Traumatic spinal cord injury researchers call for greater care, rehab access

Associate Professor Elham Mahmoudi, Ph.D., a health economist with the Department of Family Medicine, has published a study exploring trends in healthcare use and costs before and after a person experiences a traumatic spinal cord injury (TSCI) in the U.S.  

People with TSCI face multiple physical and health challenges that may make them more susceptible to Emergency Department visits and potentially preventable hospitalizations. The study highlighted that TSCI, while rare, has significant health and economic impacts.  

Results of her research were recently published in “A 5-Year Longitudinal Retrospective Cohort Study of Healthcare Use and Costs before and after Incident Traumatic Spinal Cord Injury” in the journal Archives of Physical Medicine and Rehabilitation.  

Fellow authors include Paul Lin, MS., of the Institute for Healthcare Policy & Innovation; Adit Doza, Ph.D. and Zoe Gurney, BS, both from the Department of Family Medicine; and Clinical Professor Gianna M. Rodriguez, MD, of the Department of Physical Medicine & Rehabilitation, all at the University of Michigan.  

“Information about healthcare use and costs after incident TSCI is critical to assess care patterns compared with people without TSCI to examine demand and accessibility for specific healthcare services,” Mahmoudi and her team wrote. “Even though the majority of people with TSCI face permanent disability, the first year of injury is the most critical one, not only for survival and adjustment to life after trauma but also for its associated healthcare costs.” 

The researchers examined a commercial claims database covering about one-third of the employer-based insurance market in the U.S., as well as other sources for information about patient socioeconomic characteristics. They identified people 45 years or older with a TSCI diagnosis and with five years of continuous enrollment in the insurance from 2012-2015. In total, the team looked at records of 251 people diagnosed with TSCI (cases). They also examined a pool of 2,480 people 45 years and older without TSCI (controls), for comparison. 

Total healthcare costs for TSCI patients were much higher than for those without the injury, with inpatient and professional services being the main cost drivers. On average, total healthcare costs for people with TSCI following their injury were $62,640 compared with $8,115 among controls. However, on average, total healthcare costs among cases sharply decreased after the incident year to less than $20,000 annually but remained higher than controls throughout the four-year follow-up period.  

Similarly, the adjusted average out-of-pocket costs among cases increased from $1,357 in a year before the injury to $2,497 in year 2. Although out-of-pocket costs decreased among cases, they consistently remained higher than out-of-pocket costs among controls. The team did not observe any increase in out-of-pocket costs among controls over the five-year study period. 

The study also noted an alarming increase in outpatient and inpatient services use after three years of TSCI being stabilized. 

"This could be explained by increased secondary complications such as pressure ulcers, decreased muscle strength, or other complications due to reduced mobility or a lifestyle change,” they wrote. 

The authors assert that access to high-quality rehabilitation and preventive services is essential to reducing the risk of emergency and avoidable hospitalizations. 

“Implementing policies that provide easier access to high-quality preventive and rehabilitation services for people with TSCI may improve health outcomes among this patient population and lower inpatient or ED care use,” Mahmoudi et al conclude. 

Article citation: Lin, P., Doza, A., Gurney, Z., Rodriguez, G. M., & Mahmoudi, E. (2025). A 5-year longitudinal retrospective cohort study of healthcare use and costs before and after incident traumatic spinal cord injury. Archives of Physical Medicine and Rehabilitation. https://doi.org/10.1016/j.apmr.2025.02.012