Prevalence and Predictors of Disability 24-Months after Injury for Hospitalised and Non-Hospitalised Participants: Results from a Longitudinal Cohort Study in New Zealand

Abstract

IntroductionMost studies investigating disability outcomes following injury have examined hospitalised patients. It is not known whether variables associated with disability outcomes are similar for injured people who are not hospitalised.AimsThis paper compares the prevalence of disability 24 months after injury for participants in the Prospective Outcomes of Injury Study who were hospitalised and those non-hospitalised, and also seeks to identify pre-injury and injury-related predictors of disability among hospitalised and non-hospitalised participants.MethodsParticipants, aged 18–64 years, were recruited from an injury claims register managed by New Zealand’s no-fault injury compensation insurer after referral by health care professionals. A wide range of pre-injury socio-demographic, health and psychosocial characteristics were collected, as well as injury-related characteristics; outcome is assessed using the WHODAS. Multivariable models estimating relative risks of disability for hospitalised and non-hospitalised participants were developed using Poisson regression methods.ResultsOf 2856 participants, analyses were restricted to 2184 (76%) participants for whom both pre-injury and 24 month WHODAS data were available. Of these, 25% were hospitalised. In both hospitalised and non-hospitalised groups, 13% experience disability (WHODAS≥10) 24 months after injury; higher than pre-injury (5%). Of 28 predictor variables, seven independently placed injured participants in the hospitalised group at increased risk of disability 24 months after injury; eight in the non-hospitalised. Only four predictors (pre-injury disability, two or more pre-injury chronic conditions, pre-injury BMI≥30 and trouble accessing healthcare services) were common to both the hospitalised and non-hospitalised groups. There is some evidence to suggest that among the hospitalised group, Māori have higher risk of disability relative to non-Māori.ConclusionsAt 24 months considerable disability is borne, equally, by hospitalised and non-hospitalised groups. However, predictors of disability are not necessarily consistent between the hospitalised and non-hospitalised groups, suggesting caution in generalising results from one group to the other.

Whānau hauā: Reframing disability from an Indigenous perspective

“…Disease and illness (40%) followed by accidents and injury (28%) are the main causes of disability for Mäori (Statistics New Zealand, 2015). Derrett et al (2013) noted that 19% of Mäori, both hospitalised and non-hospitalised, experience disability 24 months following an injury. These researchers also found Mäori experienced disability at a significantly higher rate than non-Mäori who are hospitalised.…”

Functioning and health-related quality of life following injury in older people: a systematic review

“…Decreases in injury-related mortality rates have contributed to an increased focus on the survivors of injury and their longer-term outcomes, functional abilities, disabilities and health-related quality of life (HRQoL) 13. Research in this area has expanded in the last 10–15 years, however, it also focuses on working age adults, and their predominant types of injury (eg, road trauma, interpersonal violence or work-related injuries) and outcomes relevant to the working age population (eg, return to work or study, loss of income or unemployment) 13 14…”

Subsequent Injury Study (SInS): Improving outcomes for injured New Zealanders

“…A recent report showed that the rate of health-related loss due to injury for Māori is at least twice that of non-Māori 21. We found that Māori have poorer outcomes 12 months after the sentinel injury,22 and are at 70% increased risk of disability 24 months after the sentinel injury compared to non-Māori 23. These findings are concerning and warrant urgent attention.…”

“…Of the POIS participants, 61% were male, 68% New Zealand European and 92% in paid employment prior to their sentinel injury 12. Participants had a range of sentinel injuries (eg, lower extremity fractures (17%), upper extremity dislocations, sprains or strains (14%), upper extremity fractures (17%) and intracranial injuries (4%));43 and 25% had been hospitalised within one week as a consequence of their sentinel injury 23…”