The Burden of Traumatic Spinal Cord Injury in the United States: Disability-Adjusted Life Years.

OBJECTIVE: To quantify the burden of traumatic spinal cord injury (SCI) as defined by nonfatal health loss and premature mortality among a large sample of participants over a 44-year period, and estimate the national burden of SCI in the United States for the year 2010. DESIGN: Longitudinal. SETTING: National SCI Model Systems and Shriners Hospitals. PARTICIPANTS: Individuals (N=51,226) were categorized by neurologic level of injury as cervical (n=28,178) or thoracic and below (n=23,048). MAIN OUTCOME MEASURES: The burden of SCI was calculated in years lost due to premature mortality (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY). RESULTS: For those with cervical level injuries, the overall YLLs and YLDs were 253,745 and 445,709, respectively, for an estimated total of 699,454 DALYs. For those with thoracic and below level injuries, the overall YLLs and YLDs were 153,885 and 213,160, respectively, for an estimated total of 367,045 DALYs. Proportionally adjusted DALYs attributable to SCI in 2010 were 445,911. CONCLUSIONS: SCIs accounted for over 1 million years of healthy life lost in a national sample over a 44-year span. We estimated that 445,911 DALYs resulted from SCIs in the US in 2010 alone, placing the national burden of SCIs above other impactful conditions such as human immunodeficiency virus/acquired immune deficiency syndrome. Future investigations may employ DALYs to monitor trends in SCI burden in response to innovations in SCI care and identify subgroups of persons with SCIs for whom tailored interventions might improve DALYs.

Disability attitudes in health care: a new scale instrument.

OBJECTIVE: The aims of this study were to develop and validate an instrument measuring attitudes toward providing health care to patients with disability, to compare the attitudes of preclinical and clinical medical students, and to examine whether sex, a background in disability, or career interest in physical medicine and rehabilitation affect medical student attitudes toward working with patients with disability. DESIGN: A cross-sectional survey was conducted in an academic medical center with participants that included preclinical (n = 63) and clinical medical (n = 58) students, physical medicine and rehabilitation residents (n = 18), and internal medicine residents (n = 10). A 17-item Disability Attitudes in Health Care scale was developed based on existing, validated geriatrics attitudes scales. Attitudes Toward Disabled Persons Form O scale was used for correlation testing. Background demographic data collected from medical student respondents included sex, previous personal or work experience with disability, and career interest in physical medicine and rehabilitation. RESULTS: The new scale demonstrated high reliability (Cronbach α = 0.74) and criterion validity (correlation coefficient = 0.54 with the Attitude Towards Disabled Persons scale). Attitudes were no different between preclinical and clinical medical students. Male medical students had more negative attitudes than female students did (P = 0.03). Students with a higher level of career interest in physical medicine and rehabilitation scored higher than less interested students did (P = 0.015). CONCLUSIONS: The new Disability Attitudes in Health Care scale developed in this study shows good internal consistency and criterion validity. Attitudes toward caring for patients with disability seem to be unrelated to the standard medical education curriculum or previous experience with disability. Specific educational experiences may be designed to engender more positive attitudes toward providing health care to this patient population.