Hospital-admitted drowning in Victoria, Australia, before and after the emergence of the COVID-19 pandemic

OBJECTIVES

To examine trends in hospitalisation following drowning in Victoria, Australia, before and after the emergence of the COVID-19 pandemic.

DESIGN

Retrospective analysis of administrative hospital admission records.

SETTING

Hospital admissions recorded in the Victorian Admitted Episodes Dataset.

PARTICIPANTS

Hospital-admitted patients with ≥1 drowning-related International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis code.

MAIN OUTCOME MEASURES

Incidence and incidence rate ratios (IRR; 95% CIs) of hospital-admitted drowning that occurred before (July 2017 to June 2019), during (July 2019 to June 2021) and after (July 2021 to June 2022) the onset of the COVID-19 pandemic.

RESULTS

There were 736 hospital admissions related to drowning in the study period; the incidence was 2.6 per 100 000 population pre-COVID-19 and dropped to 2.0 per 100 000 during (2019/2020-2020/2021) and after (2021/2022) the onset of the pandemic. Among Victorian residents, drowning was positively associated with younger age, male sex and regional/remote residence. Drowning was negatively associated with the onset of COVID-19 (IRR 0.76 (0.64, 0.90)) as well as the post-COVID-19 period (0.78 (0.64, 0.97)), compared with pre-COVID-19. Natural water drowning rates were consistently higher than pool or bathtub drowning rates. Pool or bathtub drowning rates decreased with the onset of COVID-19; no significant change was observed in the natural water drowning rate.

CONCLUSIONS

Pool and bathtub drowning rates declined since the onset of the COVID-19 pandemic, despite more time spent at home, while natural water drowning rates remained consistently high. Hospital admissions provide a valuable data source for monitoring of drowning, which is crucial to ensure a targeted, evidence-based approach to mitigate drowning risk.

Occupational injuries caused by fire and smoke in Victoria, Australia, 2003-2021: a descriptive study

OBJECTIVES

Hospital attendance related to fire, flame or smoke exposure is commonly associated with work. The aim of this study was to examine time trends and risk factors for work-related fire/flame/smoke injuries in Victoria, Australia.

METHODS

This study was based on emergency department (ED) presentation records from the Victorian Emergency Minimum Dataset, 2003-2021. Cases were people aged 15-74 years with injury-related ED presentations, if cause of injury was recorded as fire/flame/smoke, based on coded data and/or narratives. Work-related rates were calculated per employed persons; non-work rates were calculated per population. Work-related and non-work-related cases were compared using logistic regression modelling.

RESULTS

There were 11 838 ED presentations related to fire/flame/smoke: 1864 (15.7%) were work-related. Non-work-related rates were 12.3 ED presentations per 100 000 population, and work-related rates were 3.43 per 100 000 employed persons annually. Over the study period, work-related rates decreased annually by 2.0% (p<0.0001), while non-work rates increased by 1.1% (p<0.0001). Work-related cases (vs non-work) were associated with summer (vs winter), but the association with extreme bushfire periods (Victorian 'Black Saturday' and 'Black Summer') was not statistically significant. Work-related cases were less severe than non-work-related cases, evidenced by triage status and subsequent admission.

CONCLUSIONS

Rates of occupational fire/flame/smoke-related injury presentations decreased over the past two decades in Victoria, while non-work-related rates increased. This could reflect improved safety in the workplace. Hospital data, however, cannot be used to distinguish occupation or industry therefore, employment data linkage studies are recommended to further inform workplace preventive measures.

Suicide and mortality following self-harm in Culturally and Linguistically Diverse communities in Victoria, Australia: insights from a data linkage study

Background

While cultural backgrounds are well-documented to be relevant to intentional self-harm, little is known about how cultural and linguistically diverse (CALD) backgrounds affect mortality outcomes following self-harm.

Aim

This study aimed to compare the risk of all-cause mortality and suicide after intentional hospital admissions for self-harm among people from CALD (vs. non-CALD) backgrounds.

Method

Linked hospital and mortality data in Victoria, Australia, was used to assess suicide and all-cause death after hospital admissions for self-harm among patients aged 15+ years. All-cause death was identified by following up on 42,122 self-harm patients (hospitalized between 01 July 2007 and 30 June 2019) until death or 15 February 2021. Suicide death was evaluated in 16,928 self-harm inpatients (01 January 2013 and 31 December 2017) until death or 28 March 2018. Cox regression models were fitted to compare mortality outcomes in self-harm patients from CALD vs. non-CALD backgrounds.

Outcomes

During the follow-up periods, 3,716 of 42,122 (8.8%) participants died by any cause (by 15 February 2021), and 304 of 16,928 (1.8%) people died by suicide (by 28 March 2018). Compared to the non-CALD group, CALD intentional self-harm inpatients had a 20% lower risk of all-cause mortality (HR: 0.8, 95% CI: 0.7-0.9) and a 30% lower risk of suicide (HR: 0.7, 95% CI: 049-0.97). Specifically, being from North Africa/Middle East and Asian backgrounds lowered the all-cause mortality risk; however, the suicide risk in Asians was as high as in non-CALD people.

Conclusion

Overall, people from CALD backgrounds exhibited lower risks of all-cause mortality and suicide following hospital admission for self-harm compared to the non-CALD group. However, when comparing risks based on regions of birth, significant variations were observed. These findings underscore the importance of implementing culturally tailored background-specific suicide preventive actions. The study focussed on outcomes following hospital admission for self-harm and did not capture outcomes for cases of self-harm that did not result in hospital admission. This limits generalisability, as some CALD people might avoid accessing healthcare after self-harm due to cultural factors. Future research that not limited to hospital data is suggested to build on the results.

Epidemiology of work-related fall injuries resulting in hospitalisation: individual and work risk factors and severity

OBJECTIVES

Injuries at work are common and costly for individuals and employers. A common mechanism of workplace injury is through falls, but there have been few epidemiological studies of risk factors. This study aimed to identify patient, work and injury factors associated with injuries causing hospitalisation after falling at work in Victoria, Australia.

METHODS

Data came from work-related hospitalised injury admissions, identified by International Classification of Diseases and Related Health Problems, Tenth Revision Australian Modification codes and compensation status, from Victorian Admitted Episodes Dataset between 1 July 2017 and 30 June 2022. Multivariate logistic regression analyses were conducted to identify factors associated with same-level falls and falls from height.

RESULTS

This study included 42 176 work-related injury admissions: 8669 (20.6%) fall injuries and 33 507 (79.4%) other injuries. Rates of high falls were more common in males than females (0.44 (95% CI: 0.43, 0.46) vs 0.08 (0.08, 0.09) admissions per 1000 employed), while same-level falls were more common in females than males (0.21 (0.20, 0.22) vs 0.18 (0.17, 0.18)). Patients with same-level fall injuries, relative to all other work injuries, were more likely to be older women, and have at least one chronic condition; falls from height were associated with male sex and construction work and more likely to result in intracranial, internal organ injuries and fractures and longer hospital stay than non-fall injuries.

CONCLUSION

Work-related falls were common and relatively severe. Same-level falls are relatively likely to occur in older women, the fastest-growing workplace demographic, and therefore the incidence is expected to increase. Comorbidities are an important fall risk factor. Employers could consider industry-relevant high and same-level fall prevention strategies for reducing the workplace injury burden.

In-hospital complications of work-related musculoskeletal injuries

BACKGROUND, OBJECTIVES

Work-related musculoskeletal (MSK) injuries are a major contributor to morbidity worldwide and frequently result in hospitalisation. Hospital complications are common, costly, and largely preventable, but relevant data is required to address this. This study aimed to identify the incidence and factors associated with in-hospital complications of work-related MSK injuries.

METHODS

This study is based on work-related MSK hospital admission data from Victorian Admitted Episodes Database, 2016-2022. Complications were identified based on ICD-10-AM coding using CHADx (Classification of Hospital Acquired Diagnoses). Negative binomial and logistic regression analyses were performed to identify factors related to in-hospital complications.

RESULTS

In-hospital complications occurred in 6.3 % of work-related MSK injury admissions. In the adjusted models, ages ≥45 years, female sex, and area-level disadvantage were associated with in-hospital complications. Stay at public (vs private) hospitals, comorbidity, emergency admissions, and general anaesthesia were also associated. Complication rates were higher in hospitalised workers with direct head, neck, and trunk injuries and cumulative MSK disorders than those with direct extremities injuries and acute MSK conditions. The most common complications were cardiovascular, gastrointestinal complications and adverse drug events.

CONCLUSION

This study identified patient, injury and hospital-related characteristics associated with in-hospital complications of work-related MSK injuries for informing prevention strategies and risk estimation by hospital staff and workers' compensation schemes. The results demonstrate a sizable rate of complications given the relatively young and healthy study population.

Repeat self-harm and mental health service use after self-harm in Culturally and Linguistically Diverse communities: Insights from a data linkage study in Victoria, Australia

PURPOSE

To examine the associations between Culturally and Linguistically Diverse backgrounds (vs non-Culturally and Linguistically Diverse) and in-hospital death due to self-harm, repeat self-harm and mental health service use after self-harm.

METHOD

A retrospective study of 42,127 self-harm hospital inpatients aged 15+ years in Victoria, Australia, from July 2008 to June 2019. Linked hospital and mental health service data were used to assess in-hospital death, repeat self-harm and mental health service use in the 12 months following index self-harm hospital admission. Logistic regression and zero-inflated negative binomial regression models were used to estimate associations between cultural background and outcomes.

RESULTS

Culturally and Linguistically Diverse people accounted for 13.3% of self-harm hospital inpatients. In-hospital death (0.8% of all patients) was negatively associated with Culturally and Linguistically Diverse background. Within 12 months, 12.9% of patients had self-harm readmission and 20.1% presented to emergency department with self-harm. Logistic regression components of zero-inflated negative binomial regression models showed no differences in the odds of (hospital-treated) self-harm reoccurrence between Culturally and Linguistically Diverse and non- Culturally and Linguistically Diverse self-harm inpatients. However, count components of models show that among those with repeat self-harm, Culturally and Linguistically Diverse people (e.g. born in Southern and Central Asia) made fewer additional hospital revisits than non-Culturally and Linguistically Diverse people. Clinical mental health service contacts following self-harm were made in 63.6% of patients, with Culturally and Linguistically Diverse people (Asian backgrounds 43.7%) less likely to make contact than the non-Culturally and Linguistically Diverse group (65.1%).

CONCLUSIONS

Culturally and Linguistically Diverse and non-Culturally and Linguistically Diverse people did not differ in the likelihood of hospital-treated repeat self-harm, but among those with self-harm repetition Culturally and Linguistically Diverse people had fewer recurrences than non-Culturally and Linguistically Diverse people and utilised mental health services less following self-harm admissions.

Personality, perceptions and behavior: A study of speeding amongst drivers in Victoria, Australia

INTRODUCTION

Road crashes present a serious public health issue. Many people are seriously or fatally injured every year in avoidable crashes. While these crashes can have multiple contributing factors, including road design and condition, vehicle design and condition, the environment and human error, the performance of illegal driving behavior, including speeding, may also play a role. The current study aimed to examine the mediating influence that four potential deterrents (perceptions towards enforcement, crash risk, social norms and disapproval, and negative personal/emotional affect) have between the Big Five personality traits (conscientiousness; extraversion; agreeableness; neuroticism; openness) and expectations to speed.

METHODS

A total of 5,108 drivers in Victoria, Australia completed an online survey in 2019. A mediated regression analysis was used to examine pathways in a conceptual model developed for the study.

RESULTS

The results showed that perceptions towards the four potential deterrents examined did mediate the relationship (either completely or partially) between personality and expectations to speed.

CONCLUSIONS

The results of this study suggest that if interventions to deter illegal driving behavior are to be successful, one factor that could be taken into account is the personality traits of drivers who may be at greatest risk of the performance of illegal driving behaviors.

Transition between social protection systems for workers with long term health problems: A controlled retrospective cohort study

Many nations have established workers' compensation systems as a feature of their social protection system. These systems typically provide time-limited entitlements such as wage replacement benefits and funding for medical treatment. Entitlements may end for workers with long-term health conditions before they have returned to employment. We sought to determine the prevalence of transitions to alternative forms of social protection, specifically social security benefits, among injured workers with long-term disability, when workers' compensation benefits end. We linked Australian workers' compensation and social security data to examine receipt of social security payments one year before and after workers' compensation benefit cessation. Study groups included (1) injured workers whose workers' compensation benefits ceased due to reaching a 260-week limit introduced by legislative reform (N = 2761), (2) a control group of injured workers with at least 104 weeks workers compensation income support (N = 3890), and (3) a matched community control group (N = 10,114). Adjusted binary logistic regression examined the odds of transitions to social security in the injured worker groups relative to the community control group. Within 12 months of workers' compensation benefit cessation, 60% (N = 1669) of the exposed group received social security payments, of which 41% (N = 1120) received the unemployment allowance and 19% (N = 516) the disability pension. Among the work injured control group, 42% (N = 1676) received social security payments after workers compensation benefits ceased. Transitions to social security payments were significantly more common than community levels for both exposed (OR 25.0, 95%CI = 20.7, 30.1) and work injured control groups (OR 4.7, 95%CI = 4.2, 5.3). Many injured workers with long-term health problems transition to social security when their workers' compensation benefits cease. Transitions were more common among workers whose claims ended due to legislative reform which time-limited benefits. Design and implementation of system level policy reform should consider the social and economic impacts of transitions between separate social protection systems.

Trends in mortality outcomes of hospital-admitted injury in Victoria, Australia 2001-2021

Due to advancements in trauma treatment methods, it is expected that survivability of hospital-admitted injuries gradually improves over time. However, measurement of trends in all-cause injury survivability is complicated by changes in case mix, demographics and hospital admission policy. The aim of this study is to determine trends in hospital-admitted injury survivability in Victoria, Australia, taking case-mix and patient demographics into account, and to explore the potential impact of changes in hospital admission practices. Injury admission records (ICD-10-AM codes S00-T75 and T79) between 1 July 2001 and 30 June 2021 were extracted from the Victorian Admitted Episodes Dataset. ICD-based Injury Severity Score (ICISS) calculated from Survival Risk Ratios for Victoria was used as an injury severity measure. Death-in-hospital was modelled as a function of financial year, adjusting for age group, sex and ICISS, as well as admission type and length of stay. There were 19,064 in-hospital deaths recorded in 2,362,991 injury-related hospital admissions in 2001/02-2020/21. Rates of in-hospital death decreased from 1.00% (866/86,998) in 2001/02 to 0.72% (1115/154,009) in 2020/21. ICISS was a good predictor of in-hospital death with an area-under-the-curve of 0.91. In-hospital death was associated with financial year (Odds Ratio 0.950 [95%CI 0.947, 0.952]), in logistic regression modelling adjusted for ICISS, age and sex. In stratified modelling, decreasing injury death trends were observed in each of the top 10 injury diagnoses (together constituting > 50% of cases). Admission type and length of stay were added to the model: these did not alter the effect of year on in-hospital death. In conclusion, a 28% reduction in rates of in-hospital deaths in Victoria was observed over the 20-year study period, in spite of aging of the injured population. This amounts to 1222 additional lives saved in 2020/21 alone. Survival Risk Ratios therefore change markedly over time. A better understanding of the drivers of positive change will help to further reduce the injury burden in Victoria.

Intentional self-harm in culturally and linguistically diverse communities: A study of hospital admissions in Victoria, Australia

PURPOSE

To examine the rates and profiles of intentional self-harm hospital admissions among people from culturally and linguistically diverse and non-culturally and linguistically diverse backgrounds.

METHODS

A retrospective analysis of 29,213 hospital admissions for self-harm among people aged 15 years or older in Victoria, Australia, was conducted using data from the Victorian Admitted Episodes Dataset between 2014/2015 and 2018/2019. The Victorian Admitted Episodes Dataset records all hospital admissions in public and private hospitals in Victoria (population 6.5 million). Population-based incidence of self-harm, logistic regression and percentages (95% confidence intervals) were calculated to compare between culturally and linguistically diverse groups by birthplaces and the non-culturally and linguistically diverse groups of self-harm admissions.

RESULTS

When grouped together culturally and linguistically diverse individuals had lower rates of (hospital-treated) self-harm compared with the non-culturally and linguistically diverse individuals. However, some culturally and linguistically diverse groups such as those originating from Sudan and Iran had higher rates than non-culturally and linguistically diverse groups. Among self-harm hospitalised patients, those in the culturally and linguistically diverse group (vs non-culturally and linguistically diverse group) were more likely to be older, Metropolitan Victorian residents, from the lowest socioeconomic status, and being ever or currently married. Self-harm admissions by persons born in Southern and Eastern Europe were the oldest of all groups; in all other groups number of admissions tended to decrease as age increased whereas in this group the number of admissions increased as age increased.

CONCLUSION

There was considerable heterogeneity in rates of hospital-treated self-harm in culturally and linguistically diverse communities, with some countries of origin (e.g. Sudan, Iran) having significantly higher rates. Some of this variation may be due to factors relating to the mode of entry into Australia (refugee vs planned migration), and future research needs to examine this possibility and others, to better plan for support needs in the culturally and linguistically diverse communities most affected by self-harm. Combining all culturally and linguistically diverse people into one group may obscure important differences in self-harm. Different self-harm prevention strategies are likely to be needed for different culturally and linguistically diverse populations.

How representative is the Victorian Emergency Minimum Dataset (VEMD) for population-based injury surveillance in Victoria? A retrospective observational study of administrative healthcare data

OBJECTIVE

The Victorian Emergency Minimum Dataset (VEMD) is a key data resource for injury surveillance. The VEMD collects emergency department data from 39 public hospitals across Victoria; however, rural emergency care services are not well captured. The aim of this study is to determine the representativeness of the VEMD for injury surveillance.

DESIGN

A retrospective observational study of administrative healthcare data.

SETTING AND PARTICIPANTS

Injury admissions in 2014/2015-2018/2019 were extracted from the Victorian Admitted Episodes Dataset (VAED) which captures all Victorian hospital admissions; only cases that arrived through a hospital's emergency department (ED) were included. Each admission was categorised as taking place in a VEMD-contributing versus a non-VEMD hospital.

RESULTS

There were 535 477 incident injury admissions in the study period, of which 517 207 (96.6%) were admitted to a VEMD contributing hospital. Male gender (OR 1.13 (95% CI 1.10 to 1.17)) and young age (age 0-14 vs 45-54 years, OR 4.68 (95% CI 3.52 to 6.21)) were associated with VEMD participating (vs non-VEMD-participating) hospitals. Residing in regional/rural areas was negatively associated with VEMD participating (vs non-VEMD participating) hospitals (OR=0.11 (95% CI 0.10 to 0.11)). Intentional injury (assault and self-harm) was also associated with VEMD participation.

CONCLUSIONS

VEMD representativeness is largely consistent across the whole of Victoria, but varies vastly by region, with substantial under-representation of some areas of Victoria. By comparison, for injury surveillance, regional rates are more reliable when based on the VAED. For local ED-presentation rates, the bias analysis results can be used to create weights, as a temporary solution until rural emergency services injury data is systematically collected and included in state-wide injury surveillance databases.

Quantifying the Foregone Benefits of Intelligent Speed Assist Due to the Limited Availability of Speed Signs across Three Australian States

By being able to communicate the speed limit to drivers using speed sign recognition cameras, Intelligent Speed Assist (ISA) is expected to bring significant road safety gains through increased speed compliance. In the absence of complete digital speed maps and due to limited cellular connectivity throughout Australia, this study estimated the forgone savings of ISA in the event that speed signs are solely relied upon for optimal advisory ISA function. First, speed-related fatalities and serious injuries (FSI) in the Australian states of Victoria, South Australia, and Queensland (2013-2018) were identified, and published effectiveness estimates of ISA were applied to determine the potential benefits of ISA. Subsequently, taking into account speed sign presence across the three states, the forgone savings of ISA were estimated as FSI that would not be prevented due to absent speed signage. Annually, 27-35% of speed-related FSI in each state are unlikely to be prevented by ISA because speed sign infrastructure is absent, equating to economic losses of between AUD 62 and 153 million. Despite a number of assumptions being made regarding ISA fitment and driver acceptance of the technology, conservative estimates suggest that the benefits of speed signs placed consistently across road classes and remoteness levels would far outweigh the costs expected from the absence of speed signs. The development and utilisation of a methodology for estimating the foregone benefits of ISA due to suboptimal road infrastructure constitutes a novel contribution to research. This work provides a means of identifying where infrastructure investments should be targeted to capitalise on benefits offered by advanced driver assist technologies.

Pre-injury health status of truck drivers with a workers' compensation claim

Truck drivers are a vulnerable population due to the high number of workplace injuries and fatalities predominant in their occupation. In Australia, the road freight transportation industry has been identified as a national priority area in terms of creating preventative measures to improve the health and safety of its workers. With an environment conducive to poor nutritional food choices and unhealthy lifestyle behaviours, many barriers exist to creating a safe and healthy workforce. Thus, the current study aimed to describe the pre-injury hospital-recorded health conditions and health service use of truck drivers with a worker’s injury compensation claim/s when compared to workers in other industries. Data was obtained from a compensation claims database and linked with hospital admissions data recorded five years prior to the injury claim. Health and lifestyle behaviour data for the occupational code of truck drivers was compared to other occupational drivers, as well as to all other occupations. Analysis was conducted via logistic regression. The results found that when compared to other occupational drivers, truck drivers were significantly more likely to have a hospital-recorded diagnosis of diabetes and/or hypertension, as well as being significantly more likely to have a hospital record of tobacco use and/or alcohol misuse/abuse. The findings show that there is a need to review and revise existing health strategies to promote the health and wellbeing of truck drivers, especially given their challenging work environment.

Impacts of past occupational injury and long-duration compensated work disability on future hospital admissions

ObjectivesTo investigate changes in the prevalence and nature of hospital admissions towards the end of long-duration workers’ compensation claims (>2 years), and afterwards. To examine differences in hospitalisation when workers’ compensation claims end due to either a 260-week duration limit, or otherwise, and comparisons with hospitalisations of a community comparator. ApproachA retrospective cohort study examined 2475 workers, termed the s39 group, whose workers’ compensation ceased due to a 260-week limit in 2017/2018 under s39(1) of the Workers’ Compensation Act New South Wales 2012 legislative amendments (Australia). Comparator groups were injured workers with long-duration claims whose compensation ceased independently of s39 (termed the injured control group, N=3626) and a community group (N=8485). Workers’ compensation records were linked to national social security payments, and hospital admissions. Outcomes describe the prevalence and diagnostic categories of hospital admissions 12 months before, and after, the cessation of workers’ compensation stopped payments. ResultsMusculoskeletal health conditions were common diagnoses in overnight hospitalisations for injured workers. Single-day hospital care for mental health disorders were more common for injured workers (17% of same-day admissions) than for members of a community control (3% of same-day admissions) across two years. Exiting the workers’ compensation scheme is associated with significantly fewer annual hospital admissions for the injured control group (OR 0.76), but not for the s39 group (OR 1.01). Injured workers with long-duration compensated work disability were admitted to hospital more often than the community comparator group during the year after workers’ compensation stops (s39 group: OR 1.55, injured control group: OR 1.30). Across all study groups, hospital admission was more common for people receiving disability social security benefits and older age groups. ConclusionPolicy change in the New South Wales workers’ compensation system introduced a 260-week limit on compensation, leaving workers with an elevated need for hospital care after their compensation ended. Welfare policies that disrupt key determinants of health require dedicated inter-agency provisions to support the elevated health needs of those affected.

Changes in health and welfare after workers’ compensation benefits cease

ObjectivesTo investigate welfare and health service use among workers with long-duration workers’ compensation claims after workers’ compensation stopped. To identify changes in health and welfare of workers whose compensation benefits ended due to a 260-week limit under s39(1) of the Workers’ Compensation Act New South Wales 2012 legislative amendments, Australia. ApproachWorkers’ compensation claims from the New South Wales State Insurance Regulatory Authority were linked to records for social security payments, hospital and emergency department admissions, and health professional services. A cohort of 15,258 workers with long-duration workers’ compensation claims (>2 years) were classified based on whether compensation ended due to a 260-week limit (s39 group), or in circumstances where compensation benefits stopped independently of a 260-week limit (injured control group), and are contextualised with a community comparator (N=10,703). Changes in welfare and health service use were examined 12 months preceding, and 12 months following, a final workers’ compensation benefit payment. ResultsAfter workers’ compensation benefits ceased under a 260-week limit there was a 53% increase in the uptake of social security benefits such as unemployment or disability payments by the s39 group, and levels of hospitalisation remained elevated compared to a community comparator. In contrast, workers whose compensation ended for other reasons, such as returning to work, saw a 28% increase in receipt of social security payments, and coincided with decreased hospitalisation incidence after exiting the workers’ compensation scheme. Overall, receipt of welfare and use of hospital health services after workers’ compensation ended was more common for people aged 65 or older, non-homeowners, single parents, and people living outside major cities. Social security payments were underrepresented for people with compensable psychological injuries, whilst hospitalisation was overrepresented. ConclusionThe introduction of a 260-week limit on workers’ compensation benefits resulted in a cohort of workers transitioning to the social security system, and did not coincide with a characteristic reduction in hospital service use. Policy changes must recognise interconnected consequences of changes to welfare and health. Transitional supports are encouraged.

Suicide following hospital admission for mental health conditions, physical illness, injury and intentional self-harm in Victoria, Australia

Objective

The majority of suicide decedents have had contact with health services close to their death. Some of these contacts include admissions to hospitals for physical and mental health conditions, injury and intentional self-harm. This study aims to establish and quantify the risks of suicide following hospital admission for a range of mental and physical illnesses.

Methods

A retrospective analysis was carried out on existing morbidity and mortality data in Victoria. Data was extracted from the Victorian Admitted Episodes Dataset and the Victorian Suicide Register. Unplanned hospital admissions among adult patients (> = 15 years of age), discharged between 01 January 2011 and 31 December 2016 (2,430,154 admissions), were selected. Standardised Mortality Ratios were calculated for conditions with at least five linked suicides within one year of discharge from hospital.

Results

Forty-three conditions defined at the three-digit level of the International Statistical Classification of Diseases and Related Health Problems 10th Revision, were associated with at least five subsequent suicides (within one year of hospital discharge); 14 physical illnesses, 5 symptoms, signs and abnormal clinical and laboratory findings, 12 mental health conditions, and 12 types of injury and poisonings. The highest Standardised Mortality Ratios were for poisonings (range; 27.8 to 140.0) and intentional self-harm (78.8), followed by mental health conditions (range; 15.5 to 72.9), symptoms, signs and abnormal clinical and laboratory findings (range; 1.4 to 43.2) and physical illnesses (range; 0.7 to 4.9).

Conclusions

Hospital admissions related to mental health conditions and injury and poisonings including self-harm were associated with a greater risk of suicide than physical conditions. Mental health conditions such as depressive episodes, personality disorders and psychotic episodes, injuries caused by intentional-self-harm and poisonings by certain types of drugs, carbon monoxide and hormones such as insulin can be prioritised for targeting suicide prevention initiatives for persons discharged from hospitals.

Improving injury surveillance data quality: a study based on hospitals contributing to the Victorian Emergency Minimum Dataset

OBJECTIVE

In this paper, we describe the design and baseline data of a study aimed at improving injury surveillance data quality of hospitals contributing to the Victorian Emergency Minimum Dataset (VEMD).

METHODS

The sequential study phases include a baseline analysis of data quality, direct engagement and communication with each of the emergency department (ED) hospital sites, collection of survey and interview data and ongoing monitoring.

RESULTS

In 2019/20, there were 371,683 injury-related ED presentations recorded in the VEMD. Percentage unspecified, the indicator of (poor) data quality, was lowest for 'body region' (2.7%) and 'injury type' (7.4%), and highest for 'activity when injured' (29.4%). In the latter, contributing hospitals ranged from 3.0-99.9% unspecified. The 'description of event' variable had a mean word count of 10; 16/38 hospitals had a narrative word count of <5.

CONCLUSIONS

Baseline hospital injury surveillance data vary vastly in data quality, leaving much room for improvement and justifying intervention as described. Implications for public health: Hospital engagement and feedback described in this study is expected to have a marked effect on data quality from 2021 onwards. This will ensure that Victorian injury surveillance data can fulfil their purpose to accurately inform injury prevention policy and practice.

International classification of disease based injury severity score (ICISS): A data linkage study of hospital and death data in Victoria, Australia

BACKGROUND

Surveillance of severe injury incidence and prevalence using ICD-based injury severity scores (ICISS) requires valid, locally applicable diagnosis-specific survival probabilities (DSPs). This study aims to derive and validate ICISS in Victoria, Australia, and compare various ICISS methodologies in terms of accuracy and calculated severe injury prevalence.

METHODS

This study used injury admissions (ICD-10-AM coded) from the Victorian Admitted Episodes Database (VAED) linked with death data (Cause of Death - Unit Record Files: CODURF). Using design data (July 2008 - June 2014; n = 720,759), various ICISS scales were derived, based on (i) in-hospital and (ii) three-month mortality. These scales were applied to testing data (July 2014 - December 2016; n = 334,363). Logistic regression modelling was used to determine model discrimination and calibration.

RESULTS

In the design data, there were 6,337(0.9%) hospital deaths and 17,514(2.4%) three-months deaths; in the testing data, there were 2,700(0.8%) hospital deaths and 8,425(2.5%) three-month deaths. Newly developed ICISS scales had acceptable to outstanding discrimination, with Area Under the Curve ranging from 0.758 to 0.910. Age-specific ICISS scales were superior to general ICISS scales in model discrimination but inferior in model calibration. Calculated severe injury (ICISS ≤0.941) prevalence in the testing data ranged from 2% to 24%, depending on which mortality outcomes were used to calculate DRGs.

CONCLUSIONS

This study provides local, validated ICISS scores that can be used in Victoria. It is recommended that age group stratified ICISS based on the worst-injury method is used. From the comparison of various ICISS scores, reflecting the range of ICISS permutations that are currently in use, care should be taken to compare ICISS methodology before comparing severe injury prevalence per population, injury cause, and time trends.

Suicide among those who use mental health services: Suicide risk factors as evidenced from contact-based characteristics in Victoria

OBJECTIVE

The majority of suicide decedents have had contact with health services in the months before their death. Contacts for mental health services present potential suicide prevention opportunities. This study aims to compare contact-based characteristics among suicide decedents and living controls in the year subsequent to clinical mental health contact with the public health system in Victoria, Australia.

METHODS

A population-based nested case-control study of those who had mental health-related hospital and community contacts with the public health system was conducted. Cases (suicide decedents) were age and gender-matched to living controls (suicide non-decedents). These records were linked to records of suicides that occurred in the 12 months following the health service contact, between January 1, 2011, and December 31, 2016. Victorian residents aged 10 years and above were selected at the time of contact (483,933 clients). In the study population, conditional logistic regression models were used to assess the relationship between contact-based characteristics and suicide. Socio-demographics and mental health-related hospital and community contact data was retrieved from the Victorian Admitted Episodes Dataset, the Victorian Emergency Minimum Dataset and the Public Clinical Mental Health database and suicide data from the Victorian Suicide Register.

RESULTS

During a six-year period, 1,091 suicide decedents had at least one mental health contact with the public health system in the 12 months preceding the suicide. Overall, controls used more mental health services than cases; however, cases used more mental health services near the event. The relationship between the type of service and suicide differed by service type: hospital admissions and emergency department presentations had a significant positive association with suicide with an OR of 2.09 (95% CI 1.82-2.40) and OR of 1.13 (95% CI 1.05-1.22), and the effect size increased as the event approached, whereas community contacts had a significant negative association with an OR of 0.93 (95% CI 0.92-0.94), this negative association diminished in magnitude as the event approached (OR∼1).

CONCLUSION

Suicide decedents had less contact with mental health services than non-decedents; however, evidence suggests suicide decedents reach out to mental health services proximal to suicide. An increase in mental health service contact by an individual could be an indication of suicide risk and therefore an opportunity for intervention. Further, community level contact should be further explored as a possible prevention mechanism considering the majority of suicide decedents do not access the public clinical mental health services.

Sociodemographic characteristics associated with hospital contact in the year prior to suicide: A data linkage cohort study in Victoria, Australia

Aims

The aims of this study were to examine the prevalence of hospital contact in the year prior to suicide in Victoria, Australia, and to compare characteristics among those who did and did not have contact in the year prior to suicide.

Methods

The study was a data linkage cohort study of 4348 Victorians who died by suicide over the period 2011–2017. Data from the Victorian Suicide Register (VSR) was linked with hospital separations and Emergency Department (ED) presentations datasets by the Centre for Victorian Data Linkages (CVDL). The main outcomes were: (1) hospital contact for any reason, (2) hospital contact for mental-health-related reasons, and (3) hospital contact for intentional self-harm. Unadjusted and adjusted odds ratios were calculated as the measures of association.

Results

In the year prior to suicide, half of the decedents (50.0%) had hospital contact for any reason (n = 2172), 28.6% had mental-health-related hospital contact (n = 1244) and 9.9% had hospital contact for intentional self-harm (n = 432).

In the year prior to suicide, when compared with males aged 25–49 years (the reference group):

males aged 75+ years and females of all ages were significantly more likely to have hospital contact for any reason

females aged 10–24 years and 25–49 years were significantly more likely to have mental-health-related hospital contact

females aged 10–24 years and 25–49 years had 3.5 times and 2.4 times the odds of having hospital contact for intentional self-harm.

Conclusions

The comparatively high proportion of female decedents with mental-health related hospital contact in the year prior to suicide suggests improving the quality of care for those seeking help is an essential prevention initiative; this could be explored through programs such as the assertive outreach trials currently being implemented in Victoria and elsewhere in Australia. However, the sizeable proportion of males who do not have contact in the year prior to suicide was a consistent finding and represents a challenge for suicide prevention. Programs to identify males at risk in the community and engage them in the health care system are essential. In addition, promising universal and selective interventions to reduce suicide in the cohort who do not have hospital contact, include restricting access to lethal means and other public health interventions are also needed.

The impact of long-term workers' compensation benefit cessation on welfare and health service use: protocol for a longitudinal controlled data linkage study

Background

In 2012, the Australian state of New South Wales passed legislation that reformed its workers’ compensation system. Section 39 introduced a five-year limit on income replacement, with the first affected group having their benefits cease in December 2017. There is limited evidence on how this will affect their healthcare service use and where they will go for financial support.

Methods

Multiple data sources will be linked: administrate workers’ compensation claims data from the State Insurance Regulatory Authority (SIRA), universal health insurance data from the Medical Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS), state hospital and emergency department data, and social welfare data from the Department of Social Services’ Data Over Multiple Individual Occurrences (DOMINO). An estimated 4,125 injured workers had their benefits cease due to Section 39. These will form the exposure group who will be compared to 1) a similar group of workers’ compensation claimants who have had at least two years of compensated time off work but whose benefits did not cease due to Section 39; and 2) a community comparison group drawn from state hospital and emergency department records.

An accredited third party will link the data, which will be accessible only via secure virtual machine. Initial analyses will compare the prevalence and incidence of service use across groups in both the year before and year after benefit cessation; the community control will be assigned the median benefit cessation date in lieu of an actual date. To estimate the impact of benefit cessation due to Section 39, we will conduct time series analysis of the prevalence and incidence of service use.

Discussion

This study will provide much-needed evidence on the consequences of long-term benefit cessation, particularly on subsequent healthcare and welfare service use.

Australian Injury Comorbidity Indices (AICIs) to predict burden and readmission among hospital-admitted injury patients

BACKGROUND

Existing comorbidity measures predict mortality among general patient populations. Due to the lack of outcome specific and patient-group specific measures, the existing indices are also applied to non-mortality outcomes in injury epidemiology. This study derived indices to capture the association between comorbidity, and burden and readmission outcomes for injury populations.

METHODS

Injury-related hospital admissions data from July 2012 to June 2014 (161,334 patients) for the state of Victoria, Australia were analyzed. Various multivariable regression models were run and results used to derive both binary and weighted indices that quantify the association between comorbidities and length of stay (LOS), hospital costs and readmissions. The new and existing indices were validated internally among patient subgroups, and externally using data from the states of New South Wales and Western Australia.

RESULTS

Twenty-four comorbidities were significantly associated with overnight stay, twenty-seven with LOS, twenty-eight with costs, ten with all-cause and eleven with non-planned 30-day readmissions. The number of and types of comorbidities, and their relative impact were different to the associations established with the existing Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Measure (ECM). The new indices performed equally well to the long-listed ECM and in certain instances outperformed the CCI.

CONCLUSIONS

The more parsimonious, up to date, outcome and patient-specific indices presented in this study are better suited for use in present injury epidemiology. Their use can be trialed by hospital administrations in resource allocation models and patient classification models in clinical settings.

Traffic offending and deterrence: An examination of recidivism amongst drivers in Victoria, Australia born prior to 1975

To deter the performance of illegal driving behaviours, traffic infringement notices may be issued. Whilst there is a substantial body of research that has examined rates of reoffending following a traffic infringement, there have been few studies examining the length of time to next traffic offence. Where this research has been conducted, the findings do not provide current understandings, given the substantial changes in traffic sanctioning over time. The aim of this study was to address this gap, by examining risk factors for recidivism following a driver receiving a traffic infringement notice, as well as the time to next traffic offence. Licensing and infringements data held in the Driver Licensing System (DLS), maintained by the road authority in Victoria, Australia were used. All drivers included in the study were born prior to 1975, and received their first Victorian drivers licence between 1994 and 2016. Data from 203,620 drivers were used. Cox proportional hazards modelling was undertaken to examine factors associated with recidivism within 12 months of receiving a traffic infringement. 131,691 (64.7%) drivers had received at least one traffic infringement in Victoria, Australia since receiving their Victorian driver's licence. Factors found to be associated with longer time to further traffic offending in the year that followed the first infringement included being female; receiving a first Victorian driver's licence when aged 45+ years; and being licenced 10+ years. Traffic infringements deter some groups of Victorian drivers, but not others. If drivers are to be deterred from further illegal driving behaviour, it is important other countermeasures are developed and trialled.

Comparing rates and characteristics of emergency department presentations related to pharmaceutical opioid poisoning in Australia: a study protocol for a retrospective observational study

INTRODUCTION AND AIMS

Pharmaceutical opioids are an important contributor to the global 'opioid crisis', and are implicated in 70% of Australia's opioid-related mortality. However, there have been few studies which consider the relative contribution of different pharmaceutical opioids to harm.We aim to compare commonly used pharmaceutical opioids in terms of (1) rates of harm, and (2) demographic and clinical characteristics associated with that harm.

METHOD AND ANALYSIS

Observational study of emergency department presentations for non-fatal poisoning related to pharmaceutical opioid use. Data from 2009 to 2019 will be extracted from the Victorian Emergency Minimum Dataset which contains data from public hospitals with dedicated emergency departments in Victoria, Australia's second most populous state. A combination of free-text and International Classification of Diseases 10th Revision codes will be used to identify relevant cases, with manual screening of each case to confirm relevance. We will calculate supply-adjusted rates of presentations using Poisson regression for all pharmaceutical opioid cases identified, separately for nine commonly prescribed pharmaceutical opioids (buprenorphine, codeine, fentanyl, methadone, morphine, oxycodone, oxycodone-naloxone, tapentadol, tramadol), and for a multiple opioid category. We will use multinomial logistic regression to compare demographic and clinical characteristics, such as triage category, across opioid types.

ETHICS AND DISSEMINATION

This work is conducted under approval 21427 from the Monash University Human Research Ethics Committee for ongoing injury surveillance. As per conditions of approval, cells of <5 will not be reported, though zeroes will be preserved. We will present project findings in a peer-reviewed journal article as well as at relevant scientific conferences.

The Australian Injury Comorbidity Indices (AICIs) to predict in-hospital complications: A population-based data linkage study

Background

Hospital-admitted patients are at risk of experiencing certain adverse outcomes during their hospital-stay. Patients may need to be admitted to the intensive care unit or be placed on the ventilator while there is also a possibility for complications to develop. Pre-existing comorbidity could increase the risk of these outcomes. The Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Measure (ECM), originally derived for mortality outcomes among general medical populations, are widely used for assessing these in-hospital complications even among specific injury populations. This study derived indices to specifically capture the effect of comorbidity on intensive care unit and ventilator use as well as hospital-acquired complications for injury patients.

Methods

Retrospective data on injury hospital-admissions from July 2012 to June 2014 (161,334 patients) for the state of Victoria, Australia was analysed. Results from multivariable regression analysis were used to derive the Australian Injury Comorbidity Indices (AICIs) for intensive care unit and ventilator hours and hospital-acquired complications. The AICIs, CCI and ECM were validated on data from Victoria and two other Australian states.

Results

Five comorbidities were significantly associated with intensive care unit hours, two with ventilator hours and fifteen with hospital-acquired complications for hospitalised injury patients. Not all diseases listed in the CCI or ECM were found to be associated with these outcomes. The AICIs performed equally well in terms of predictive ability to the long-listed ECM and in most instances outperformed the CCI.

Conclusions

Associations between outcomes and comorbidities vary based on the type of outcome measure. The new comorbidity indices developed in this study provide a relevant, parsimonious and up-to-date method to capture the effect of comorbidity on in-hospital complications among admitted injury patients and is better suited for use in that context compared to the CCI and ECM.

Trends in lawyer use in road traffic injury compensation claims

Injury compensation claimants use legal services to help them navigate compensation schemes, including accessing benefits and resolving disputes. Little is known, however, about the extent of lawyer use by compensation claimants, including changes over time. This paper presents findings from one of the largest empirical investigations of lawyer use in an injury compensation setting to date. Using evidence from more than 275,000 claims in the road traffic injury scheme in the state of Victoria, Australia, this study examines the prevalence of, and changes in, lawyer use between 2000 and 2015. The analysis identifies a significant increase in the use of lawyers in the scheme, and explores possible explanations. This study provides critical insights into lawyer use in compensation settings: the steep increase in lawyer involvement has both access to justice and financial implications for compensation schemes, given the associations between lawyer use, claimant outcomes, and long-term scheme viability.

The Australian Injury Comorbidity Index to Predict Mortality

STUDY OBJECTIVE

Existing comorbidity indices such as the Charlson comorbidity index are dated yet still widely used. This study derives and validates up-to-date comorbidity indices for hospital-admitted injury patients, specific to mortality outcomes.

METHODS

Injury-related hospital admissions data for 2 cohorts of patients in the Australian state of Victoria were linked to mortality data: July 2012 to June 2014 (161,334 patients) and July 2006 to June 2015 (614,762 patients). Logistic regression models were fitted, and results were used to derive binary and weighted comorbidity indices to predict mortality outcomes. The indices were validated with data from New South Wales (Australia).

RESULTS

There were 11 comorbidity groups identified as associated with inhospital death (cohort 1), 13 with 30-day mortality, and 19 with 1-year mortality (cohort 2). The newly derived weights for comorbidities were very different from the Charlson comorbidity index weights for some conditions. The area under the curve statistics for inhospital death, 30-day mortality, and 1-year mortality were similar for the newly derived binary comorbidity indices (0.920, 0.923, and 0.910, respectively), the Charlson comorbidity index (0.915, 0.919, and 0.906, respectively), and the Elixhauser comorbidity measure (0.924, 0.923, and 0.908, respectively). The false-negative rates for the new binary indices (15.8%, 15.8%, and 16.3%, respectively) were statistically equal to those of the Charlson comorbidity index (17.4%, 16.3%, and 16.5%, respectively) and the Elixhauser comorbidity measure (15.2%, 14.8%, and 16.3%, respectively).

CONCLUSION

The newly derived Australian Injury Comorbidity Indices, which are a binary representation of individual conditions associated with the outcome of interest, are useful in quantifying the effect of comorbidity among injury patients. They include a shorter list of conditions than existing indices such as the Charlson comorbidity index and Elixhauser comorbidity measure, are up to date, and consider the individual association of each condition over a summed score such as the Charlson comorbidity index. Indices that quantify the effect of comorbidities should consider the population, disease prevalence, and outcome of interest and require periodic updating.

Evaluation of community coalition training effects on youth hospital-admitted injury incidence in Victoria, Australia: 2001-2017

BACKGROUND

Injuries are one of the three leading causes of morbidity and mortality for young people internationally. Although community risk factors are modifiable causes of youth injury, there has been limited evaluation of community interventions. Communities That Care (CTC) offers a coalition training process to increase evidence-based practices that reduce youth injury risk factors.

METHOD

Using a non-experimental design, this study made use of population-based hospital admissions data to evaluate the impact on injuries for 15 communities that implemented CTC between 2001 and 2017 in Victoria, Australia. Negative binomial regression models evaluated trends in injury admissions (all, unintentional and transport), comparing CTC and non-CTC communities across different age groups.

RESULTS

Statistically significant relative reductions in all hospital injury admissions in 0-4 year olds were associated with communities completing the CTC process and in 0-19 year olds when communities began their second cycle of CTC. When analysed by subgroup, a similar pattern was observed with unintentional injuries but not with transport injuries.

CONCLUSION

The findings support CTC coalition training as an intervention strategy for preventing youth hospital injury admissions. However, future studies should consider stronger research designs, confirm findings in different community contexts, use other data sources and evaluate intervention mechanisms.

Societal determinants of violent death: The extent to which social, economic, and structural characteristics explain differences in violence across Australia, Canada, and the United States

In this ecological study, we attempt to quantify the extent to which differences in homicide and suicide death rates between three countries, and among states/provinces within those countries, may be explained by differences in their social, economic, and structural characteristics. We examine the relationship between state/province level measures of societal risk factors and state/province level rates of violent death (homicide and suicide) across Australia, Canada, and the United States. Census and mortality data from each of these three countries were used. Rates of societal level characteristics were assessed and included residential instability, self-employment, income inequality, gender economic inequity, economic stress, alcohol outlet density, and employment opportunities). Residential instability, self-employment, and income inequality were associated with rates of both homicide and suicide and gender economic inequity was associated with rates of suicide only. This study opens lines of inquiry around what contributes to the overall burden of violence-related injuries in societies and provides preliminary findings on potential societal characteristics that are associated with differences in injury and violence rates across populations.

•

This study opens lines of inquiry around what contributes to the overall burden of violence-related injuries in societies.

•

Differences in homicide and suicide death between and within countries may be explained by social, economic, and structural characteristics.

•

Residential instability, self-employment, and income inequality were associated with rates of both homicide and suicide.

•

Gender economic inequity was associated with rates of suicide only.

Complications, burden and in-hospital death among hospital treated injury patients in Victoria, Australia: a data linkage study

Background

A wide range of outcome measures can be calculated for hospital-treated injury patients. These include mortality, use of critical care services, complications, length of stay, treatment costs, readmission and nursing care after discharge. Each address different aspects and phases of injury recovery and can yield vastly different results. This study aims to: (1) measure and report this range of outcomes in hospital-treated injury patients in a defined population; and (2) describe the associations between injury characteristics, socio-demographics and comorbidities and the various outcomes.

Methods

A retrospective analysis was conducted of injury-related hospital admissions from July 2012 to June 2014 (152,835 patients) in Victoria, Australia. The admission records were linked within the dataset, enabling follow-up, to assess the outcomes of in-hospital death, burden, complications and 30-day readmissions. Associations between factors and outcomes were determined using univariate regression analysis.

Results

The proportion of patients who died in hospital was 0.9%, while 26.8% needed post-discharge care. On average patients had 2.4 complications (confidence interval (CI) 2.4–2.5) related to their initial injury, the mean cost of treating a patient was Australian dollars 7013 (CI 6929–7096) and the median length of stay was one day (inter quartile range 1–3). Intensive-care-unit-stay was recorded in 3% of the patients. All-cause 30-day readmissions occurred in 12.3%, non-planned 30-day readmissions in 7.9%, while potentially avoidable 30-day readmissions were observed in 3.2% of the patients. Increasing age was associated with all outcomes. The need for care post-discharge from hospital was highest among children and the oldest age group (85 years and over). Injury severity was associated with all adverse outcomes. Increasing number of comorbidities increased the likelihood of all outcomes. Overall, outcomes are shown to differ by age, gender, comorbidities, body region injured, injury type and injury severity, and to a lesser extent by socio-economic areas.

Conclusions

Outcomes and risk factors differ depending on the outcome measured, and the method used for measuring the outcome. Similar outcomes measured in different ways produces varying results. Data linkage has provided a valuable platform for a comprehensive overview of outcomes, which can help design and target secondary and tertiary preventive measures.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7080-y) contains supplementary material, which is available to authorized users.

The impact of opioid analgesic prescription uptake on the costs of recovery from injury: Evidence from compensable orthopaedic road trauma patients

Long-term opioid prescribing after compensable orthopaedic injury may contribute to the 'long right tail' in the cost of recovery. The aim of this study was to estimate the effect of prescription opioid uptake on injury compensation cost, using orthopaedic road traffic injury claims data from Victoria, Australia. We used a maximum likelihood estimation that accounts for potential endogeneity associated with opioid uptake, utilizing information on the doctor's differential propensity to prescribe opioids when treating other compensable injury patients. Our results suggest that opioid recipients incurred significantly greater hospital costs, income compensation payments, and medical and paramedical expenses. Overall, income compensation was the primary driver of the claim cost difference between opioid recipients and non-recipients. The findings imply that there is scope to impose restrictions on long-term opioid usage, and to encourage the use of alternative pain relief medicines.

Trends in the leading causes of injury mortality, Australia, Canada, and the United States, 2000-2014

OBJECTIVES

The aim of this study was to highlight the differences in injury rates between populations through a descriptive epidemiological study of population-level trends in injury mortality for the high-income countries of Australia, Canada and the United States.

METHODS

Mortality data were available for the US from 2000 to 2014, and for Canada and Australia from 2000 to 2012. Injury causes were defined using the International Classification of Diseases, Tenth Revision external cause codes, and were grouped into major causes. Rates were direct-method age-adjusted using the US 2000 projected population as the standard age distribution.

RESULTS

US motor vehicle injury mortality rates declined from 2000 to 2014 but remained markedly higher than those of Australia or Canada. In all three countries, fall injury mortality rates increased from 2000 to 2014. US homicide mortality rates declined, but remained higher than those of Australia and Canada. While the US had the lowest suicide rate in 2000, it increased by 24% during 2000-2014, and by 2012 was about 14% higher than that in Australia and Canada. The poisoning mortality rate in the US increased dramatically from 2000 to 2014.

CONCLUSION

Results show marked differences and striking similarities in injury mortality between the countries and within countries over time. The observed trends differed by injury cause category. The substantial differences in injury rates between similarly resourced populations raises important questions about the role of societal-level factors as underlying causes of the differential distribution of injury in our communities.

The Impact of Pre-existing Health Conditions on Cost of Recovery after Workplace Injury: Insight from population-based data linkage in the State of Victoria, Australia

ABSTRACTObjectiveComorbidity is known to affect length of hospital stay and mortality after trauma but less is known about its impact on recovery beyond the acute care period. A main challenge to study the impact of pre-existing conditions is that information on these conditions is not collected systematically and comprehensively. The aim of this study was to investigate the role of pre-existing health conditions in recovery from workplace injury using linked data. ApproachIn Victoria, Australia, approximately 85% of the labour force is covered by the state workers compensation scheme regulated by WorkSafe Victoria. The scheme provides financial compensation for healthcare and income support to eligible injured workers. . One year of WorkSafe claims for injuries that occurred between 1/07/2008 and 31/06/2009 (N = 49,171) were linked to eight years of pre-injury hospital admission admissions and emergency department presentations, received from the state Department of Health and Human Services. Main outcomes of the study included the total and categorical cost of recovery (e.g. hospital, medical, allied health) measured over short (2-6 months), medium (1-2 years) and long-term (5 years) periods. All models controlled for characteristics of the worker, workplace and injury.ResultsThe preliminary results show that the cost of recovery from workplace injury is significantly associated with history of pre-injury admissions: Workers with pre-injury admissions have higher cost of recovery including longer periods of time off work as well as further cost of health service use during recovery. As this is an ongoing project, further detailed results will be presented at the conference such as the impact of admission under each category of pre-existing conditions according to ICD codes on a wide range of outcomes after workplace injury.Conclusion Our findings are expected to help government injury compensation regulators to better understand the drivers of compensation costs and other key system outcomes such as return to work. The findings will support better allocation of financial resources, better internal management of claims and efficient allocation of physical and human resources and therefore greater client satisfaction leading to ensuring faster recovery, return to work and more effective as well as efficient service provision.

Prescription Opioid and Benzodiazepine Use After Road Traffic Injury

BACKGROUND

Motor vehicle crash victims with physical injury are likely to receive prescription opioids and benzodiazepines. Potential mental trauma and lack of primary treating physician contribute to the risk of adverse opioid outcomes for this group. The purpose of this study is to characterise opioid and benzodiazepine prescribing after road traffic injury.

METHOD

Individuals who claimed Transport Accident Commission compensation for a noncatastrophic injury that occurred between 2010 and 2012 in Victoria, Australia and who provided consent for pharmaceutical benefits scheme (PBS) linkage were included (n = 734). PBS records dating between 12 months preinjury and 18 months postinjury were provided by the Department of Human Services.

RESULTS

In the year before injury, 10.5% of participants received prescription opioids; after injury, 45.1% of hospitalized and 21.1% of nonhospitalized participants received opioids. Benzodiazepines were used by 4.8% preinjury, and 7.0% and 7.4% postinjury (with and without hospitalization, respectively). Postinjury, 39% of opioid use and 73% of benzodiazepine use was potentially unrelated to the injury.

CONCLUSIONS

Prescription opioid and benzodiazepine before road traffic injury was substantial: the significance of postinjury prescription drug use cannot be established without taking preinjury use into account. It may be beneficial for pain medication to be managed by a pain treatment coordinator, in this injured population with high rates of pre-existing opioid and benzodiazepine use.

Caregiving and mental health among workers: Longitudinal evidence from a large cohort of adults in Thailand

BACKGROUND

As people in middle and lower income countries live longer, more people become sick, disabled, and frail and the demand for family caregiving grows. Thailand faces such challenges. This study investigates the relationship between caregiving and mental health among workers drawn from a large longitudinal cohort of Thai adults.

METHODS

Participants were drawn from the Thai Health-Risk Transition Study, a cohort study since 2005 of distance-learning adult Open University students residing nationwide. Caregiving status and binary psychological distress outcome (score 19-30 on Kessler 6) were recorded in 2009 and 2013 among cohort members who were paid workers at both years (n=33,972). Multivariate logistic regression was used to estimate the relationship between four-year longitudinal caregiving status and psychological distress in 2013, adjusting for potential covariates.

RESULTS

Longitudinal analyses revealed the transitional nature of care with 25% exiting and 10% entering the caring role during the four-year follow-up. Based on multivariate logistic regression, 2009-2013 caregiving status was significantly associated with psychological distress. Cohort members transitioning into caregiving and those who were caregivers in both 2009 and 2013 had a higher risk for psychological distress than non-caregivers (Adjusted Odds Ratios 1.40 [1.02-1.96] and 1.64 [1.16-2.33], respectively).

CONCLUSION

Our findings provide evidence on caregiving and associated risk for psychological distress among working Thais. This adds to the limited existing literature in middle-income countries and highlights the potential pressure among caregivers in balancing work and care while preserving their own mental health.

Non-Fatal Injury in Thailand From 2005 to 2013: Incidence Trends and Links to Alcohol Consumption Patterns in the Thai Cohort Study

Background

We analyzed population-based injury trends and the association between injury and alcohol consumption patterns in Thailand, a middle-income country undergoing rapid social change.

Methods

A nationwide cohort of 42 785 Thai adult Open University students, who were aged 15 to 87 years at enrolment, participated in cross-sectional assessments at baseline (2005) and 8 years later (2013). Incident non-fatal traffic and non-traffic injuries were recorded. Alcohol consumption patterns were categorized as follows: non-drinkers, occasional light drinkers, occasional heavy drinkers, regular drinkers, and ex-drinkers. Logistic regression was used to assess associations in 2005 and 2013 between injuries and alcohol consumption. We adjusted odds ratios (ORs) for socio-demographic factors, stress, health behaviors, and risk-taking behaviors.

Results

Incidence estimates in 2013 were standardized to the age structure of 2005: the standardized rates were 10% (95% confidence interval [CI], 9.32–9.89) for participants with at least one non-traffic injury and 5% (95% CI, 4.86–5.29) for those with at least one traffic injury. Both standardized incidences for non-traffic and traffic injuries were significantly lower than corresponding rates in 2005 (20% and 6%, respectively). Alcohol consumption was significantly associated with non-traffic injury in 2005, but the association disappeared in 2013. For example, non-traffic injury was associated with regular drinking (adjusted OR 1.17; 95% CI, 1.01–1.40) in 2005, but not in 2013 (adjusted OR 0.89; 95% CI, 0.73–1.10). In both survey years, traffic injury was not associated with occasional heavy drinking when adjusted for health and risk-taking behavior.

Conclusions

We examined non-fatal injury and the health-risk transition in Thailand in 2005 and 2013. Our data revealed decreases in alcohol consumption and non-fatal injury in the Thai Cohort between 2005 and 2013. Alcohol-related injury in Thailand today could be amenable to preventive intervention.

The influence of social support on healthcare service use following transport-related musculoskeletal injury

BACKGROUND

Social support has been identified as a significant factor in the recovery of individuals with musculoskeletal injury (MSI). However, relatively limited research has examined the mechanisms through which social support influences healthcare service use. This research examines the direct effects, mediating effects and effect modification of social support on healthcare service use among people with MSI sustained in a transport accident.

METHODS

The study design was secondary data analysis of cross-sectional surveys of compensated transport accident victims in Victoria in 2010 and 2011, linked to compensation claims and payment records. Analyses included (i) zero-inflated negative binomial and logistic regressions to model healthcare service use (direct effect), (ii) the Karlson, Holme and Breen (KHB) method to assess social support as a mediator of predisposing factors, need factors and healthcare service use (mediation effect), and (iii) interactions to assess social support as a modifier between predisposing factors, need factors and healthcare service use (effect modification).

RESULTS

Results of the direct analyses showed that support from family was associated with lower uptake of allied healthcare services (odds ratio (OR) 2.17; 95 % confidence intervals (CI) 1.21-3.91). Support from friends was associated with lower uptake (OR 1.87; 95 % CI 1.09-3.21) and lower rate (i.e. number of services per person) of allied healthcare services (incidence rate ratio (IRR) 0.65; 95 % CI 0.52-0.83). Support from friends (OR 0.60; 95 % CI 0.38-0.95) was also associated with lower uptake of mental healthcare services. No statistically significant mediation effects were identified for family or friends' support on the uptake of allied and mental healthcare services. Family support was found to modify the association between socio-economic indexes for areas and mental healthcare service use. In the group that reported having no social support, mental healthcare service uptake in the socioeconomically advantaged group was lower than in the disadvantaged group (OR 0.36; 95 % CI 0.16-0.83).

CONCLUSIONS

The findings suggest that social support has a direct and modifying effect on healthcare service use but does not mediate the association between predisposing factors, need factors and healthcare service use. The study findings have implications for the role of social support in the prevention, treatment and intervention of individuals with MSI.

The effect of pre-existing health conditions on the cost of recovery from road traffic injury: insights from data linkage of medicare and compensable injury claims in Victoria, Australia

Background

Comorbidity is known to affect length of hospital stay and mortality after trauma but less is known about its impact on recovery beyond the immediate post-accident care period. The aim of this study was to investigate the role of pre-existing health conditions in the cost of recovery from road traffic injury using health service use records for 1 year before and after the injury.

Methods

Individuals who claimed Transport Accident Commission (TAC) compensation for a non-catastrophic injury that occurred between 2010 and 2012 in Victoria, Australia and who provided consent for Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) linkage were included (n = 738) in the analysis. PBS and MBS records dating from 12 months prior to injury were provided by the Department of Human Services (Canberra, Australia). Pre-injury use of health service items and pharmaceuticals were considered to indicate pre-existing health condition. Bayesian Model Averaging techniques were used to identify the items that were most strongly correlated with recovery cost. Multivariate regression models were used to determine the impact of these items on the cost of injury recovery in terms of compensated ambulance, hospital, medical, and overall claim cost.

Results

Out of the 738 study participants, 688 used at least one medical item (total of 15,625 items) and 427 used at least one pharmaceutical item (total of 9846). The total health service cost of recovery was $10,115,714. The results show that while pre-existing conditions did not have any significant impact on the total cost of recovery, categorical costs were affected: e.g. on average, for every anaesthetic in the year before the accident, hospital cost of recovery increased by 24 % [95 % CI: 13, 36 %] and for each pathological test related to established diabetes, hospital cost increased by $10,407 [5466.78, 15346.28]. For medical costs, each anaesthetic led to $258 higher cost [174.16, 341.16] and every prescription of drugs used in diabetes increased the cost by 8 % [5, 11 %].

Conclusions

Services related to pre-existing conditions, mainly chronic and surgery-related, are likely to increase certain components of cost of recovery after road traffic trauma but pre-existing physical health has little impact on the overall recovery costs.

Recovery from musculoskeletal injury: the role of social support following a transport accident

Background

Social support can be an important coping resource for persons recovering from injury. In this study, we examined the effects of family structure and sources of social support on physical health, persistent pain and return to work (RTW) outcomes following musculoskeletal injury (MSI) sustained in a transport accident.

Methods

Secondary analysis of Transport Accident Commission (TAC) cross-sectional surveys held in 2010 and 2011 was conducted. In total 1649 persons with MSI were identified and included. Family structure was determined by marital status and number of children. Sources of social support were measured as perceived help from family, friends, neighbours and employers. Physical health was measured with the Physical Component Summary (PCS) score of the Short-Form-12 Health Survey Version 2. Persistent pain was defined as self-reported persistent pain experienced in the last 3 months, and RTW was defined as being back at work for ≥3 months at time of interview. Multiple linear and logistic regressions were used for the analyses.

Results

Family and friends’ support was associated with better physical health among persons with >1 day hospital stay. Being married or in a de facto relationship was associated with greater PCS score among non-hospitalised persons. Being widowed/separated/divorced was associated with more self-reported persistent pain (odds ratio 1.62 [95 % confidence intervals 1.11–2.37]). Support from family (0.40 [0.24–0.68]), friends (0.29 [0.17–0.47]) and neighbours (0.59 [0.41–0.84]) was associated with less persistent pain. Among women, support from family (0.09 [0.01–0.78]) was negatively associated with RTW, whereas support from friends (3.03 [1.15–8.02]) was positively associated with RTW. These associations were not observed among men. For both men (5.62 [2.77–11.38]) and women (7.22 [2.58–20.20]), support from employers was positively associated with RTW.

Conclusion

Family structure and sources of social support had a positive impact on physical health, persistent pain and RTW following MSI. This study highlights the importance of identifying people who have limited access to a social support network. Those with limited access to social support after a transport accident could potentially benefit from the provision of formal sources of practical and psychological support.

Use of antidepressant medication after road traffic injury

OBJECTIVES

Mental ill health after road traffic injury is common, as is the use of antidepressant medication after injury. Little is known about antidepressant use by injured people prior to their injury. The aim of this study is to describe the nature and extent of antidepressant use before and after road traffic injury.

METHODS

Victorian residents who claimed Transport Accident Commission (TAC) compensation for a non-catastrophic injury that occurred between 2010 and 2012 and provided consent for Pharmaceutical Benefits Scheme (PBS) linkage were included (n=734). PBS records dating from 12 months prior through to 12 months post injury were provided by the Department of Human Services (Canberra). PBS and TAC claims data were linked.

RESULTS

Among participants, 12% used antidepressants before injury (84.4D efined Daily Doses/1000 person-days) and 17% used antidepressants after injury (114.1DDD/1000p-d). Only 7.7% of the injured cohort commenced antidepressant treatment post injury. Thus, of all post-injury antidepressant use, 45% could potentially be related to the incident injury, with the remaining 55% most probably a continuation of pre-injury use. Pre-injury use was more common among women (109.4 vs. 54.6 DDD/1000p-d, p<0.0001), and those with whiplash injury (119.3 vs. 73.1, p=0.03). Cyclists and motorcyclists were less likely to use antidepressants pre-injury than car drivers (18.3 vs. 16.9 vs. 109.3, respectively; p<0.001).

CONCLUSIONS

Less than half of post-injury antidepressant use could potentially be attributable to the incident injury. These results highlight the importance of obtaining information on pre-injury health status before interpreting post-injury health service use to be an outcome of the injury in question.

Car Licensing Trends of the Babyboomer Cohort (b. 1946-1965) Compared to Earlier Birth Cohorts: Effects on the Driving Population in the State of Victoria, Australia

OBJECTIVE

The objective of this article was to explore trends in licensing among babyboomer older drivers in the state of Victoria, Australia. The study aims were to (1) compare the car licensing trends of the babyboomer cohort to that of previous birth cohorts and (2) predict the number of babyboomers licensed to drive a car in 2021 when the babyboomer cohort reaches an average age of 65 years.

METHODS

The residential population of Victoria, Australia, for 2001-2013 was obtained from the Australian Bureau of Statistics; car licensing statistics were obtained from VicRoads. Birth cohorts from 1916 to 1975 were defined in 10-year birth-year intervals. Population size was modeled using logistic regression. License prevalence was modeled using a logit model.

RESULTS

The babyboomer cohort (1946-1965) in Victoria is 1.7 times larger than the cohort before them. At age 60 years, license prevalence among babyboomers was higher than in previous cohorts: 88% in the 1936-1945 cohort vs. 96% in the 1946-1955 cohort. When the babyboomers reach 65 years (average) in 2021, we estimate there to be over twice as many license holders among them than in the preceding cohort (n = 1,300,094 vs. 630,830, respectively).

CONCLUSIONS

Aging of the babyboomer cohort will have a greater impact on the driving population than on the general population, due to the multiplicative effect of cohort size and license prevalence. The impact of road user aging on burden of injury can be minimized by focusing prevention at crashes typical to older drivers, such as intersection crashes, and promoting car safety features among older drivers.

The impact of family and work-related social support on musculoskeletal injury outcomes: a systematic review

PURPOSE

Social support has been identified as a key factor in facilitating better health outcomes following injury. However, there is limited research on the role of social support in recovery from musculoskeletal injury (MSI), the leading cause of morbidity and disability in the world. The aim of this study is to review the extent to which family and work-related social support (e.g. co-workers, supervisors) has been identified as a factor in the outcomes (physical, psychological, economic) of individuals with MSI.

METHODS

Eight online databases were searched for observational studies reporting findings on family and work-related social support in populations with MSI. Data extraction, quality assessment and a systematic critical synthesis were carried out on included studies.

RESULTS

Fourteen relevant articles were identified. The majority of the studies focused on social support from co-workers or supervisors (n = 11), while three studies focused on social support from the family. Overall, the evidence for the relation between work-related support and MSI outcomes was inconclusive. Similarly, there was limited and inconclusive evidence to demonstrate a relationship between family support and MSI outcomes.

CONCLUSIONS

The results of this review are inconclusive. Further research is needed to understand the role of social support in rehabilitation efforts following MSI. Recommendations for future research are provided.

Gender differences in occupational injury incidence

OBJECTIVES

To describe the frequency and distribution of workplace injury claims by gender, and quantify the extent to which observed gender differences in injury claim rates are attributable to differential exposure to work-related factors.

METHODS

WorkSafe Victoria (Australia) workers' compensation data (254,704 claims with affliction onset 2004-2011) were analysed. Claim rates were calculated by combining compensation data with state-wide employment data.

RESULTS

Mental disorder claim rates were 1.9 times higher among women; physical injury claim rates were 1.4 times higher among men. Adjusting for occupational group reversed the gender difference in musculoskeletal and tendon injury claim rates, i.e., these were more common in women than men after adjusting for occupational exposure.

CONCLUSIONS

Men had higher rates of physical injury claims than women, but this was mostly attributable to occupational factors. Women had higher rates of mental disorder claims than men; this was not fully explained by industry or occupation.

Examining physiological responses across different driving maneuvers during an on-road driving task: a pilot study comparing older and younger drivers

OBJECTIVE

This pilot study aimed to investigate physiological responses during an on-road driving task for older and younger drivers.

METHODS

Five older drivers (mean age = 74.60 years [2.97]) and 5 younger drivers (mean age = 30.00 years [3.08]) completed a series of cognitive assessments (Montreal Cognitive Assessment [MoCA], Mini Mental Status Examination [MMSE]; Trail Making Test [Trails A and Trails B]) and an on-road driving task along a predetermined, standardized urban route in their own vehicle. Driving performance was observed and scored by a single trained observer using a standardized procedure, where driving behaviors (appropriate and inappropriate) were scored for intersection negotiation, lane changing, and merging. During the on-road driving task, participants' heart rate (HR) was monitored with an unobtrusive physiological monitor.

RESULTS

Younger drivers performed significantly better on all cognitive assessments compared to older drivers (MoCA: t(8) = 3.882, P <.01; MMSE: t(8) = 2.954, P <.05; Trails A: t(8) = -2.499, P <.05; Trails B: t(8) = -3.262, P <.05). Analyses of participants' performance during the on-road driving task revealed a high level of appropriate overall driving behavior (M = 87%, SD = 7.62, range = 73-95%), including intersection negotiation (M = 89%, SD = 8.37%), lane changing (M = 100%), and merging (M = 53%, SD = 28.28%). The overall proportion of appropriate driving behavior did not significantly differ across age groups (younger drivers: M = 87.6%, SD = 9.04; older drivers: M = 87.0%, SD = 6.96; t(8) = 0.118, P =.91).

CONCLUSIONS

Although older drivers scored lower than younger drivers on the cognitive assessments, there was no indication of cognitive overload among older drivers based on HR response to the on-road driving task. The results provide preliminary evidence that mild age-related cognitive impairment may not pose a motor vehicle crash hazard for the wider older driver population. To maintain safe mobility of the aging population, further research into the specific crash risk factors in the older driver population is warranted.