Injury characteristics and EQ-5D as predictors of personal wellbeing after injury

Objectives:A longitudinal study examined the relationships of injury severity, whether the injury was accidental or was caused by an assault, and self-reported EQ-5D soon after injury, with long-term personal wellbeing among participants with a range of injury types and severity.Methods:Interviews with participants recruited in the Prospective Outcomes of Injury Study (POIS) were conducted up to four time points in the 24 months after injury. Key explanatory variables were New Injury Severity Score (NISS), whether the injury was accidental or resulted from assault, and self-reported health status (five EQ-5D questions and a similar question about cognition) reported at three months. The main outcome measure at 24 months was the Personal Wellbeing Index (PWI) (PWI <70=‘low’ wellbeing). Univariate and multivariable analyses examined relationships between explanatory variables and low PWI.Results:Even in a group of people with injuries traditionally regarded as being of mild or moderate anatomical severity, wellbeing continues to be affected for an appreciable time post-injury, with a quarter (27%) of study participants having a low level of personal wellbeing 24 months after their injury. Neither anatomical injury severity nor hospitalisation were predictive of low personal wellbeing. An increased risk of low personal wellbeing was observed in participants whose injury was caused by an intentional assault (rather than accident), and in those who reported problems three months post-injury with EQ-5D self-care, anxiety/depression or cognitive functioning.Conclusions:Identification of such individuals early after an injury is of particular importance and ensuring adequate support services are put in place that encourage re-integration back into work and social networks could help prevent on-going poor wellbeing

A cohort study of short-term functional outcomes following injury: the role of pre-injury socio-demographic and health characteristics, injury and injury-related healthcare

<p>Abstract</p> <p>Background</p> <p>Injury outcome studies have tended to collect limited pre-injury characteristics, focus on a narrow range of injury types, predictors and outcomes, and be restricted to high threat to life injuries. We sought to identify the role of pre-injury socio-demographic and health characteristics, injury and injury-related healthcare in determining short-term functional outcomes for a wide range of injuries.</p> <p>Methods</p> <p>Study participants (aged 18-64 years inclusive) were those in the Prospective Outcomes of Injury Study, a cohort of 2856 persons who were injured and registered with New Zealand's national no-fault injury insurance agency. All information used in this paper was obtained directly from the participants, primarily by telephone interviews, approximately three months after their injury. The functional outcomes of interest were the five dimensions of the EQ-5D plus a cognitive dimension. We initially examined bivariate relationships between our independent measures and the dependent measures. Our multivariate analyses included adjustment for pre-injury EQ-5D status and time between injury and when information was obtained from participants.</p> <p>Results</p> <p>Substantial portions of participants continued to have adverse outcomes approximately three months after their injury. Key pervasive factors predicting adverse outcomes were: being female, prior chronic illness, injuries to multiple body regions, being hospitalized for injury, self-perceived threat to life, and difficulty accessing health services.</p> <p>Conclusion</p> <p>Future injury outcome studies should include participants whose injuries are considered 'minor', as judged by acute health service utilization, and also consider a wider range of potential predictors of adverse outcomes.</p

Accuracy of evidence-based criteria for identifying an incident hip fracture in the absence of the date of injury: a retrospective database study

Objectives: Hospital discharge data (HDD) in many health systems do not capture the date of injury (DOI); the absence of this date hinders researchers’ ability to distinguish repeat from incident injury admissions. Various approaches using somewhat arbitrary criteria have been explored to increase the accuracy of incident injury identification. However, these approaches have not been validated against a data source which contains DOI. The aim of this study was to determine the accuracy of evidence-based criteria for identifying fall-related incident hip fractures in the absence of DOI using HDD containing DOI as the reference standard. Design: Retrospective database study. Setting: New Zealand. Participants: 8761 patients aged 65+ years admitted for fall-related hip fracture between 1 July 2005 and 30 June 2008, inclusive. Outcome measures: We defined person-identifying HDD containing DOI as the reference standard and calculated measures of the accuracy of evidence-based criteria for identifying fall-related incident hip fractures from HDD not containing DOI. The criteria were principal diagnosis of hip fracture, mechanism of injury indicating a fall, admission type emergency, admission source other than a transfer and presence of hip operation code(s). For a subsequent fall-related hip fracture, additional criteria were time between successive hip fractures ≥120 days, and all external cause-of-injury codes being different to those for the previous hip fracture. Results: The sensitivity and specificity of the criteria for identifying fall-related incident hip fractures from data not containing DOI were 96.7% and 99.3%, respectively, compared with the reference standard. The application of these criteria resulted in a slight underestimation of the percentage of patients with multiple hip fractures. Conclusions: Although it is preferable to have DOI; this study demonstrates that evidence-based criteria can be used to reliably identify fall-related incident hip fractures from the person-identifying HDD when DOI is unavailable

Incident type 2 diabetes and risk of fracture: a comparative cohort analysis using UK primary care records

Objective: To estimate risk of fracture in men and women with recent diagnosis of type 2 diabetes compared to individuals without diabetes. Research Design and Methods: In this cohort study we used routinely-collected UK primary care data from The Health Improvement Network. In adults (>35 years) diagnosed with type 2 diabetes between 2004-2013 fractures sustained until 2019 were identified and compared to fractures sustained in individuals without diabetes. Multivariable models estimated time to first fracture following diagnosis of diabetes. Annual prevalence rates included at least one fracture in a given year. Results: Among 174,244 individuals with incident type 2 diabetes and 747,290 without diabetes, there was no increased risk of fracture among males with diabetes (adjusted hazards ratio (aHR) 0.97 (95%CI 0.94, 1.00)) and a small reduced risk among females (aHR 0.94, (95%CI 0.92, 0.96)). In those aged 85 years and over those in the diabetes cohort were at significantly lower risk of incident fracture (Males: aHR 0.85, 95%CI 0.71, 1.00; Females: aHR 0.85, 95%CI 0.78, 0.94). For those in the most deprived areas, aHRs were 0.90 (95%CI 0.83, 0.98) for males and 0.91 (95%CI 0.85, 0.97) for females. Annual fracture prevalence rates, by sex, were similar for those with and without type 2 diabetes.Conclusion: We found no evidence to suggest a higher risk of fracture following diagnosis of type 2 diabetes. After a diagnosis of type 2 diabetes individuals should be encouraged to make positive lifestyle changes, including undertaking weight-bearing physical activities that improve bone health

Trends and determinants of excess winter mortality in New Zealand: 1980 to 2000

<p>Abstract</p> <p>Background</p> <p>Although many countries experience an increase in mortality during winter, the magnitude of this increase varies considerably, suggesting that some winter excess may be avoidable. Conflicting evidence has been presented on the role of gender, region and deprivation. Little has been published on the magnitude of excess winter mortality (EWM) in New Zealand (NZ) and other Southern Hemisphere countries.</p> <p>Methods</p> <p>Monthly mortality rates per 100,000 population were calculated from routinely collected national mortality data for 1980 to 2000. Generalised negative binomial regression models were used to compare mortality rates between winter (June–September) and the warmer months (October–May).</p> <p>Results</p> <p>From 1980–2000 around 1600 excess winter deaths occurred each year with winter mortality rates 18% higher than expected from non-winter rates. Patterns of EWM by age group showed the young and the elderly to be particularly vulnerable. After adjusting for all major covariates, the winter:non-winter mortality rate ratio from 1996–2000 in females was 9% higher than in males. Mortality caused by diseases of the circulatory system accounted for 47% of all excess winter deaths from 1996–2000 with mortality from diseases of the respiratory system accounting for 31%. There was no evidence to suggest that patterns of EWM differed by ethnicity, region or local-area based deprivation level. No decline in seasonal mortality was evident over the two decades.</p> <p>Conclusion</p> <p>EWM in NZ is substantial and at the upper end of the range observed internationally. Interventions to reduce EWM are important, but the surprising lack of variation in EWM by ethnicity, region and deprivation, provides little guidance for how such mortality can be reduced.</p

Inequalities and Child Protection System Contact in Aotearoa New Zealand: Developing a Conceptual Framework and Research Agenda

There is a growing movement to integrate conceptual tools from the health inequalities field into research that examines the relationship between inequalities and chances of child protection system contact. This article outlines the key concepts of an inequalities perspective, and discusses how these apply to inequalities in child protection in the Aotearoa New Zealand context. Drawing on existing research, this article shows that while there is evidence of links between deprivation, ethnicity, location and system contact, a more systematic research agenda shaped by an inequalities perspective would contribute to understanding more fully the social determinants of contact with the child protection system. An inequalities perspective provides balance to the current &lsquo;social investment&rsquo; policy approach that targets individuals and families for service provision, with little attention to how structural inequalities impact on system contact. Directions for research are discussed, with some specific questions suggested. These include questions relating to the relationships between social inequalities and various decision points in the child protection system; if a social gradient exists and how steep it is; the inter-relationship between ethnicity, deprivation and patterns of system contact; and how similarly deprived children in different locations compare with each other in relation to child protection system contact, that is, is there an &lsquo;inverse intervention law&rsquo; operating

Financial wellbeing of older workers following injury – research utilising Statistics New Zealand’s Integrated Data Infrastructure

ABSTRACT Objectives 1. To undertake epidemiological analyses of New Zealand’s newly available linked longitudinal administrative data on financial wellbeing outcomes in older workers to understand the implications of injury in an ageing workforce 2. To gain an understanding of Statistics NZ’s Integrated Data Infrastructure (IDI) to inform the future use of the IDI specifically for health research Approach The impact of injury on the income of older workers was quantified by comparing financial well-being outcomes for injured and non-injured older workers over a 3 year period using IDI linked records on: i) injury claims; ii) personal taxation records; and iii) benefit receipt. Older workers were identified as all individuals aged 45 years and over in 2009 who had employment related tax payments in the previous year. Anyone with injury prior to 2009 for which earnings-related compensation was still being received in 2009 was excluded. Those that had an entitlement claim accepted by NZ’s Accident Compensation Corporation (ACC) for an injury that occurred in 2009 were defined as injured older workers, the remainder were considered non-injured. Date of injury was used as the reference date from which to calculate financial outcomes for injured older workers; non-injured workers were randomly assigned a date in 2009. Financial wellbeing, assessed by total earnings (income from wages and salary, employment related compensation from ACC and benefit receipt), was compared between injured and non-injured older workers at 1, 2 and 3 years following the reference date. Potential explanatory variables, such as gender, region of residency, and previous income/earnings received, was examined in multi-variable analyses. Results From individually linked records in the IDI, considerable data management was required to identify those that met the criteria for injured and non-injured older workers. Preliminary analyses indicate total earnings at all 3 time periods differ between older workers that are injured and those that aren’t. Breakdown of total earnings by source of income sheds light on some of these differences. Observed differences are not consistent between each 5-year age group. Conclusions The outcomes of injury are multi-faceted. The impact of injury on the financial well-being of older workers is concerning given NZ’s comprehensive universal injury compensation and welfare systems. The ability to use individually-linked longitudinal administrative records from Government agencies made this research possible, although using the IDI was not without its challenges

The New Zealand serious non-fatal self-harm indicators: how valid are they for monitoring trends?

Background: To monitor accurately injury incidence trends, indicators should measure incidence independently of extraneous factors. Frequencies and rates of New Zealand's serious non-fatal self-harm indicators may be prone to fluctuations in reporting owing, for example, to changing social norms. Hence, they have been considered provisional. Aim: To validate empirically the serious non-fatal self-harm indicators. Methods: All serious non-fatal first admissions to hospital were identified and classified according to whether principal diagnosis (PDx) was injury or mental disorder, and conversely whether contributing diagnoses were mental disorder or injury. The proportion assigned self-harm external cause of injury code (E-code) was calculated for each year from 2001 to 2007. Subsequently, all cases with a self-harm E-code were identified, and the proportion with a PDx of injury and contributing diagnosis of mental disorder, or PDx of mental disorder and contributing diagnosis of injury over time, were determined. Results: No linear changes over time were detected in the proportion of cases assigned an injury PDx, or the proportion assigned a mental disorder PDx, or the proportion with a self-harm E-code. The estimated maximum observed increase in the frequency of serious non-fatal self-harm hospitalisation explained by changes in reporting was 19- 40%. Conclusion: Identification of serious non-fatal self-harm events using an operational definition of PDx of injury, a self-harm first listed E-code, and an appropriate severity cut-off point, is a valid method of monitoring incidence and rates in New Zealand