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Sex-related discrepancies in the access to optimal care and outcomes after traumatic spinal cord injury: A retrospective cohort study using data from a Canadian registry

Julio C Furlan , Tian Shen , Dilnur Kurban 
PMID: 36170894 DOI: 10.1016/j.apmr.2022.09.006


To compare males and females who were stratified into subgroups corresponding to premenopausal, perimenopausal and postmenopausal ages, regarding access to optimal care and their outcomes after tSCI.

Study design: 

Retrospective cohort study.


18 acute care centers and 13 rehabilitation facilities across Canada.

This study included 5571 individuals with tSCI at C1-L2 who were enrolled in the Rick Hansen Spinal Cord Injury Registry from July/2004 to September/2019. Females were compared with males in the younger (age≤ 40 years), middle-aged (ages: 41-50), and older (>50 years) subgroups.


In the younger subgroups, females (n=408) were significantly younger, had a greater proportion of aboriginals and transportation-related tSCIs, underwent surgical treatment more often, and had a greater sensory score change than males (n=1613). In the middle-aged subgroups, females (n=174) had a greater proportion of high-thoracic tSCIs than males (n=666). In the older subgroups, females (n=660) were significantly older, had more fall-related and less severe tSCIs, had a shorter stay at the rehabilitation center, had less spasticity, and were discharged home less often than males (n=2050).

The results of this study suggest some sex-related differences in individuals’ demographics and injury characteristics, but fewer discrepancies between females and males regarding their access to optimal care and outcomes after tSCI. Overall, future clinical trials could consider inclusion of males and females of all age groups to enhance recruitment and augment generalizability.

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