Rural-urban variation in COVID-19 vaccination uptake in Aotearoa New Zealand: Examining the national roll-out.

This study aimed to understand rural-urban differences in the uptake of COVID-19 vaccinations during the peak period of the national vaccination roll-out in Aotearoa New Zealand (NZ). Using a linked national dataset of health service users aged 12+ years and COVID-19 immunization records, age-standardized rates of vaccination uptake were calculated at fortnightly intervals, between June and December 2021, by rurality, ethnicity, and region. Rate ratios were calculated for each rurality category with the most urban areas (U1) used as the reference. Overall, rural vaccination rates lagged behind urban rates, despite early rapid rural uptake. By December 2021, a rural-urban gradient developed, with age-standardized coverage for R3 areas (most rural) at 77%, R2 81%, R1 83%, U2 85%, and U1 (most urban) 89%. Age-based assessments illustrate the rural-urban vaccination uptake gap was widest for those aged 12-44 years, with older people (65+) having broadly consistent levels of uptake regardless of rurality. Variations from national trends are observable by ethnicity. Early in the roll-out, Indigenous Maori residing in R3 areas had a higher uptake than Maori in U1, and Pacific peoples in R1 had a higher uptake than those in U1. The extent of differences in rural-urban vaccine uptake also varied by region.

Impact of legislative reform on worker fatalities in New Zealand workplaces: a 30-year retrospective population-level analysis.

OBJECTIVES: To determine the impact of major legislative changes to New Zealand's Occupational Health and Safety (OHS) legislation with the adoption of the Robens model as a means to control occupational risks on the burden and risk of work-related fatal injury (WRFI). METHODS: Population-based comparison of WRFI to workers aged 15-84 years occurring during three periods: before (pre:1985-1992), after legislative reform (post-1:1993-2002) and after subsequent amendment (post-2:2003-2014). Annual age-industry standardised rates were calculated with 95% CI. Multivariable Poisson regression was used to estimate age-adjusted annual percentage changes (APC) for each period, overall and stratified by high-risk industry and occupational groups. RESULTS: Over the 30-year period, 2053 worker deaths met the eligibility criteria. Age-adjusted APC in rates of worker WRFI changed little between periods: pre (-2.8%, 95% CI 0.0% to -5.5%); post-1 (-2.9%, 95% CI -1.3% to -4.5%) and post-2 (-2.9%, 95% CI -1.3% to -4.4%). There was no evidence of differences in slope. Variable trends in worker WRFI were observed for historically high-risk industry and occupational groups. CONCLUSIONS: The rate of worker WRFI decreased steadily over the 30-year period under examination and there was no evidence that this pattern of declining WRFI was substantially altered with the introduction of Robens-styled OHS legislative reforms. Beyond headline figures, historically high-risk groups had highly variable progress in reducing worker WRFI following legislative reform. This study demonstrates the value in including prereform data and high-risk subgroup analysis when assessing the performance of OHS legislative reforms to control occupational risks.

Missing cases of injury death: use of quantitative methods and case reviews to inform future improvements in case definition.

BACKGROUND: Knowledge of fatal injuries is required to inform prevention activities. Where hospital patients with an injury principal diagnosis (PDx) died and were certified to a medical underlying cause of death (UCoD), there is the potential to underestimate injury mortality. We sought to characterise injury/non-injury (NI) mismatches between PDx and UCoD by identifying which subgroups had small/large mismatches, and to understand why mismatches had occurred using informative examples. METHOD: Hospital records (n=10 234) with a PDx of injury were linked to the mortality collection using a unique personal identifier. Percentages UCoD coded to a NI were tabulated, for three follow-up periods and by selected variables. Additionally, we reviewed a sample of 70 records for which there was a mismatch. RESULTS: %NIs were 39%, 66% and 77% for time from injury to death of <1 week, <90 days and <1 year, respectively. Variations in %NI were found for all variables. Illustrative examples of 70 medical UCoD deaths showed that for 12 cases the injury event was unequivocally judged to have resulted in premature death. A further 16 were judged as injury deaths using balance of probability arguments. CONCLUSION: There is variation in rates of mismatch between PDx of injury and UCoD of NI. While legitimate reasons exist for mismatches in certain groups, a material number of injury deaths are not captured using UCoD alone; a new operational definition of injury death is needed. Early solutions are proposed. Further work is needed to investigate operational definitions with acceptable false positive and negative detection rates.

Access to advanced-level hospital care: differences in prehospital times calculated using incident locations compared with patients' usual residence.

Studies estimate that 84% of the USA and New Zealand's (NZ) resident populations have timely access (within 60 min) to advanced-level hospital care. Our aim was to assess whether usual residence (ie, home address) is a suitable proxy for location of injury incidence. In this observational study, injury fatalities registered in NZ's Mortality Collection during 2008-2012 were linked to Coronial files. Estimated access times via emergency medical services were calculated using locations of incident and home. Using incident locations, 73% (n=4445/6104) had timely access to care compared with 77% when using home location. Access calculations using patients' home locations overestimated timely access, especially for those injured in industrial/construction areas (18%; 95% CI 6% to 29%) and from drowning (14%; 95% CI 7% to 22%). When considering timely access to definitive care, using the location of the injury as the origin provides important information for health system planning.

Prevalence and predictors of post-traumatic stress symptoms in 2200 hospitalised and non-hospitalised injured New Zealanders.

OBJECTIVE: Post-traumatic stress disorder following injuries unrelated to mass casualty events has received little research attention in New Zealand. Internationally, most studies investigating predictors of post-injury post-traumatic stress disorder focus on hospitalised patients although most survivors are not hospitalised. We compared the prevalence and predictors of symptoms suggestive of post-traumatic stress disorder 12 months following injury among hospitalised and non-hospitalised entitlement claimants in New Zealand's Accident Compensation Corporation. This government-funded universal no-fault insurance scheme replaced tort-based compensation for injuries in 1974 since when civil litigation (which can bias post-traumatic stress disorder estimates) has been rare. METHODS: A total of 2220 Accident Compensation Corporation claimants aged 18-64 years recruited to the Prospective Outcomes of Injury Study were interviewed at 12 months post-injury to identify symptoms suggestive of post-traumatic stress disorder using the Impact of Events Scale. Multivariable models examined the extent to which baseline sociodemographic, injury, health status and service interaction factors predicted the risk of post-traumatic stress disorder symptoms among hospitalised and non-hospitalised groups. RESULTS: Symptoms suggestive of post-traumatic stress disorder were reported by 17% of hospitalised and 12% of non-hospitalised participants. Perceived threat to life at the time of the injury doubled this risk among hospitalised (adjusted relative risk: 2.0; 95% confidence interval: 1.2-3.2) and non-hospitalised (relative risk: 1.8; 95% confidence interval: 1.2-2.8) participants. Among hospitalised participants, other predictors included female gender, Pacific and 'other' minority ethnic groups, pre-injury depressive symptoms, financial insecurity and perceived inadequacies in healthcare interactions, specifically information and time to discuss problems. Among non-hospitalised survivors, predictors included smoking, hazardous drinking, assault and poor expectations of recovery. CONCLUSION: One in six hospitalised and one in eight non-hospitalised people reported post-traumatic stress disorder symptoms 12 months following injury. Perceived threat to life was a strong predictor of this risk in both groups. Identifying early predictors of post-traumatic stress disorder, regardless of whether the injury required hospitalisation, could help target tailored interventions that can reduce longer-term psychosocial morbidity.

Decade of fatal injuries in workers in New Zealand: insights from a comprehensive national observational study.

INTRODUCTION: Current priorities and strategies to prevent work-related fatal injury (WRFI) in New Zealand (NZ) are based on incomplete data capture. This paper provides an overview of key results from a comprehensive 10-year NZ study of worker fatalities using coronial records. METHODS: A data set of workers, aged 15-84 years at the time of death who died in the period 2005-2014, was created using coronial records. Data collection involved: (1) identifying possible cases from mortality records using selected external cause of injury codes; (2) linking these to coronial records; (3) retrieving and reviewing records for work-relatedness; and (4) coding work-related cases. Frequencies, percentages and rates were calculated. Analyses were stratified into workplace and work-traffic settings. RESULTS: Over the decade, 955 workers were fatally injured, giving a rate of 4.8 (95% CI 5.6 to 6.3) per 100 000 worker-years. High rates of worker fatalities were observed for workers aged 70-84 years, indigenous Maori and for males. Workers employed in mining had the highest rate in workplace settings while transport, postal and warehousing employees had the highest rate in work-traffic settings. Vehicle-related mechanisms dominated the mechanism and vehicles and environmental agents dominated the breakdown agencies contributing to worker fatalities. DISCUSSION: This study shows the rates of worker fatalities vary widely by age, sex, ethnicity, occupation and industry and are a very serious problem for particular groups. Future efforts to address NZ's high rates of WRFI should use these findings to aid understanding where preventive actions should be prioritised.

Evaluating the impact of prehospital care on mortality following major trauma in New Zealand: a retrospective cohort study.

BACKGROUND: Injury is a leading cause of death and health loss in New Zealand and internationally. The potentially fatal or severe consequences of many injuries can be reduced through an optimally structured prehospital trauma care system that can provide timely and appropriate care. OBJECTIVE: To investigate the relationship between emergency medical services (EMS) care and survival to hospital for major trauma cases in New Zealand. METHODS: This project is a retrospective cohort study of New Zealand major trauma cases attended by EMS providers over a 2-year period. Outcomes include survival to hospital and survival in hospital for at least 24 hours. The project has three phases: (1) identification of the cohort and assembling a bespoke longitudinal dataset linking EMS, New Zealand Major Trauma Registry and Coronial data; (2) describing the pathways and processes of care to inform an investigation of the relationships between types of EMS care and survival using propensity score modelling to adjust for case-mix differences; (3) assessment of the implications for future practice, policy and research. DISCUSSION: The study findings will help identify opportunities to optimise the delivery of EMS care in New Zealand by informing the development or revision of existing major trauma EMS policies and guidelines, and to provide a baseline for monitoring the impact of future initiatives. Establishing an evidence-base will support a whole-of-system appraisal that could include broader complex variables relating to healthcare services throughout the continuum of trauma care.

Developing the geographic classification for health, a rural-urban classification for New Zealand health research and policy: A research protocol.

INTRODUCTION: Rural-urban health inequities, exacerbated by deprivation and ethnicity, have been clearly described in the international literature. To date, the same inequities have not been as clearly demonstrated in Aotearoa New Zealand despite the lower socioeconomic status and higher proportion of Maori living in rural towns. This is ascribed by many health practitioners, academics and other informed stakeholders to be the result of the definitions of 'rural' used to produce statistics. AIMS: To outline a protocol to produce a 'fit-for-health purpose' rural-urban classification for analysing national health data. The classification will be designed to determine the magnitude of health inequities that have been obscured by use of inappropriate rural-urban taxonomies. METHODS: This protocol paper outlines our proposed mixed-methods approach to developing a novel Geographic Classification for Health. In phase 1, an agreed set of community attributes will be used to modify the new Statistics New Zealand Urban Accessibility Classification into a more appropriate classification of rurality for health contexts. The Geographic Classification for Health will then be further developed in an iterative process with stakeholders including rural health researchers and members of the National Rural Health Advisory Group, who have a comprehensive 'on the ground' understanding of Aotearoa New Zealand's rural communities and their attendant health services. This protocol also proposes validating the Geographic Classification for Health using general practice enrolment data. In phase 2, the resulting Geographic Classification for Health will be applied to routinely collected data from the Ministry of Health. This will enable current levels of rural-urban inequity in health service access and outcomes to be accurately assessed and give an indication of the extent to which older classifications were masking inequities.

Factors related to absence of toxicological investigation following fatal injury: a retrospective quantitative review of Coronial records in New Zealand.

PURPOSE: The accuracy of cause of death certification is strongly influenced by the quality of post mortem investigations (autopsies). In New Zealand, this can include toxicological investigation at the discretion of the Coroner. Little is known both within New Zealand and internationally about potential selection biases related to Coronial cases not undergoing toxicology investigation. METHODS: A retrospective review of eligible injury-related deaths referred to a Coroner in New Zealand in 2014 was undertaken. Using data collected from the Australasian National Coronial Information System and New Zealand's Mortality Collection, descriptive analyses were undertaken to understand patterns related to toxicology report requests and patterns within toxicology reports. RESULTS: In New Zealand in 2014, 25% of 744 Coronial cases for fatal injury in those under 85 years of age did not have corresponding toxicological reports. Reports were more likely to be absent in females (adjusted Odds Ratio (aOR) 1.7, 95%CI 1.0, 2.7), and in decedents aged under 15 and over 65 years (aOR 11.0 and 4.1 respectively). More than half (56%, 95% CI 45%, 67%) of the deaths due to falls did not receive toxicological investigation. CONCLUSION: Better understanding of selection biases in Coronial processes helps inform policymakers, researchers, and practitioners of the limitations of available toxicological evidence.

Predictors of subsequent injury at work: findings from a prospective cohort of injured workers in New Zealand.

OBJECTIVES: People who have experienced a work-related injury can experience further work injuries over time. This study examines predictors of subsequent work-related injuries over 24 months among a cohort of injured workers. METHODS: Participants were those recruited to the earlier Prospective Outcomes of Injury Study (POIS) who had a work-related injury (the 'sentinel' injury). Data from POIS participant interviews were combined with administrative data from the Accident Compensation Corporation (New Zealand's no-fault universal injury insurer) and hospital discharge data. Modified Poisson regression modelling was used to examine whether presentinel injury sociodemographic and health, sentinel injury or presentinel injury work-related factors predicted subsequent work-related injuries. RESULTS: Over a third of participants (37%) had at least one subsequent work-related injury in 24 months. Factors associated with an increased risk of work-related subsequent injury included being in a job involving carrying or moving heavy loads more than half the time compared with those in jobs that never involved such tasks (RR 1.42, 95% CI 1.01 to 2.01), having an inadequate household income compared with those with an adequate household income (RR 1.33, 95% CI 1.02 1.74) and being aged 50-64 years compared with those aged 30-49 years (RR 1.25, 95% 1.00 to 1.57). CONCLUSION: Subsequent work-related injuries occur frequently, and presenting with a work-related injury indicates a potentially important intervention point for subsequent injury prevention. While the strength of associations were not strong, factors identified in this study that showed an increased risk of subsequent work-related injuries may provide a useful focus for injury prevention or rehabilitation attention.

Decade of variable progress: trends in fatal injury in workers in New Zealand from a national observational study.

INTRODUCTION: Analyses of secular trends in work-related fatal injury in New Zealand have previously only considered the total working population, potentially hiding trends for important subgroups of workers. This paper examines trends in work-related fatalities in worker subgroups between 2005 and 2014 to indicate where workplace safety action should be prioritised. METHODS: A dataset of fatally injured workers was created; all persons aged 15-84 years, fatally injured in the period 2005-2014, were identified from mortality records, linked to coronial records which were then reviewed for work relatedness. Poisson regression modelling was used to estimate annual percentage change in rates by age, sex, ethnicity, employment status, industry and occupation. RESULTS: Overall, worker fatalities decreased by 2.4% (95% CI 0.0% to 4.6%) annually; an average reduction of 18 deaths per year from baseline (2005). Significant declines in annual rates were observed for younger workers (15-29 and 30-49 years), indigenous Maori, those in the public administration and service sector, and those in community and personal service occupations. Increases in annual rates occurred for workers in agriculture and forestry and fisheries sectors and for labourers. Rates of worker deaths in work-traffic settings declined faster than in workplace settings. DISCUSSION: Although overall age-standardised rates of work-related fatal injury have been declining, these trends were variable. Sources of injury risk in identifiable subgroups with increases in annual rates need to be urgently addressed. This study demonstrates the need for regular, detailed examination of the secular trends to identify those subgroups of workers requiring further workplace safety attention.

Potential survivability of prehospital injury deaths in New Zealand: a cross-sectional study.

INTRODUCTION: Acknowledging a notable gap in available evidence, this study aimed to assess the survivability of prehospital injury deaths in New Zealand. METHODS: A cross-sectional review of prehospital injury death postmortems (PM) undertaken during 2009-2012. Deaths without physical injuries (eg, drownings, suffocations, poisonings), where there was an incomplete body, or insufficient information in the PM, were excluded. Documented injuries were scored using the AIS and an ISS derived. Cases were classified as survivable (ISS <25), potentially survivable (ISS 25-49) and non-survivable (ISS >49). RESULTS: Of the 1796 cases able to be ISS scored, 11% (n=193) had injuries classified as survivable, 28% (n=501) potentially survivable and 61% (n=1102) non-survivable. There were significant differences in survivability by age (p=0.017) and intent (p<0.0001). No difference in survivability was observed by sex, ethnicity, day of week, seasonality or distance to advanced-level hospital care. 'Non-survivable' injuries occurred more commonly among those with multiple injuries, transport-related injuries and aged 15-29 year. The majority of 'survivable' cases were deceased when found. Among those alive when found, around half had received either emergency medical services (EMS) or bystander care. One in five survivable cases were classified as having delays in receiving care. DISCUSSION: In New Zealand, the majority of injured people who die before reaching hospital do so from non-survivable injuries. More than one third have either survivable or potentially survivable injuries, suggesting an increased need for appropriate bystander first aid, timeliness of EMS care and access to advanced-level hospital care.

Use of mixed methods to investigate case definitions to improve the identification of serious injury cases from hospital episode data.

INTRODUCTION: It has been commonplace internationally, when using hospital data, to use the principal diagnosis to identify injury cases and the first external cause of injury code (E-code) to identify the main cause. Our purpose was to investigate alternative operational definitions of serious non-fatal injury to identify cases of interest for injury surveillance, both overall and for four common causes of injury. METHODS: Serious non-fatal injury cases were identified from New Zealand (NZ) hospital discharge data using an alternative definition: that is, case selection using principal and additional diagnoses. Separately, identification of cause used all E-codes on the discharge record. Numbers of cases identified were contrasted with those captured using the usual definition. Views of NZ government stakeholders were sought regarding the acceptability of the additional cases found using these alternative definitions. Views of international experts were also canvassed. RESULTS: When using all diagnoses there was a 7% increase in 'all injury' cases identified, a 17% increase in self-harm cases and 8% increase in falls cases. Use of all E-codes resulted in a 4% increase in self-harm cases, 2% increase in assault cases and 1% increase in both falls and motor vehicle traffic crash cases. DISCUSSION: A case definition based solely on principal diagnosis fails to count a material number of serious non-fatal injury cases that are of interest to the injury prevention community. There is a need, therefore, to use an alternative case definition that includes additional diagnoses. Use of multiple E-codes to classify cause of injury should be considered.

Using hospital discharge data for injury research or surveillance? An observational study illustrating the impact of administrative change.

INTRODUCTION: Hospital discharge data provide an important basis for determining priorities for injury prevention and monitoring trends in incidence. This study aims to illustrate the impact of a recent change in administrative practice on estimates of hospitalised injury incidence and to investigate the extent to which different case selection affects trends in injury incidence rates. METHODS: New Zealand (NZ) hospital discharges (2000-2014) with a primary diagnosis of injury were identified. Additional case selection criteria included first admissions only, and for serious injury, a high threat-to-life estimate. Comparisons were made, over time and by District Health Board, between hospitalised injury incidence estimates that included, or not, short-stay emergency department (SSED) discharges. RESULTS: Of the 1 229 772 injury hospital discharges, 365 114 were SSED; 16% of the annual total in 2000, 38% in 2014. Identification of readmissions prior to the exclusion of SSED discharges resulted in 30 724 cases being erroneously removed. Age-standardised rates of hospitalised injury over the 15-year period increased by, on average, 2.7% per year when SSED discharges were included; there was minimal secular change (-0.2%) when SSEDs were excluded. For serious hospitalised injury, the annual increase was 2.3% when SSED was included compared with 1.1% when SSEDs were excluded. CONCLUSION: Spurious trends in hospitalised injury incidence can result when administrative practices are not appropriately accounted for. Exclusion of SSED discharges before the identification of readmissions and the use of a severity threshold are recommended to minimise the reporting bias in NZ hospitalised injury incidence estimates.

Impact of further injury on participation in work and activities among those previously injured: results from a New Zealand prospective cohort study.

PURPOSE: To examine participation in paid work, unpaid work and activities 12 months after a sentinel (initial) injury, and to determine the impact of sustaining a subsequent injury (SI) on these participation outcomes. METHODS: Participants were recruited to the Prospective Outcomes of Injury Study following an Accident Compensation Corporation (ACC; New Zealand's no-fault injury insurer) entitlement claim injury. Outcomes were whether participants reported reduced paid work hours, reduced unpaid work (e.g. housework, gardening) or reduced activities (e.g. socialising, leisure pursuits) at 12 months compared to before the sentinel injury event. SIs were ACC claims of any type. Using multivariable models, characteristics of SIs were examined as potential predictors of reduced participation. RESULTS: At 12 months, 30% had reduced paid work hours, 12% had reduced unpaid work and 25% had reduced activities. Sustaining a SI predicted reduced paid work (RR 1.5; 95% CI 1.2, 1.8), but not unpaid work or activities. Participants who had sustained intracranial SIs were at highest risk of reduced paid work (RR 3.2, 95% CI 1.9, 5.2). Those sustaining SIs at work were less likely to have reduced paid work (RR 0.7; 95% CI 0.6, 1.0) than those with only non-work SIs. Participants sustaining assaultive SIs had higher risk of reduced unpaid work (RR 2.6, 95% CI 1.0, 6.8). CONCLUSIONS: Reduced participation is prevalent after a substantive sentinel injury, and sustaining a SI impacts on return to paid work. Identification of SI characteristics that put people at high risk of participation restriction may be useful for focusing on rehabilitative attention.

Injury upon injury: a prospective cohort study examining subsequent injury claims in the 24 months following a substantial injury.

OBJECTIVES: This study examines subsequent injuries reported to the Accident Compensation Corporation (ACC), New Zealand's universal no-fault injury insurer, in the 24 months following an ACC entitlement claim injury event. Specific aims were to determine the: (1) 12 and 24 month cumulative incidence of at least one ACC-reported subsequent injury (ACC-SUBS-Inj), (2) characteristics of participants with and without ACC-SUBS-Inj, (3) frequency of ACC-SUBS-Inj, (4) time periods in which people are at higher risk of ACC-SUBS-Inj and (5) types of ACC-SUBS-Inj. METHODS: Interview data collected directly from participants in the Prospective Outcomes of Injury Study (POIS) were combined with ACC-SUBS-Inj data from ACC and hospital discharge datasets. A subsequent injury was defined as any injury event resulting in an ACC claim within 24 months following the injury event for which participants were recruited to POIS (the sentinel injury). All ACC-SUBS-Inj were included irrespective of whether they were the same as the sentinel injury or not. RESULTS: Of 2856 participants, 58% (n=1653) experienced at least one ACC-SUBS-Inj in 24 months; 31% (n=888) had more than one ACC-SUBS-Inj. The time period of lowest risk of ACC-SUBS-Inj was the first 3 months following the sentinel injury event. Spine sprain/strain was the type of injury with the greatest number of ACC-SUBS-Inj claims per person. CONCLUSIONS: More than half of those with an ACC entitlement claim injury incurred further injury events that resulted in a claim in the following 24 months. Greater understanding of these subsequent injury events provides an avenue for injury prevention.

Empirical validation of the New Zealand serious non-fatal injury outcome indicator for 'all injury'.

Our purpose was to empirically validate the official New Zealand (NZ) serious non-fatal 'all injury' indicator. To that end, we aimed to investigate the assumption that cases selected by the indicator have a high probability of admission. Using NZ hospital in-patient records, we identified serious injury diagnoses, captured by the indicator, if their diagnosis-specific survival probability was ≤0.941 based on at least 100 admissions. Corresponding diagnosis-specific admission probabilities from regions in Canada, Denmark and Greece were estimated. Aggregate admission probabilities across those injury diagnoses were calculated and inference made to New Zealand. The admission probabilities were 0.82, 0.89 and 0.90 for the regions of Canada, Denmark and Greece, respectively. This work provides evidence that the threshold set for the official New Zealand serious non-fatal injury indicator for 'all injury' captures injuries with high aggregate admission probability. If so, it is valid for monitoring the incidence of serious injuries.

Preventable injury deaths: identifying opportunities to improve timeliness and reach of emergency healthcare services in New Zealand.

BACKGROUND: Traumatic injury is a leading cause of premature death and health loss in New Zealand. Outcomes following injury are very time sensitive, and timely access of critically injured patients to advanced hospital trauma care services can improve injury survival. OBJECTIVE: This cross-sectional study will investigate the epidemiology and geographic location of prehospital fatal injury deaths in relation to access to prehospital emergency services for the first time in New Zealand. DESIGN AND STUDY POPULATION: Electronic Coronial case files for the period 2008-2012 will be reviewed to identify cases of prehospital fatal injury across New Zealand. METHODS: The project will combine epidemiological and geospatial methods in three research phases: (1) identification, enumeration, description and geocoding of prehospital injury deaths using existing electronic injury data sets; (2) geocoding of advanced hospital-level care providers and emergency land and air ambulance services to determine the current theoretical service coverage in a specified time period and (3) synthesising of information from phases I and II using geospatial methods to determine the number of prehospital injury deaths located in areas without timely access to advanced-level hospital care. DISCUSSION: The findings of this research will identify opportunities to optimise access to advanced-level hospital care in New Zealand to increase the chances of survival from serious injury. The resulting epidemiological and geospatial analyses will represent an advancement of knowledge for injury prevention and health service quality improvement towards better patient outcomes following serious injury in New Zealand and similar countries.

Two years after injury: prevalence and early post-injury predictors of ongoing injury-related problems.

PURPOSE: To determine, in a cohort with injuries classified anatomically as mainly minor or moderate and for which only 25% were hospitalised acutely, the prevalence of ongoing problems attributed by participants to their injury 2 years prior, and to examine whether three-month post-injury experiences and expectations predict such problems. METHODS: Participants (N = 2231; 18-64 years at injury) were those in the Prospective Outcomes of Injury Study who completed the initial three-month and final two-year interviews. The outcome measure was whether participants reported ongoing injury-related problems at 2 years. Possible early post-injury predictors were identified from the first interview; pre-injury and injury-related potential confounders from the first interview, insurer records and hospital discharge records. Multivariable models estimated relative risks. RESULTS: Almost half the participants reported injury-related problems at 2 years. Participants reporting non-recovery at 3 months were more likely than those reporting recovery to have ongoing problems at 2 years, ranging from participants expecting to get better soon [adjusted RR 2.2, 95% CI (1.7,2.8)) to those expecting to never get better (aRR 3.1, 95% CI (2.4,4.0)]. Several three-month post-injury experiences also predicted ongoing problems at 2 years. Participants at highest risk included those with extreme pain [aRR 2.1, 95% CI (1.7,2.5)], and less involvement in usual activities [aRR 1.7, 95% CI (1.5,1.9)]. CONCLUSIONS: Findings indicate that early post-injury characteristics predict longer-term recovery among this cohort, most of who were not classified as seriously injured, and provide guidance for future studies on interventions to reduce poor outcome prevalence, particularly focussing on pain management and enabling return to independence and social participation.

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

BACKGROUND: Subsequent injury (SI) is a major contributor to disability and costs for individuals and society. AIM: To identify modifiable risk factors predictive of SI and SI health and disability outcomes and costs. OBJECTIVES: To (1) describe the nature of SIs reported to New Zealand's no-fault injury insurer (the Accident Compensation Corporation (ACC)); (2) identify characteristics of people underaccessing ACC for SI; (3) determine factors predicting or protecting against SI; and (4) investigate outcomes for individuals, and costs to society, in relation to SI. DESIGN: Prospective cohort study. METHODS: Previously collected data will be linked including data from interviews undertaken as part of the earlier Prospective Outcomes of Injury Study (POIS), ACC electronic data and national hospitalisation data about SI. POIS participants (N=2856, including 566 Maori) were recruited via ACC's injury register following an injury serious enough to warrant compensation entitlements. We will examine SI over the following 24 months for these participants using descriptive and inferential statistics including multivariable generalised linear models and Cox's proportional hazards regression. DISCUSSION: Subsequent Injury Study (SInS) will deliver information about the risks, protective factors and outcomes related to SI for New Zealanders. As a result of sourcing injury data from New Zealand's 'all injury' insurer ACC, SInS includes people who have been hospitalised and not hospitalised for injury. Consequently, SInS will provide insights that are novel internationally as other studies are usually confined to examining trauma registries, specific injuries or injured workers who are covered by a workplace insurer rather than a 'real-world' injury population.