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.

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.

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.

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.

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.

Epidemiology and 6- and 12-Month Outcomes of Intimate Partner Violence and Other Violence-Related Traumatic Brain Injury in Major Trauma: A Population-Based Trauma Registry Study.

OBJECTIVE: To compare the epidemiology, in-hospital outcomes, and 6-month and 12-month patient-reported, outcomes of major trauma patients with intimate partner violence (IPV)-related traumatic brain injury (TBI) with other interpersonal violence (OV)-related TBI. SETTING: Victoria, Australia. PARTICIPANTS: Adult (≥18 years) major trauma cases with TBI (concussion, skull fracture, or intracranial injury), injured through IPV or OV, between July 2010 and June 2020, and included on the population-based Victorian State Trauma Registry. There were 133 adult major trauma cases due to IPV and 1796 due to OV. The prevalence of TBI was 39% (n = 52) in the IPV group and 56% (n = 1010) in the OV group. DESIGN: Registry-based cohort study. MAIN MEASURES: Trauma care indicators and 6- and 12-month patient-reported outcomes (self-reported disability, Glasgow Outcome Scale-Extended, EQ-5D-3L, and return to work). RESULTS: The annual incidence (95% CI) of major trauma involving TBI was 0.11 (0.08-0.14) per 100 000 population for IPV and 2.11 (1.98-2.24) per 100 000 for OV. A higher proportion of IPV-related cases were women (73% vs 5%), had sustained a severe TBI (Glasgow Coma Scale score 3-8; 27% vs 15%), were admitted to intensive care (56% vs 37%), and died in hospital (14% vs 5%). The median (interquartile range) time to definitive care (4.7 hours vs 3.3 hours) and head computed tomographic scan (5.0 hours vs 3.1 hours) was longer in the IPV group. Follow-up rates at 6 and 12 months were 71% and 69%, respectively. The 6- and 12-month outcomes were generally poorer in the IPV-related group. CONCLUSION: The incidence of IPV-related major trauma with TBI was low. However, the prevalence of severe TBI, the time to key aspects of clinical care, in-hospital mortality, and longer-term work-related disability were higher. However, power to detect differences was low due to the small number of IPV-related cases compared with the OV group.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Prescription opioids for occupational injury: results from workers' compensation claims records.

OBJECTIVE: The objective of this study is to identify the prevalence of opioid prescription use in an Australian workers' compensation population and assess predictors of long-term use. DESIGN: Retrospective administrative data analysis. SETTING: WorkSafe Victoria (Australia) workers' compensation. SUBJECTS: Workers with a workers' compensation claim were included if the injury/illness started in 2008 or 2009 (N = 54,931). METHODS: Claim payments records dating up to 2 years postinjury were analyzed to determine receipt of prescription opioids. Long-term use was defined as use of any opioid beyond 1 year postinjury. RESULTS: Within the follow-up period, 8,933 (16.3%) workers claimed prescription opioids: 10.0% claimed opioids in the first year only, and 6.3% claimed opioids beyond the first year. The most commonly received opioids were codeine (10.4%), oxycodone (7.5%), and tramadol (5.0%). Dextropropoxyphene, which is considered unsafe in many countries because of potentially fatal side effects, was used by 1.9% of injured workers. Progression to long-term use of opioids was common (N = 3,446; 39%): age (35-64 years; the association with age followed an inverse U-shaped curve), women, laborers, lower socioeconomic status, greater work disability, and greater hospital expense were associated with opioid use beyond the first year postinjury. CONCLUSION: Prescription opioid use for workplace injury in Australia is common but not as common as reports from U.S. workers' compensation schemes. The type of opioid and number of repeat prescriptions are factors that should be carefully considered by practitioners prescribing opioids to injured workers: progression to long-term use is common and not fully explained by injury severity.