Longitudinal healthcare utilization among traumatic spinal cord injury patients: a 20 year retrospective study using population-based data

Abstract Background Patients with traumatic spinal cord injury (TSCI) experience the healthcare system in a heterogeneous fashion after initial injury. This study performs a retrospective analysis of administrative data to identify patterns of longitudinal healthcare utilization among patients with TSCI in British Columbia, Canada, up to 20 years after initial hospitalization. Methods Using population-based administrative databases, adult patients with incident TSCIs were identified between January 2001 and December 2021. Population-based healthcare administrative and demographic data were used to determine physician services (primary care and specialist), hospital admissions (elective surgical, medical, and emergency department), and clinical information. Descriptive summaries measuring healthcare utilization per person year were calculated. Average utilization calculated in person years since the time of injury was compared between those under 65 years of age and those who were over 65, and based on the level of injury (cervical vs. thoracic/lumbar). Latent-class analysis identified characteristics associated with high healthcare utilization. Results The cohort included 4132 patients with an incident TSCI. On average, the patients had 18.9 primary care provider (PCP) visits per person year after their injury occurred. Patients had 13.9 specialist visits per person year, of which the most common was with a neurologist. The average rate of hospital admission for all patients was 1.4 visits per year, and emergency department encounters occurred on average were 0.7 visits per year. Patients 65 and over and those with cervical injuries consistently utilized more healthcare resources compared to younger patients and those with thoracic/lumbar injuries (p < 0.001). Latent class modelling found that the highest healthcare utilization was among those with cervical spinal cord injuries and who lived in an urban area. Conclusions Patients with TSCI had heterogeneous patterns of primary and specialist healthcare utilization up to 20 years after injury. Further analysis revealed that patients who had had cervical injuries and resided in urban centres accessed healthcare resources more frequently.