Center for Disease Control and Prevention; 1995.
,
Guidelines for Surveillance of Central Nervous System Injury.
Edward J. Hines, Jr. VA Hospital. VIReC research user guide: FY 2002 VHA medical SAS outpatient datasets. Hines, IL: Veterans Affairs Information Resource Center; January 2003. http://www.virec.research.va.gov/References/RUG/RUG-Outpatient02.pdf. Accessed November 10, 2010. http://www.virec.research.va.gov/References/RUG/RUG-Outpatient02.pdf.
Edward J. Hines, Jr. VA Hospital. VIReC research user guide: FY 2002 VHA medical SAS inpatient datasets. Hines, IL: Veterans Affairs Information Resource Center; April 2003. http://www.virec.research.va.gov/References/RUG/RUG-Inpatient02.pdf. Accessed November 10, 2010. http://www.virec.research.va.gov/References/RUG/RUG-Inpatient02.pdf
Edward J. Hines, Jr. VA Hospital. VIReC research user guide: VHA pharmacy prescription data. 2nd ed. Hines, IL: Veterans Affairs Information Resource Center; November 2008. http://www.virec.research.va.gov/References/RUG/RUG-Pharmacy-2nd-Ed-er.pdf. Accessed November, 10 2010. http://www.virec.research.va.gov/References/RUG/RUG-Pharmacy-2nd-Ed-er.pdf.
Thomas AJ, Eberly LE, Davey SG, Neaton JD. ZIP-code-based versus tract-based income measures as long-term risk-adjusted mortality predictors. Am J Epidemiol. 2006;164(6):586-590.
,
ZIP-code-based versus tract-based income measures as long-term risk-adjusted mortality predictors
, Am J Epidemiol.
, vol. 164
(pg. 586
-590
) FY 2008 Geographic Access to Veterans Health Administration Services. Office of the Assistant Deputy Under Secretary for Health Policy and Planning; 2008.
Phibbs C, Barnett P, Fan A, Harden C, King S, Scott J. Research Guide to Decision Support System National Cost Extracts. Menlo Park, CA:, Health Economics Resource Center of Health Service R&D Services Department of Veterans Affairs; 2010. http://www.herc.research.va.gov/files/BOOK_621.pdf http://www.herc.research.va.gov/files/BOOK_621.pdf
Smith MW, Chow A. Fee Basis Data: A Guide for Researchers. Menlo Park, CA: VA Palo Alto, Health Economics Resource Center; 2010.
,
Fee Basis Data: A Guide for Researchers.
Barber JA, Thompson SG. Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med. 2000;19(23):3219-3236.
,
Analysis of cost data in randomized trials: an application of the non-parametric bootstrap
, Stat Med.
, vol. 19
(pg. 3219
-3236
) Efron B, Tibshirani R. An Introduction to the Bootstrap. New York: Chapman and Hall; 1993.
,
An Introduction to the Bootstrap
Long JS, Freese J. Regression Models for Categorical Dependent Variables Using Stata. 2nd ed. College Station, TX: Stata Press; 2006.
,
Regression Models for Categorical Dependent Variables Using Stata.
Barber J, Thompson S. Multiple regression of cost data: use of generalized linear models. J Health Serv Res Policy. 2004;9:197-204.
,
Multiple regression of cost data: use of generalized linear models
, J Health Serv Res Policy.
, vol. 9
(pg. 197
-204
) McCullagh P, Nelder J. Generalized Linear Models. 2nd ed. London: Chapman and Hall; 1989.
,
Generalized Linear Models.
Manning WG, Mullahy J. Estimating log models: to transform or not to transform? J Health Econ. 2001;20(4):461-494.
,
Estimating log models: to transform or not to transform?
, J Health Econ.
, vol. 20
(pg. 461
-494
) Ones K, Yilmaz E, Beydogan A, Gultekin O, Caglar N. Comparison of functional results in non-traumatic and traumatic spinal cord injury. Disabil Rehabil. 2007;29(15):1185-1191.
,
Comparison of functional results in non-traumatic and traumatic spinal cord injury
, Disabil Rehabil.
, vol. 29
(pg. 1185
-1191
) Migliorini CE, New PW, Tonge BJ. Comparison of depression, anxiety and stress in persons with traumatic and non-traumatic post-acute spinal cord injury. Spinal Cord. 2009;47(11):783-788.
,
Comparison of depression, anxiety and stress in persons with traumatic and non-traumatic post-acute spinal cord injury
, Spinal Cord.
, vol. 47
(pg. 783
-788
) McKinley WO, Tewksbury MA, Godbout CJ. Comparison of medical complications following nontraumatic and traumatic spinal cord injury. J Spinal Cord Med. 2002;25(2):88-93.
,
Comparison of medical complications following nontraumatic and traumatic spinal cord injury
, J Spinal Cord Med.
, vol. 25
(pg. 88
-93
) McKinley WO, Tewksbury MA, Mujteba NM. Spinal stenosis vs traumatic spinal cord injury: a rehabilitation outcome comparison. J Spinal Cord Med. 2002;25(1):28-32.
,
Spinal stenosis vs traumatic spinal cord injury: a rehabilitation outcome comparison
, J Spinal Cord Med.
, vol. 25
(pg. 28
-32
) Gupta A, Taly AB, Srivastava A, Vishal S, Murali T. Traumatic vs non-traumatic spinal cord lesions: comparison of neurological and functional outcome after in-patient rehabilitation. Spinal Cord. 2008;46(7):482-487.
,
Traumatic vs non-traumatic spinal cord lesions: comparison of neurological and functional outcome after in-patient rehabilitation
, Spinal Cord.
, vol. 46
(pg. 482
-487
) McKinley WO, Seel RT, Gadi RK, Tewksbury MA. Nontraumatic vs. traumatic spinal cord injury: a rehabilitation outcome comparison. Am J Phys Med Rehabil. 2001;80(9):693-699.
,
Nontraumatic vs. traumatic spinal cord injury: a rehabilitation outcome comparison
, Am J Phys Med Rehabil.
, vol. 80
(pg. 693
-699
) Yu W, Ravelo A, Wagner TH, et al. Prevalence and costs of chronic conditions in the VA health care system. Med Care Res Rev. 2003;60(3 Suppl):146S-167S.
,
Prevalence and costs of chronic conditions in the VA health care system
, Med Care Res Rev.
, vol. 60
(pg. 146S
-167S
) New PW, Rawicki HB, Bailey MJ. Nontraumatic spinal cord injury: demographic characteristics and complications. Arch Phys Med Rehabil. 2002;83(7):996-1001.
,
Nontraumatic spinal cord injury: demographic characteristics and complications
, Arch Phys Med Rehabil.
, vol. 83
(pg. 996
-1001
) Fow NR, Yee J, Wilson-O’Connor D, Spataro R. MMPI-2 profiles in traumatic and non-traumatic spinal cord injured patients. J Clin Psychol. 1996;52(5):573-579.
,
MMPI-2 profiles in traumatic and non-traumatic spinal cord injured patients
, J Clin Psychol.
, vol. 52
(pg. 573
-579
) Osterthun R, Post MW, van Asbeck FW. Characteristics, length of stay and functional outcome of patients with spinal cord injury in Dutch and Flemish rehabilitation centres. Spinal Cord. 2009;47(4):339-344.
,
Characteristics, length of stay and functional outcome of patients with spinal cord injury in Dutch and Flemish rehabilitation centres
, Spinal Cord.
, vol. 47
(pg. 339
-344
) Lishner DM, Richardson M, Levine P, Patrick D. Access to primary health care among persons with disabilities in rural areas: a summary of the literature. J Rural Health. 1996;12(1):45-53.
,
Access to primary health care among persons with disabilities in rural areas: a summary of the literature
, J Rural Health.
, vol. 12
(pg. 45
-53
) LaVela SL, Smith B, Weaver FM, Miskevics SA. Geographical proximity and health care utilization in veterans with SCI&D in the USA. Soc Sci Med. 2004;59(11):2387-2399.
,
Geographical proximity and health care utilization in veterans with SCI&D in the USA
, Soc Sci Med.
, vol. 59
(pg. 2387
-2399
) Garshick E, Kelley A, Cohen SA, et al. A prospective assessment of mortality in chronic spinal cord injury. Spinal Cord. 2005;43(7):408-416.
,
A prospective assessment of mortality in chronic spinal cord injury
, Spinal Cord.
, vol. 43
(pg. 408
-416
) Rajan S, Hammond MC, Goldstein B. Trends in diabetes mellitus indicators in veterans with spinal cord injury. Am J Phys Med Rehabil. 2008;87(6):468-474.
,
Trends in diabetes mellitus indicators in veterans with spinal cord injury
, Am J Phys Med Rehabil.
, vol. 87
(pg. 468
-474
) Chen D, Apple DF, Jr., Hudson LM, Bode R. Medical complications during acute rehabilitation following spinal cord injury--current experience of the Model Systems. Arch Phys Med Rehabil. 1999;80(11):1397-1401.
,
Medical complications during acute rehabilitation following spinal cord injury--current experience of the Model Systems
, Arch Phys Med Rehabil.
, vol. 80
(pg. 1397
-1401
) Finnerup NB, Johannesen IL, Sindrup SH, Bach FW, Jensen TS. Pain and dysesthesia in patients with spinal cord injury: a postal survey. Spinal Cord. 2001;39(5):256-262.
,
Pain and dysesthesia in patients with spinal cord injury: a postal survey
, Spinal Cord.
, vol. 39
(pg. 256
-262
) Jensen MP, Hoffman AJ, Cardenas DD. Chronic pain in individuals with spinal cord injury: a survey and longitudinal study. Spinal Cord. 2005;43(12):704-712.
,
Chronic pain in individuals with spinal cord injury: a survey and longitudinal study
, Spinal Cord.
, vol. 43
(pg. 704
-712
) Siddall PJ, McClelland JM, Rutkowski SB, Cousins MJ. A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain. 2003;103(3):249-257.
,
A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury
, Pain.
, vol. 103
(pg. 249
-257
) Ullrich PM, Jensen MP, Loeser JD, Cardenas DD, Weaver FM. Pain among veterans with spinal cord injury. J Rehabil Res Dev. 2008;45(6):793-800.
,
Pain among veterans with spinal cord injury
, J Rehabil Res Dev.
, vol. 45
(pg. 793
-800
) French DD, Campbell RR, Sabharwal S, Nelson AL, Palacios PA, Gavin-Dreschnack D. Health care costs for patients with chronic spinal cord injury in the Veterans Health Administration. J Spinal Cord Med. 2007;30(5):477-481.
,
Health care costs for patients with chronic spinal cord injury in the Veterans Health Administration
, J Spinal Cord Med.
, vol. 30
(pg. 477
-481
) Yu W, Ravelo A, Wagner TH, Barnett PG. The relationships among age, chronic conditions, and healthcare costs. Am J Manag Care. 2004;10(12):909-916.
,
The relationships among age, chronic conditions, and healthcare costs
, Am J Manag Care.
, vol. 10
(pg. 909
-916
) Yu W, Smith B, Kim S, Chow A, Weaver FM. Major medical conditions and VA healthcare costs near end of life for veterans with spinal cord injuries and disorders. J Rehabil Res Dev. 2008;45(6):831-839.
,
Major medical conditions and VA healthcare costs near end of life for veterans with spinal cord injuries and disorders
, J Rehabil Res Dev.
, vol. 45
(pg. 831
-839
) Burnett DM, Cifu DX, Kolakowsky-Hayner S, Kreutzer JS. Predicting “charge outliers” after spinal cord injury: a multicenter analysis of demographics, injury characteristics, outcomes, and rehabilitation charges. Arch Phys Med Rehabil. 2001;82(1):114-119.
,
Predicting “charge outliers” after spinal cord injury: a multicenter analysis of demographics, injury characteristics, outcomes, and rehabilitation charges
, Arch Phys Med Rehabil.
, vol. 82
(pg. 114
-119
) Johnson RL, Brooks CA, Whiteneck GG. Cost of traumatic spinal cord injury in a population-based registry. Spinal Cord. 1996;34(8):470-480.
,
Cost of traumatic spinal cord injury in a population-based registry
, Spinal Cord.
, vol. 34
(pg. 470
-480
) DeVivo MJ. Causes and costs of spinal cord injury in the United States. Spinal Cord. 1997;35(12):809-813.
,
Causes and costs of spinal cord injury in the United States
, Spinal Cord.
, vol. 35
(pg. 809
-813
) Menter RR, Whiteneck GG, Charlifue SW et al. Impairment, disability, handicap and medical expenses of persons aging with spinal cord injury. Paraplegia. 1991;29(9):613-619.
,
Impairment, disability, handicap and medical expenses of persons aging with spinal cord injury
, Paraplegia.
, vol. 29
(pg. 613
-619
) Cifu DX, Seel RT, Kreutzer JS, McKinley WO. A multicenter investigation of age-related differences in lengths of stay, hospitalization charges, and outcomes for a matched tetraplegia sample. Arch Phys Med Rehabil. 1999;80(7):733-740.
,
A multicenter investigation of age-related differences in lengths of stay, hospitalization charges, and outcomes for a matched tetraplegia sample
, Arch Phys Med Rehabil.
, vol. 80
(pg. 733
-740
) Kashner TM. Agreement between administrative files and written medical records: a case of the Department of Veterans Affairs. Med Care. 1998;36(9):1324-1336.
,
Agreement between administrative files and written medical records: a case of the Department of Veterans Affairs
, Med Care.
, vol. 36
(pg. 1324
-1336
)
This content is only available as a PDF.
