The association between disability and unintentional injuries among adolescents in a general education setting: Evidence from a Swedish population-based school survey

The association between disability and mortality: a mixed-methods study

BACKGROUND

Globally, 1·3 billion people have a disability and are more likely to experience poor health than the general population. However, little is known about the mortality or life expectancy gaps experienced by people with disabilities. We aimed to undertake a systematic review and meta-analysis of the association between disability and mortality, compare these findings to the evidence on the association of impairment types and mortality, and model the estimated life expectancy gap experienced by people with disabilities.

METHODS

We did a mixed-methods study, which included a systematic review and meta-analysis, umbrella review, and life expectancy modelling. For the systematic review and meta-analysis, we searched MEDLINE, Global Health, PsycINFO, and Embase for studies published in English between Jan 1, 2007, and June 7, 2023, investigating the association of mortality and disability. We included prospective and retrospective cohort studies and randomised controlled trials with a baseline assessment of disability and a longitudinal assessment of all-cause mortality or cause-specific mortality. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We did a random-effects meta-analysis to calculate a pooled estimate of the mortality rate ratio for people with disabilities compared with those without disabilities. We did an umbrella review of meta-analyses examining the association between different impairment types and mortality. We used life table modelling to translate the mortality rate ratio into an estimate of the life expectancy gap between people with disabilities and the general population. The systematic review and meta-analysis is registered with PROSPERO, CRD42023433374.

FINDINGS

Our search identified 3731 articles, of which 42 studies were included in the systematic review. The meta-analysis included 31 studies. Pooled estimates showed that all-cause mortality was 2·24 times (95% CI 1·84-2·72) higher in people with disabilities than among people without disabilities, although heterogeneity between the studies was high (τ2=0·28, I2=100%). Modelling indicated a median gap in life expectancy of 13·8 years (95% CI 13·1-14·5) by disability status. Cause-specific mortality was also higher for people with disabilities, including for cancer, COVID-19, cardiovascular disease, and suicide. The umbrella review identified nine meta-analyses, which showed consistently elevated mortality rates among people with different impairment types.

INTERPRETATION

Mortality inequities experienced by people with disabilities necessitate health system changes and efforts to address inclusion and the social determinants of health.

FUNDING

National Institute for Health and Care Research, Rhodes Scholarship, Indonesia Endowment Funds for Education, Foreign, Commonwealth and Development Office (Programme for Evidence to Inform Disability Action), and the Arts and Humanities Research Council.

Influence of physical fitness components on personality factors and risk perception of children and adolescents: a cross-sectional study

OBJECTIVES

To examine the associations of cardiorespiratory fitness (VO2 max) and muscular strength with indicators related to the risk scale, such as perceived competence, sensation seeking, competitiveness, risk taking and risk perception in sports.

DESIGN

Cross-sectional study.

SETTING

High schools from the Region of Murcia (Spain).

PARTICIPANTS

Three-hundred-and-seventeen adolescents participated (mean age: 13.69±1.2 years old).

PRIMARY AND SECONDARY OUTCOME MEASURES

Body mass, body height, Course-Navette test, upper limb strength and psychoeducational factors that determine the propensity towards sports accidents in school children, the Sports Accident Propensity Scale were evaluated. It was performance t-test for independent samples, stepwise multiple linear regression models and a multiple mediation analysis.

RESULTS

The analysis showed significant differences with respect to sex in height, VO2 max, handgrip strength and in all factors of the questionnaire (p=0.02-<0.01). Adolescents who presented greater VO2 max, strength in the handgrip test and age showed a higher score in factors 1 and 3. Higher scores in factor 2 were associated with better VO2 max and strength in handgrip test. Youngers and better values of strength in the handgrip showed higher score in factors 4 and 5. The mediation analysis with two mediating variables (handgrip strength and VO2 max) showed a significant indirect effect. When handgrip strength and VO2 max were included in the equations, the association between sex and each factor ceased to be significant.

CONCLUSION

This study highlights the potential benefits of muscular strength (handgrip) and VO2 max in the perceived risk scale, and the variable of age on this.

TRIAL REGISTRATION NUMBER

Clinical trial: NCT05544370 (pre-results).

Association between hearing loss and trauma based on population data of Korea

BACKGROUND

Although several studies have been conducted to assess the association between hearing loss (HL) and trauma, no studies have analyzed trauma comprehensively based on population-based data.

OBJECTIVES

To investigate the association between HL and trauma in daily life using National Health Insurance Service National Sample Cohort data of Korea.

MATERIALS AND METHODS

People who were registered with severe or mild hearing disability by the Korean government from 2002 to 2015, were included in this study. Trauma was defined as an outpatient visit or admission under diagnostic codes associated with trauma. The risk for trauma was analyzed using multiple logistic regression model.

RESULTS

There were 5,114 subjects in the mild hearing disability group and 1,452 in the severe hearing disability group. The risk for trauma was significantly higher in the mild and severe hearing disability groups than in the control group. The risk was higher in the mild hearing disability group than in the severe hearing disability group.

CONCLUSIONS AND SIGNIFICANCE

Individuals with hearing disability are at a higher risk for trauma based on population-based data in Korea, which indicates that HL increases the risk for trauma.

Unintentional Injuries Are Associated with Self-Reported Child Maltreatment among Swedish Adolescents

Injuries constitute a large share of childhood morbidity and mortality. This study examines whether adolescents with self-reported experiences of different types of child maltreatment more frequently reported unintentional injury events requiring health- or dental care during the last year and/or hospitalization at any time during childhood. Cross-sectional data from a Swedish national representative school survey (2016) including 4741 adolescents were used (78.5% response rate). Data were analyzed with univariate tests and multiple logistic regression. Statistically significant associations between reported experiences of physical, psychological and sexual abuse, neglect, and witnessing partner violence during childhood and reported unintentional injuries requiring health- or dental care during the last year were found (aOR:s between 1.39-1.77). The corresponding association for poly-victimization was aOR 1.91 (95% CI 1.39-2.62). Furthermore, a linear-by-linear association was seen for degree of victimization and number of episodes of unintentional injuries that required care in the last year (p = 0.000), as well as lifetime hospitalizations (p = 0.000). This study shows significant associations between child maltreatment and unintentional injuries requiring health- and/or dental care and hospitalization. To improve both injury and child maltreatment prevention, healthcare professionals need to pay particular attention to children and adolescents who repeatedly seek healthcare services due to injurious events.

Determination of risk factors associated with unintentional injury in children: Case-control study

OBJECTIVE

This study aimed to determine the risk factors associated with unintentional injury in children aged 0-6 years.

DESIGN

This is a case-control study.

SAMPLE

A total of 150 participants (n: 75 case group, n: 75 control group) were included in the study. The case group consisted of mothers of children who had unintentional injuries and the control group was composed of the mothers of children who did not have unintentional injuries.

MEASUREMENTS

Data were collected using the Participant Information Form and the Identification of Safety Precautions of Mothers with 0-6 year-old Children for the Prevention of Unintentional Injuries Scale.

RESULTS

The mean attitude score of the mothers in the case group toward preventing unintentional injury (177.72 ± 15.53) was found to be higher than the mean score of the mothers in the control group (171.64 ± 17.93). An increase in mothers' scores on preventing unintentional injury reduces the risk of children having unintentional injuries 0.98 times.

CONCLUSION

The findings of the study revealed that mothers' attitudes toward preventing injury, the birth order of the child, and the child having a disability increase risk for unintentional injury.

Characterizing physical trauma in children and youth with special health care needs

BACKGROUND

Children and youth with special health care needs (CYSHCN) have or are at an increased risk for a chronic condition necessitating medical and related services beyond what children usually require. While evidence suggests that CYSHCN are at an increased risk of injury, little is known about this population within the trauma system. This study describes CYSHCN within the pediatric trauma system and examines patterns of injury risk (i.e., intent, place of injury, trauma type, and mechanism of injury) based on special health care need (SHCN) status.

METHODS

For this cross-sectional study, we used data from the 2018 National Trauma Data Bank to identify pediatric encounters (1-18 years, N = 115,578) and compare demographics (sex, race/ethnicity, insurance status, and age) by CYSHCN status using χ 2 and t tests. Children and youth with special health care needs encounters were compared with non-SHCN encounters using multinomial logistic regression models, controlling for demographics.

RESULTS

Overall, 16.7% pediatric encounters reported an SHCN. Children and youth with special health care needs encounters are older, and a higher proportion is publicly insured than non-SHCN encounters ( p < 0.001). Furthermore, CYSHCN encounters have a higher risk of assault (relative risk, 1.331) and self-inflicted (relative risk, 4.208) injuries relative to unintentional injury ( p < 0.001), as well as a higher relative risk of traumatic injury occurring in a private residence ( p < 0.01) than other locations such as school (relative risk, 0.894). Younger CYSHCN encounters have a higher risk of assault relative to unintentional injury when compared with non-SHCN encounters ( p < 0.01). Pediatric trauma encounters reporting mental health and alcohol/substance use disorder SHCN have a higher probability of self-inflicted and assault injuries than non-SHCN encounters ( p < 0.001).

CONCLUSIONS

These findings suggest that CYSHCN have different traumatic injury patterns than their non-SHCN peers, particularly in terms of intentional and private residence injury, and deserve a special focus for traumatic injury prevention.

LEVEL OF EVIDENCE

Prognostic/epidemiologic, level III.

Assessment of medical morbidities in a rhesus monkey model of naturally occurring low sociality

People with autism spectrum disorder (ASD) exhibit a variety of medical morbidities at significantly higher rates than the general population. Using an established monkey model of naturally occurring low sociality, we investigated whether low-social monkeys show an increased burden of medical morbidities compared to their high-social counterparts. We systematically reviewed the medical records of N = 152 (n = 73 low-social; n = 79 high-social) rhesus macaques (Macaca mulatta) to assess the number of traumatic injury, gastrointestinal, and inflammatory events, as well as the presence of rare medical conditions. Subjects' nonsocial scores, determined by the frequency they were observed in a nonsocial state (i.e., alone), and macaque Social Responsiveness Scale-Revised (mSRS-R) scores were also used to test whether individual differences in social functioning were related to medical morbidity burden. Medical morbidity type significantly differed by group, such that low-social monkeys incurred higher rates of traumatic injury compared to high-social monkeys. Nonsocial scores and mSRS-R scores also significantly and positively predicted traumatic injury rates, indicating that monkeys with the greatest social impairment were most impacted on this health measure. These findings from low-social monkeys are consistent with well-documented evidence that people with ASD incur a greater number of traumatic injuries and receive more peer bullying than their neurotypical peers, and add to growing evidence for the face validity of this primate model. LAY SUMMARY: People with autism exhibit multiple medical problems at higher rates than the general population. We conducted a comprehensive medical record review of monkeys that naturally exhibit differences in sociality and found that low-social monkeys are more susceptible to traumatic injuries than high-social monkeys. These results are consistent with reports that people with autism also incur greater traumatic injury and peer bullying and add to growing evidence for the validity of this monkey model.

ADHD and accidents over the life span - A systematic review

Studies have demonstrated an increased risk of accidents and injuries in children, adolescents and adults with attention-deficit/hyperactivity disorder (ADHD). However, little is known about how accident risk may alter over the lifespan. Additionally, it would be important to know if the most common types of accidents and injuries differ in ADHD patients over different age groups. Furthermore, there is increasing evidence of an ameliorating effect of ADHD medication on accident risk. Lastly, the underlying risk factors and causal mechanisms behind increased accident risk remain unclear. We therefore conducted a systematic review focusing on the above described research questions. Our results suggested that accident/injury type and overall risk changes in ADHD patients over the lifespan. ADHD medication appeared to be similarly effective at reducing accident risk in all age groups. However, studies with direct comparisons of accident/injuries and effects of medication at different age groups or in old age are still missing. Finally, comorbidities associated with ADHD such as substance abuse appear to further increase the accident/injury risk.

A reappraisal of injuries and accidents in people with epilepsy

PURPOSE OF REVIEW

We review data on injuries and traffic accidents affecting people with epilepsy with emphasis on the overall risk of injuries, specific types of injuries, and risk factors.

RECENT FINDINGS

Population-based studies of incident epilepsy cohorts indicate that the risk of physical injuries in people with epilepsy in general is increased only modestly. The risk is higher in selected populations that attend epilepsy clinics or referral centers. Soft tissue injuries, dislocations, and fractures are the most common injures, whereas the greatest increase in risk is reported for more uncommon injuries such as drowning. People with epilepsy are at a two-fold to four-fold increased risk for fatal injuries. Comorbidities contribute to fatal as well as nonfatal injuries. The other major risk factor is poorly controlled major convulsive seizures (generalized as well as focal to bilateral tonic-clonic seizures). Serious transport accidents associated with increased risks for people with epilepsy include pedestrian, bicycle, as well as car accidents.

SUMMARY

Individualized information on the risk of physical injuries and accidents should be part of counseling of patients with epilepsy. Improved seizure control is likely the most effective way to reduce risks, but work place and home adjustments should also be considered.

The epidemiology of injury among adolescents with hearing loss, health beliefs regarding injury and associated factors

BACKGROUND

Adolescents with hearing loss are more at risk of injury. Their injuries commonly occur at school, in traffic, and other sporting areas and can adversely affect their health.

OBJECTIVE

The study aims were to understand the epidemiology of the injuries that occurred among adolescents with hearing loss and to explore their health beliefs regarding injury and their associated factors.

METHODS

A cross-sectional study was conducted over the period 2018-2019 with 218 adolescents with hearing loss. A sociodemographic questionnaire, an accident and knowledge questionnaire, the Health Belief Model (HBM)-based Injury Scale and a school accident form were provided by interviewers who were fluent in sign language. Descriptive statistics, the Mann-Whitney U, Kruskal-Wallis tests and regression analysis were used to analyze the responses given to the above instruments.

RESULTS

Forty-six percent of the adolescents with hearing loss experienced accidents, with pedestrian (42.9%) and passenger (42.9%) types being the most common traffic-related injuries and bleeding (29.4%) and fracture (23.5%) for school related injuries. Factors that are protective against injuries are higher parental education level (father education: OR 1.08, 95% CI = 0.81-1.44; mother education: OR 0.77, 95% CI = 0.59-1.01), and higher knowledge of traffic signs (right: OR 1.23, 95% CI = 0.62-2.42; green: OR 0.59, 95% CI = 0.28-1.23). Factors that were associated with elevated risk of injuries included worse hearing loss categories (OR 3.39, 95% CI = 1.07-8.99).

CONCLUSIONS

Adolescents with hearing loss are commonly injured. Schools should consider education on how adolescents with hearing loss can protect themselves through potential tailored HBM-based injury prevention interventions.

Injuries in children and adolescents with psychiatric disorders

BACKGROUND

Unintentional injuries are a leading cause of morbidity and mortality in children of all ages. Prevention strategies require knowledge of risk factors, and behavior and psychiatric disorders have been suggested to influence the risk of injury during childhood. While externalizing disorders have been found to increase the risk for injuries, results are mixed regarding internalizing disorders, such as affective and anxiety conditions, and Autism Spectrum Disorders (ASD). There is a need for large scale studies relying on robust data sources. The aim of the present study was to examine the association between psychiatric disorders and injuries requiring medical attention, in a large population-based cohort of 350,000 children and adolescents in Sweden.

METHODS

Data were obtained from the regional health care database Vega. Psychiatric diagnoses and injury diagnoses obtained during 2014-2018 for individuals aged 0-17 years in 2016 were extracted. Descriptive statistics were used to examine differences in 5-year injury prevalence between children with and without different psychiatric diagnoses. Logistic regression was used in age-stratified models to test the association between psychiatric diagnoses and injuries requiring medical attention.

RESULTS

The results show an increased risk for concurrent injuries in general, but the patterns vary by age and psychiatric disorder. Externalizing disorders and anxiety conditions were associated with concurrent injuries, while individuals with ASD had a lower risk for most injuries included. Affective disorders were associated with an increased risk for wounds, concussion, complications and poisoning, while the risk for fractures was decreased. Self-inflicted injury was more common in all psychiatric conditions investigated during adolescence, except for ASD. Children and adolescents with many types of psychiatric disorders were also at increased risk for a concurrent maltreatment diagnosis.

CONCLUSIONS

A general pattern of increased risk for concurrent injuries in children and adolescents with most psychiatric diagnoses was found, but the associations vary by age and type of psychiatric disorder. The results add to the literature on risk factors for injuries in children and adolescents, supporting diagnosis specific patterns. Several psychiatric diagnoses were associated with a marked increase in injury risk, indicating a high burden of disease for affected individuals.