Estimation of indirect costs based on employment and earnings changes after spinal cord injury: an observational study.

STUDY DESIGN: Cross-sectional. OBJECTIVES: (1) Identify changes in employment status and earnings after spinal cord injury (SCI). (2) Estimate annual indirect costs and lifetime indirect costs due to lost earnings for various age and neurologic categories of those with SCI. (3) Compare our estimates with previous research. SETTING: Medical university in southeastern United States. METHODS: A population-based cohort of 307 participants met eligibility criteria of: (1) residual impairment resulting from traumatic SCI, (2) at least 1 year post injury, (3) between 23 and 64 years old at time of injury, (4) <65 years old at time of measurement, and (5) complete information on injury level, injury completeness, employment status, and earnings before and after injury. Main outcomes were employment status and earnings at the time of injury and post injury. Earnings were adjusted for inflation and the value of fringe benefits. RESULTS: Employment rate decreased from 87% at the time of injury to 35% after injury. Average annual indirect costs were $29,354 in 2019 dollars. Lifetime indirect costs for persons injured at age 25 varied by severity of injury, ranging from 0.5 to 2.3 million dollars. Lifetime indirect costs for persons injured at age 50 ranged from 0.3 to 0.6 million dollars. CONCLUSIONS: Our estimate of indirect costs is lower than the previously estimated number. However, the higher unemployment rate and decreased earnings after SCI still make a heavy economic burden. With improvements in employment outcomes after SCI, the indirect costs affecting individuals, their families, and society can be further reduced.