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Introduction: The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the first component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health system of Aotearoa-New Zealand (NZ), little is known about inequities in EMS-delivered care and transport pathways to hospital-level care. Methods: This population-level cohort study on out-of-hospital care, based on national EMS data, included trauma patients <85 years in age who were injured in a road traffic crash (RTC). In this study we examined the combined relationship between ethnicity and geographical location of injury in EMS out-of-hospital care and transport pathways following RTCs in Aotearoa-NZ. Analyses were stratified by geographical location of injury (rural and urban) and combined ethnicity-geographical location (rural Maori, rural non-Maori, urban Maori, and urban non-Maori). Results: In a two-year period, there were 746 eligible patients; of these, 692 were transported to hospital. Indigenous Maori comprised 28% (196) of vehicle occupants attended by EMS, while 47% (324) of patients' injuries occurred in a rural location. The EMS transport pathways to hospital for rural patients were slower to reach first hospital (total in slowest tertile of time 44% vs 7%, P ≥ 0.001) and longer to reach definitive care (direct transport, 77% vs 87%, P = 0.001) compared to urban patients. Maori patients injured in a rural location were comparatively less likely than rural non-Maori to be triaged to priority transport pathways (fastest dispatch triage, 92% vs 97%, respectively, P = 0.05); slower to reach first hospital (total in slowest tertile of time, 55% vs 41%, P = 0.02); and had less access to specialist trauma care (reached tertiary trauma hospital, 51% vs 73%, P = 0.02). Conclusion: Among RTC patients attended and transported by EMS in NZ, there was variability in out-of-hospital EMS transport pathways through to specialist trauma care, strongly patterned by location of incident and ethnicity. These findings, mirroring other health disparities for Maori, provide an equity-focused evidence base to guide clinical and policy decision makers to optimize the delivery of EMS care and reduce disparities associated with out-of-hospital EMS care.
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Accidentes de Tránsito , Servicios Médicos de Urgencia , Disparidades en Atención de Salud , Población Rural , Heridas y Lesiones , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Accidentes de Tránsito/estadística & datos numéricos , Estudios de Cohortes , Servicios Médicos de Urgencia/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Nueva Zelanda , Población Rural/estadística & datos numéricos , Transporte de Pacientes/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Heridas y Lesiones/terapia , Heridas y Lesiones/etnologíaRESUMEN
INTRODUCTION: Various attempts at automation have been made to reduce the administrative burden of manually assigning Abbreviated Injury Severity (AIS) codes to derive Injury Severity Scores (ISS) in trauma registry data. The accuracy of the resulting measures remains unclear, especially in the New Zealand (NZ) context. The aim of this study was to compare ISS derived from hospital discharge International Classification of Diseases Australian Modification (ICD-10-AM) codes with ISS recorded in the NZ Trauma Registry (NZTR). METHODS: Individuals admitted to hospital and enrolled in the NZTR between 1 December 2016 and 30 November 2018 were included. ISS were calculated using a modified ICD to AIS mapping tool. The agreement between both methods for raw scores was assessed by the Intraclass Correlation Coefficient (ICC), and for categorical scores the Kappa and weighted Kappa index were used. Analysis was conducted by gender, age, ethnicity, and mechanism of injury. RESULTS: 3,156 patients fulfilled the inclusion criteria. The ICC for agreement between the methods was poor (0.40, 95 % CI: 0.37-0.43). The Kappa index indicated slight agreement between both methods when using a cut-off value of 12 (0.06; 95 % CI: 0.01-0.12) and 15 (0.13 6; 95 % CI: 0.09-0.17). CONCLUSION: Although the overall agreement between NZTR-ISS and ICD-ISS was slight, ICD-derived scores may be useful to describe injury patterns and for body region-specific estimations when manually coded ISS are not available.
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Clasificación Internacional de Enfermedades , Heridas y Lesiones , Humanos , Puntaje de Gravedad del Traumatismo , Nueva Zelanda , Australia , Sistema de Registros , Escala Resumida de TraumatismosRESUMEN
Background: Work poses increased risk of injury not only for workers but also for the public, yet the broader impact of work-related injury is not quantified. This study, utilising population data from New Zealand, estimates the societal burden of work-related fatal injury (WRFI) by including bystanders and commuters. Methods: This observational study selected deaths due to unintentional injury, in persons aged 0-84 years using International Classification of Disease external cause codes, matched to coronial records, and reviewed for work-relatedness. Work-relatedness was determined by the decedent's circumstances at the time of the incident: working for pay, profit, in kind, or an unpaid capacity (worker); commuting to or from work (commuter); or a bystander to another's work activity (bystander). To estimate the burden of WRFI, frequencies, percentages, rates, and years-of-life lost (YLL) were estimated. Results: In total 7,707 coronial records were reviewed of which 1,884 were identified as work-related, contributing to 24% of the deaths and 23% of the YLL due to injury. Of these deaths close to half (49%) occurred amongst non-working bystanders and commuters. The overall burden of WRFI was widespread across age, sex, ethnic and deprivation sub-groups. Injury deaths due to machinery (97%) and due to being struck by another object (69%) were predominantly work-related. Interpretation: When utilising a more inclusive definition of work-relatedness the contribution of work to the societal burden of fatal injuries is substantial, conservatively estimated at one quarter of all injury deaths in New Zealand. Other estimates of WRFI likely exclude a similar number of fatalities occurring among commuters and bystanders. The findings, also relevant to other OECD nations, can guide where public health efforts can be used, alongside organisational actions, to reduce WRFI for all those impacted.
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This narrative review describes efforts to improve the care and prevention of fragility fractures in New Zealand from 2012 to 2022. This includes development of clinical standards and registries to benchmark provision of care, and public awareness campaigns to promote a life-course approach to bone health. PURPOSE: This review describes the development and implementation of a systematic approach to care and prevention for New Zealanders with fragility fractures, and those at high risk of first fracture. Progression of existing initiatives and introduction of new initiatives are proposed for the period 2022 to 2030. METHODS: In 2012, Osteoporosis New Zealand developed and published a strategy with objectives relating to people who sustain hip and other fragility fractures, those at high risk of first fragility fracture or falls and all older people. The strategy also advocated formation of a national fragility fracture alliance to expedite change. RESULTS: In 2017, a previously informal national alliance was formalised under the Live Stronger for Longer programme, which includes stakeholder organisations from relevant sectors, including government, healthcare professionals, charities and the health system. Outputs of this alliance include development of Australian and New Zealand clinical guidelines, clinical standards and quality indicators and a bi-national registry that underpins efforts to improve hip fracture care. All 22 hospitals in New Zealand that operate on hip fracture patients currently submit data to the registry. An analogous approach is ongoing to improve secondary fracture prevention for people who sustain fragility fractures at other sites through nationwide access to Fracture Liaison Services. CONCLUSION: Widespread participation in national registries is enabling benchmarking against clinical standards as a means to improve the care of hip and other fragility fractures in New Zealand. An ongoing quality improvement programme is focused on eliminating unwarranted variation in delivery of secondary fracture prevention.
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Fracturas de Cadera , Osteoporosis , Fracturas Osteoporóticas , Anciano , Australia , Fracturas de Cadera/prevención & control , Humanos , Nueva Zelanda/epidemiología , Osteoporosis/complicaciones , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/prevención & control , Prevención SecundariaRESUMEN
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.
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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.
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Ahogamiento , Servicios Médicos de Urgencia , Ahogamiento/epidemiología , Hospitales , HumanosRESUMEN
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.
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Trastornos por Estrés Postraumático , Heridas y Lesiones , Femenino , Hospitalización , Humanos , Nueva Zelanda/epidemiología , Prevalencia , Estudios Prospectivos , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Heridas y Lesiones/epidemiologíaRESUMEN
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.
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Accidentes por Caídas , Médicos Forenses , Adolescente , Anciano , Autopsia , Causas de Muerte , Femenino , Humanos , Masculino , Nueva Zelanda/epidemiología , Estudios RetrospectivosRESUMEN
Helicopter Emergency Medical Services (HEMS) in New Zealand (NZ) are located at hospitals or airports near the communities they serve. This may result in suboptimal response times. Timely access to advanced hospital care improves critically injured patients' chances of survival. This study optimised the location of HEMS bases in NZ and compared current versus optimal placement on timely access for surrounding populations. Optimal placement of HEMS bases could result in 113,886 additional people (3% of the population) benefiting from access to advanced hospital care within one hour. Optimal placement would especially benefit indigenous Maori as well as deprived and rural communities.
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Ambulancias Aéreas , Servicios Médicos de Urgencia , Aeronaves , Humanos , Nueva Zelanda/epidemiología , Estudios Retrospectivos , Población RuralRESUMEN
Injury is a leading cause of disability and is costly. This prospective cohort study extension aims to improve disability, health, and wellbeing outcomes for injured New Zealanders, including for Maori. We will identify predictors and modifiable risk factors of long-term outcomes (positive and negative), and develop an Injury Early Care Tool (INJECT) to inform the implementation of effective interventions to improve outcomes. In the Prospective Outcomes of Injury Study (POIS), 2856 people participated following an injury (occurring between 2007 and 2009) registered with New Zealand's no-fault accident compensation scheme (ACC). POIS-10 will invite 2121 people (including 358 Maori) who completed a 24-month POIS interview and agreed to follow-up, anticipating 75% participation (n = 1591). Interviews will collect sociodemographic characteristics, life events, comorbidities, and new injuries since participants' 24-month interview, as well as key disability, health, and wellbeing outcomes 12 years post-injury. Injury-related data will be collected from ACC and hospitalisation records 12 years post-injury. Regression models for the main outcomes will examine the direct effects of predictor variables after adjustment for a wide range of confounders. POIS-10 is enhanced by our partnership with ACC, and expert advisors and will benefit injured people, including Maori, through increased understanding of mechanisms and interventions to improve long-term post-injury outcomes.
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BACKGROUND: Of the five million injury deaths that occur globally each year, an estimated 70% occur before the injured person reaches hospital. Although reducing the time from injury to definitive care has been shown to achieve better outcomes for patients, the relationship between injury incident location and access to specialist care has been largely unexplored. OBJECTIVE: To determine the number and distribution of prehospital (on-scene/en route) trauma deaths without timely access to a hospital with surgical and intensive care capabilities, overall and by estimated injury survivability. METHODS: New Zealand's Mortality Collection and Hospital Discharge dataset were used to select prehospital injury deaths in 2009-2012. These records were linked to files held by Australasia's National Coronial Information Service (NCIS) to estimate, for the trauma subset, injury survivability. Using geographical locations of injury for the prehospital trauma fatalities, time from Emergency Medical System call-out to arrival at the closest specialist hospital was estimated. RESULTS: Of 1,752 prehospital trauma fatalities, 14.7% (95%CI 13.0, 16.4) had potentially survivable injuries that occurred in locations without timely access (prehospital phase >60 minutes). More than half (132 of 257) of the potentially survivable prehospital trauma fatalities without timely access died as a result of a motor vehicle traffic crash. Only 10% (95%CI 5.7, 16.0) of prehospital trauma fatalities from falls were estimated to be potentially survivable and without timely access compared to 24.6% (95%CI 18.5, 31.5) of prehospital firearm fatalities. Through using geospatial techniques, "hot spot" locations of potentially survivable injuries without timely access to specialist major trauma hospitals were apparent. CONCLUSION: Approximately 15% of prehospital trauma fatalities in New Zealand that are potentially survivable occur in locations without timely access to advanced level hospital care. Continued emphasis is required on both improving timely access to advanced trauma care, and on primary prevention of serious injuries. Decisions regarding trauma service delivery, a modifiable system-level factor, should consider the geographic distribution of locations of these injury events alongside the resident population distribution.
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Servicios Médicos de Urgencia , Heridas y Lesiones , Accidentes por Caídas , Servicio de Urgencia en Hospital , Hospitales , Humanos , Nueva Zelanda/epidemiología , Heridas y Lesiones/terapiaRESUMEN
OBJECTIVE: There is interest in opportunities that lie in the prehospital setting to reduce the substantial burden of fatal injury. This study examines the epidemiology of prehospital and in-hospital fatal injury in New Zealand. METHODS: All deaths registered in 2008-2012 with an underlying cause of death external cause-code V01-Y36 (ICD-10-AM) were identified. The setting of death was determined following linkage to, and review of, hospital discharge data and Coronial records. RESULTS: Of 7,522 injury deaths, 80% occurred in a prehospital setting, with the highest burden relating to males. Within those fatally injured, 25-54-year-olds had a higher risk of prehospital death than 55-84-year-olds (adjusted Relative Risk [aRR] 1.20, 95%CI 1.16, 1.20). Similarly, those injured due to drowning (aRR 1.39, CI 1.26, 1.53) and non-hanging suffocation (aRR 1.31, CI 1.18, 1.45) had a higher risk of prehospital death than those 'struck by/machinery'. CONCLUSION: Prehospital deaths account for four out of five fatal injuries in New Zealand. Of the fatally injured population, the probability of prehospital death differed by age, sex, injury mechanism and intent. Implications for public health: This study highlights the importance of strengthening prevention efforts to reduce the substantive burden of prehospital fatalities in New Zealand.
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Ahogamiento/epidemiología , Servicios Médicos de Urgencia/estadística & datos numéricos , Mortalidad Hospitalaria/etnología , Heridas y Lesiones/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Causas de Muerte , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Distribución por Sexo , Factores Socioeconómicos , Tasa de Supervivencia , Heridas y Lesiones/etnología , Adulto JovenRESUMEN
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.
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Servicios Médicos de Urgencia , Estudios de Cohortes , Hospitales , Humanos , Nueva Zelanda/epidemiología , Estudios RetrospectivosRESUMEN
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.
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Ocupaciones , Lugar de Trabajo , Accidentes de Trabajo , Humanos , Industrias , Masculino , Nueva Zelanda/epidemiologíaRESUMEN
Despite the high burden of sleep disturbances among the general population, there is limited information on prevalence and impact of poor sleep among injured workers. This study: (a) estimated the prevalence of sleep disturbance following work-related injury; and (b) examined the longitudinal association between sleep disturbances and disability/functioning, accounting for reciprocal relationships and mental illness. Longitudinal survey data were collected from workers' compensation claimants with a time-loss claim in Victoria, Australia (N = 700). Surveys were conducted at baseline, 6â months and 12â months. Sleep disturbance was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. Disability/functioning was based on self-reported activity limitations, participation restrictions and emotional functioning. Path models examined the association between disability/functioning and sleep. Mean sleep disturbance T-scores were 55.2 (SD 11.4) at 6â months, with 36.4% of the sample having a T-score of 60+. Longitudinal relationships were observed between disability (specifically, emotional functioning) and sleep disturbances across successive follow-up waves. For example, each unit increase in T2 emotional functioning (five-point scale) was associated with a 1.1 unit increase in T3 sleep disturbance (approximately 29-76 scale). Cross-lagged path models found evidence of a reciprocal relationship between disability and sleep, although adjustment for mental illness attenuated the estimates to the null. In conclusion, sleep disturbances are common among workers' compensation claimants with work injuries/illnesses. Given the links between some dimensions of disability, mental health and sleep disturbances, the findings have implications for the development of interventions that target the high prevalence of sleep problems among working populations.
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Traumatismos Ocupacionales/complicaciones , Trastornos del Sueño-Vigilia/etiología , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Traumatismos Ocupacionales/psicología , Adulto JovenRESUMEN
In high income countries, children under 15 years of age are exposed to workplace hazards when they visit or live on worksites or participate in formal or informal work. This study describes the causes and circumstances of unintentional child work-related fatal injuries (child WRFI) in New Zealand. Potential cases were identified from the Mortality Collection using International Classification of Disease external cause codes: these were matched to Coronial records and reviewed for work-relatedness. Data were abstracted on the socio-demographic, employment and injury-related circumstances. Of the 1335 unintentional injury deaths in children from 1999 through 2014, 206 (15%) were identified as dying from a work-related injury: 9 workers and 197 bystanders-the majority involving vehicle crashes or being stuck by moving objects in incidents occurring on farms or public roads. Those at highest risk were males, preschoolers, and those of Maori or European ethnicity. Work made a notable contribution to the burden of unintentional fatal injury in children with most deaths highly preventable, largely by adult intervention and legislation. To address the determinants of child WRFI greater attention on rural farm and transport settings would result in a significant reduction in the injury mortality rates of New Zealand children.
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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.
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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.
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Accidentes de Trabajo , Traumatismos Ocupacionales/epidemiología , Lesiones de Repetición/epidemiología , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Estudios Prospectivos , Factores de Riesgo , Factores Socioeconómicos , Adulto JovenRESUMEN
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.
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PURPOSE: To examine differences in the return to work (RTW) process for workers' compensation claimants with psychological injuries compared to those with musculoskeletal (MSK) injuries. METHODS: We collected data from 869 workers' compensation claimants in Victoria, Australia, at three time points over a 12-month period (21% with psychological injury claims). RTW was assessed through self-report. Potential mediators were identified at the personal, health-care provider, workplace and system levels. The relationships between injury type, mediating factors and RTW were assessed using path analysis, with adjustment for confounders through inverse probability weighting. RESULTS: We observed better RTW outcomes for claimants with MSK injuries (compared to those with psychological injuries) at T1 and T2, but not at T3. We also observed differences between psychological injuries and MSK injuries and all but two of the mediating factors examined. These differences, in particular related to supervisor response to injury, consultative RTW planning and offers of accommodation, as well as differences in mental health symptoms, explained approximately two-thirds of differences in RTW between injury types at T1. Differences in RTW at T2 were explained by mediating factors, and differences in RTW at T1. CONCLUSION: Claimants with work-related psychological injuries experience a variety of challenges in RTW compared to those with MSK injuries. While treating and preventing further exacerbation of psychological symptoms should remain an important part of the rehabilitation process, other modifiable factors, in particular supervisor response to injury and consultative RTW planning and modified duties, should be prioritised to reduce inequalities in RTW across injury types.