TY - JOUR
T1 - Injury severity and increased socioeconomic differences
T2 - A population-based cohort study
AU - Madsen, Christian
AU - Gabbe, Belinda J.
AU - Holvik, Kristin
AU - Alver, Kari
AU - Grøholt, Else Karin
AU - Lund, Johan
AU - Lyons, Jane
AU - Lyons, Ronan A.
AU - Ohm, Eyvind
N1 - Funding Information:
This research was internally funded and received no specific grant from any funding agency. BJG was supported by an Australian Research Council Future Fellowship (FT170100048) during the preparation of this manuscript. The Regional Committee for Medical and Health Research Ethics in Norway (REC approval number: 2014/1945) approved the study in advance. Informed consent was not obtained from the individual participants included in the study, as data were obtained from nationwide health registries to which reporting is mandatory. Not applicable. Data from the Norwegian Patient Registry have been used in this publication. The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by the Norwegian Patient Registry is intended or should be inferred.
Funding Information:
This research was internally funded and received no specific grant from any funding agency. BJG was supported by an Australian Research Council Future Fellowship ( FT170100048 ) during the preparation of this manuscript.
Publisher Copyright:
© 2022 The Authors
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Background: Several studies have documented an inverse gradient between socioeconomic status (SES) and injury mortality, but the evidence is less consistent for injury morbidity. The aim of this study was to investigate the association between SES and injury severity for acute hospitalizations in a nationwide population-based cohort. Methods: We conducted a registry-based cohort study of all individuals aged 25–64 years residing in Norway by 1st of January 2008. This cohort was followed from 2008 through 2014 using inpatient registrations for acute hospitalizations due to all-cause injuries. We derived two measures of severity: threat-to-life using the International Classification of Disease-based Injury Severity Score (ICISS), and threat of disability using long-term disability weights from the Injury-VIBES project. Robust Poisson regression models, with adjustment for age, sex, marital status, immigrant status, municipality population size and healthcare region of residence, were used to calculate incidence rate ratios (IRRs) by SES measured as an index of education, income, and occupation. Results: We identified 177,663 individuals (7% of the population) hospitalized with at least one acute injury in the observation period. Two percent (n = 4,186) had injuries categorized with high threat-to-life, while one quarter (n = 43,530) had injuries with high threat of disability. The overall adjusted IRR of hospitalization among people with low compared to high SES was 1.57 (95% CI 1.55, 1.60). Comparing low to high SES, injuries with low threat-to-life were associated with an IRR of 1.56 (95% CI 1.54, 1.59), while injuries with high threat-to-life had an IRR of 2.25 (95% CI 2.03, 2.51). Comparing low to high SES, injuries with low, medium, and high threat of disability were associated with IRRs of respectively, 1.15 (95% CI 1.11, 1.19), 1.70 (95% CI 1.66, 1.73) and 1.99 (95% CI 1.92, 2.07). Discussion: We observed an inverse gradient between SES and injury morbidity, with the steepest gradient for the most severe injuries. This suggests a need for targeted preventive measures to reduce the magnitude and burden of severe injuries for patients with low socioeconomic status.
AB - Background: Several studies have documented an inverse gradient between socioeconomic status (SES) and injury mortality, but the evidence is less consistent for injury morbidity. The aim of this study was to investigate the association between SES and injury severity for acute hospitalizations in a nationwide population-based cohort. Methods: We conducted a registry-based cohort study of all individuals aged 25–64 years residing in Norway by 1st of January 2008. This cohort was followed from 2008 through 2014 using inpatient registrations for acute hospitalizations due to all-cause injuries. We derived two measures of severity: threat-to-life using the International Classification of Disease-based Injury Severity Score (ICISS), and threat of disability using long-term disability weights from the Injury-VIBES project. Robust Poisson regression models, with adjustment for age, sex, marital status, immigrant status, municipality population size and healthcare region of residence, were used to calculate incidence rate ratios (IRRs) by SES measured as an index of education, income, and occupation. Results: We identified 177,663 individuals (7% of the population) hospitalized with at least one acute injury in the observation period. Two percent (n = 4,186) had injuries categorized with high threat-to-life, while one quarter (n = 43,530) had injuries with high threat of disability. The overall adjusted IRR of hospitalization among people with low compared to high SES was 1.57 (95% CI 1.55, 1.60). Comparing low to high SES, injuries with low threat-to-life were associated with an IRR of 1.56 (95% CI 1.54, 1.59), while injuries with high threat-to-life had an IRR of 2.25 (95% CI 2.03, 2.51). Comparing low to high SES, injuries with low, medium, and high threat of disability were associated with IRRs of respectively, 1.15 (95% CI 1.11, 1.19), 1.70 (95% CI 1.66, 1.73) and 1.99 (95% CI 1.92, 2.07). Discussion: We observed an inverse gradient between SES and injury morbidity, with the steepest gradient for the most severe injuries. This suggests a need for targeted preventive measures to reduce the magnitude and burden of severe injuries for patients with low socioeconomic status.
KW - Hospitalization
KW - ICISS
KW - Injury
KW - Injury-VIBES
KW - Risk-adjusted severity
KW - Socioeconomic status
UR - https://www.scopus.com/pages/publications/85127340058
U2 - 10.1016/j.injury.2022.03.039
DO - 10.1016/j.injury.2022.03.039
M3 - Article
C2 - 35365351
AN - SCOPUS:85127340058
SN - 0020-1383
VL - 53
SP - 1904
EP - 1910
JO - Injury
JF - Injury
IS - 6
ER -