Women vs men after traumatic spinal cord injury: Longitudinal sex differences in secondary complications, rehospitalization burden, and community participation

Background Long-term outcomes after traumatic spinal cord injury (TSCI) reflect secondary complications, rehospitalization, and participation restriction, yet longitudinal sex differences remain incompletely characterized. Objective/Hypothesis To examine female-versus-male differences in secondary complications, rehospitalization burden, and community participation across post-injury anniversary waves. Methods We analyzed the SpinTal Cord Injury Model Systems Public Use Dataset 2021ARPublic. Of 34,675 baseline records screened, 29,049 participants with recorded female/male sex entered the longitudinal analytic cohort, contributing 72,299 person-waves across waves 1-40. Repeated-measures models adjusted for baseline sociodemographic/injury covariates. Urinary tract infection (UTI) and pressure-ulcer models used 2012-2021 interviews; fall and weeks-employed models used 2017-2021 interviews. Denominators varied by variable availability and valid responses. Results Women had higher adjusted odds of UTI (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.25 to 1.45), higher pain interference (OR, 1.18; 95% CI, 1.11 to 1.24), and higher pain severity (beta, 0.32; 95% CI, 0.23 to 0.41). Women had lower pressure-ulcer odds (OR, 0.86; 95% CI, 0.80 to 0.94), similar fall odds, slightly higher any-rehospitalization odds, but fewer rehospitalization days. In participation subsets, women had lower Craig Handicap Assessment and Reporting Technique (CHART) Mobility, lower competitive employment, and fewer weeks employed, but higher CHART Occupation. Conclusions Sex-related differences after TSCI were multidomain and nonuniform. Women experienced greater urinary and pain burden with less favorable mobility and employment-related participation, but lower pressure-ulcer odds. These findings support sex-informed follow-up across complications, hospital use, and participation after TSCI, and caution against treating sex differences as uniformly favorable or unfavorable across outcomes.