{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T22:13:21Z","timestamp":1768947201978,"version":"3.49.0"},"reference-count":33,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chung Hie Oh & Jin-Sang Chung"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Neurogenic bowel dysfunction (NBD) is a major chronic sequela of spinal cord injury (SCI) with substantial implications for rehabilitation and long-term management. However, population-level evidence describing how gastrointestinal (GI) diagnostic codes are used following SCI, particularly within administrative healthcare systems, remains limited. Methods: We conducted a nationwide retrospective cohort study using administrative claims data from the Korean National Health Insurance Service (NHIS). A total of 584,266 adults with trauma-related SCI encounters between 2009 and 2019 were identified. GI diagnostic codes\u2014paralytic ileus (K56), irritable bowel syndrome (K58), and functional bowel disorders (K59)\u2014were evaluated as administrative proxies for bowel dysfunction. Demographic characteristics, disability status, regional factors, and health behaviors were analyzed using multivariable logistic regression. Results: GI diagnostic codes were frequently recorded after SCI, most commonly irritable bowel syndrome (approximately 30%) and functional bowel disorders (approximately 37%), whereas paralytic ileus was uncommon. Greater disability severity, female sex, older age, and rural residence were consistently associated with higher odds of GI diagnostic coding. Physical activity showed robust inverse associations across all models. Inverse associations observed with smoking and alcohol consumption were interpreted as reflecting residual confounding or health-related selection, rather than biological protective effects. Conclusions: Patterns of GI diagnostic coding after SCI likely reflect the clinical burden and management needs of neurogenic bowel dysfunction within healthcare systems, rather than the development of new gastrointestinal diseases. These findings underscore the importance of individualized bowel management, incorporation of structured physical activity into rehabilitation programs, and equitable access to SCI rehabilitation services, particularly for individuals with greater disability or those living in rural areas.<\/jats:p>","DOI":"10.3390\/jcm15020760","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T08:36:33Z","timestamp":1768898193000},"page":"760","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gastrointestinal Diagnostic Coding After Spinal Cord Injury: Health Behavior Correlates and Implications for Neurogenic Bowel Management in a Nationwide Claim-Based Cohort"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6530-0530","authenticated-orcid":false,"given":"Young-Hwan","family":"Lim","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jae-Hyeong","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeong-Won","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9807-8783","authenticated-orcid":false,"given":"Jong-Moon","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Happy Rehabilitation Medicine Clinic, Daegu 42122, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6250-9908","authenticated-orcid":false,"given":"Dongwoo","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Data Science, Hanmi Pharmaceutical Co., Ltd., Seoul 05545, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jungkuk","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Data Science, Hanmi Pharmaceutical Co., Ltd., Seoul 05545, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6918-5694","authenticated-orcid":false,"given":"Hyun Wook","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Graduate School of Medicine, CHA University, Seongnam 13488, Republic of Korea"},{"name":"Institute for Biomedical Informatics, Graduate School of Medicine, CHA University, Seongnam 13488, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4867-6854","authenticated-orcid":false,"given":"Kyung-Tae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Bokwang Hospital, Daegu 42734, Republic of Korea"},{"name":"Joint Institute for Regenerative Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6649-4715","authenticated-orcid":false,"given":"Myung-Gwan","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Graduate School of Medicine, CHA University, Seongnam 13488, Republic of Korea"},{"name":"Institute for Biomedical Informatics, Graduate School of Medicine, CHA University, Seongnam 13488, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1636-8665","authenticated-orcid":false,"given":"Tae-Du","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea"},{"name":"Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1007\/s00345-018-2301-z","article-title":"Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury","volume":"36","author":"Hamid","year":"2018","journal-title":"World J. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Liu, Y., Yang, X., He, Z., Li, J., Li, Y., Wu, Y., Manyande, A., Feng, M., and Xiang, H. (2023). Spinal cord injury: Global burden from 1990 to 2019 and projections up to 2030 using Bayesian age\u2013period\u2013cohort analysis. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1304153"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1097\/BRS.0000000000004417","article-title":"Spinal cord injury: The global incidence, prevalence, and disability from the Global Burden of Disease Study 2019","volume":"47","author":"Ding","year":"2022","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Sneij, A., Farkas, G.J., Mason, M.R.C., and Gater, D.R. (2022). Nutrition education to reduce metabolic dysfunction for spinal cord injury: A module-based nutrition education guide for healthcare providers and consumers. J. Pers. Med., 12.","DOI":"10.3390\/jpm12122029"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S86","DOI":"10.1016\/S0003-9993(97)90416-0","article-title":"Neurogenic bowel dysfunction after spinal cord injury: Clinical evaluation and rehabilitative management","volume":"78","author":"Stiens","year":"1997","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1016\/S0140-6736(96)91487-7","article-title":"Bowel dysfunction in spinal-cord-injury patients","volume":"347","author":"Glickman","year":"1996","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1001\/jama.2020.22532","article-title":"Diagnosis and treatment of irritable bowel syndrome: A review","volume":"325","author":"Camilleri","year":"2021","journal-title":"JAMA"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"226","DOI":"10.3892\/mmr.2022.12742","article-title":"Functional bowel symptoms in the general population (review)","volume":"26","author":"Ohlsson","year":"2022","journal-title":"Mol. Med. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Nilsson, D., and Ohlsson, B. (2021). Gastrointestinal symptoms and irritable bowel syndrome are associated with female sex and smoking in the general population and with unemployment in men. Front. Med., 8.","DOI":"10.3389\/fmed.2021.646658"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1038\/sc.2012.158","article-title":"The global map for traumatic spinal cord injury epidemiology: Update 2011, global incidence rate","volume":"52","author":"Lee","year":"2014","journal-title":"Spinal Cord"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"50","DOI":"10.5535\/arm.2013.37.1.50","article-title":"Epidemiologic change of patients with spinal cord injury","volume":"37","author":"Shin","year":"2013","journal-title":"Ann. Rehabil. Med."},{"key":"ref_12","unstructured":"National Health Insurance Service (2025). National Health Information Database, NHIS. Available online: https:\/\/nhiss.nhis.or.kr\/en\/z\/a\/001\/lpza001m01en.do."},{"key":"ref_13","unstructured":"SAS Institute Inc. (SAS Enterprise Guide 7.1, 2015). SAS Enterprise Guide 7.1, [software]."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Magnuson, F.S., Christensen, P., Krassioukov, A., Rodriguez, G., Emmanuel, A., Kirshblum, S., and Krogh, K. (2023). Neurogenic bowel dysfunction in patients with spinal cord injury and multiple sclerosis\u2014An updated and simplified treatment algorithm. J. Clin. Med., 12.","DOI":"10.3390\/jcm12226971"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1038\/s41393-024-01002-8","article-title":"Bowel burdens: A systematic review and meta-analysis examining the relationships between bowel dysfunction and quality of life after spinal cord injury","volume":"62","author":"Lee","year":"2024","journal-title":"Spinal Cord"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1007\/s10620-008-0516-3","article-title":"Gender differences in gastrointestinal, psychological, and somatic symptoms in irritable bowel syndrome","volume":"54","author":"Cain","year":"2009","journal-title":"Dig. Dis. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101807","DOI":"10.1016\/j.eclinm.2022.101807","article-title":"Frailty status and risk of irritable bowel syndrome in middle-aged and older adults: A large-scale prospective cohort study","volume":"56","author":"Wu","year":"2022","journal-title":"eClinicalMedicine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1038\/sj.sc.3100531","article-title":"Constipation and other chronic gastrointestinal problems in spinal cord injury patients","volume":"36","author":"Beke","year":"1998","journal-title":"Spinal Cord"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lin, Y.-H., Tseng, Y.-H., Chen, Y.-C., Lin, M.-H., Chou, L.-F., Chen, T.-J., and Hwang, S.-J. (2013). The rural\u2013urban divide in ambulatory care of gastrointestinal diseases in Taiwan. BMC Int. Health Hum. Rights, 13.","DOI":"10.1186\/1472-698X-13-15"},{"key":"ref_20","first-page":"55","article-title":"Inequities in rural and urban health care utilization among individuals diagnosed with inflammatory bowel disease: A retrospective population-based cohort study from Saskatchewan, Canada","volume":"6","author":"Osei","year":"2022","journal-title":"J. Can. Assoc. Gastroenterol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1053\/j.gastro.2023.05.017","article-title":"Health disparities in inflammatory bowel disease care driven by rural versus urban residence: Challenges and potential solutions","volume":"165","author":"Deepak","year":"2023","journal-title":"Gastroenterology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1080\/10790268.2021.2021043","article-title":"Relationship between neurogenic bowel dysfunction severity and functional status, depression, and quality of life in individuals with spinal cord injury","volume":"46","author":"Ture","year":"2023","journal-title":"J. Spinal Cord Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1093\/ije\/dyy027","article-title":"Is smoking heaviness causally associated with alcohol use? A Mendelian randomization study in four European cohorts","volume":"47","author":"Taylor","year":"2018","journal-title":"Int. J. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.amjmed.2015.10.013","article-title":"Moderate alcohol consumption is not associated with reduced all-cause mortality","volume":"129","author":"Goulden","year":"2016","journal-title":"Am. J. Med."},{"key":"ref_25","unstructured":"Nabi, R., Bonvini, M., Kennedy, E.H., Huang, M.-Y., Smid, M., and Scharfstein, D.O. (2021). Semiparametric sensitivity analysis: Unmeasured confounding in observational studies. arXiv."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1038\/sj.sc.3101119","article-title":"Bowel dysfunction following spinal cord injury","volume":"39","author":"Lynch","year":"2001","journal-title":"Spinal Cord"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1038\/sc.2013.86","article-title":"Members of the Working Group on Transanal Irrigation. Consensus review of best practice of transanal irrigation in adults","volume":"51","author":"Emmanuel","year":"2013","journal-title":"Spinal Cord"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1038\/sc.2008.137","article-title":"Management of neurogenic bowel dysfunction in the community after spinal cord injury: A postal survey in the United Kingdom","volume":"47","author":"Coggrave","year":"2009","journal-title":"Spinal Cord"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1016\/j.apmr.2004.02.022","article-title":"Patterns of alcohol and substance use and abuse in persons with spinal cord injury: Risk factors and correlates","volume":"85","author":"Tate","year":"2004","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"04197","DOI":"10.7189\/jogh.14.04197","article-title":"Physical activity and constipation: A systematic review of cohort studies","volume":"14","author":"Cui","year":"2024","journal-title":"J. Glob. Health"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Severo, J.S., Silva, A.C.A.d., Santos, B.L.B.d., Reinaldo, T.S., Oliveira, A.M.d., Lima, R.S.P., Torres-Leal, F.L., Santos, A.A.d., and Silva, M.T.B.d. (2025). Physical exercise as a therapeutic approach in gastrointestinal diseases. J. Clin. Med., 14.","DOI":"10.3390\/jcm14051708"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1016\/j.apmr.2020.11.002","article-title":"Effect of different forms of activity-based recovery training on bladder, bowel, and sexual function after spinal cord injury","volume":"102","author":"Hubscher","year":"2021","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1038\/s41393-019-0392-z","article-title":"Changes in bowel function following exoskeletal-assisted walking in persons with spinal cord injury: An observational pilot study","volume":"58","author":"Chun","year":"2020","journal-title":"Spinal Cord"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/760\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T08:56:14Z","timestamp":1768899374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/760"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,16]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020760"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020760","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,16]]}}}