116 Function, health related quality of life and cost after injury in a city of north india: a multi site cohort study. (1st September 2016) - Jagnoor, Jagnoor
Abstract : Background: The burden of traumatic injury in India is high, but remains ill-defined and poorly quantified. The aim of this project was to measure the impact of traumatic injuries on functioning and health-related quality-of-life (HRQoL), economic impactand to identify predictors of poor outcomes post-injury. Methods: A prospective observational study was conducted at three hospital sites in Chandigarh, North India in 2014–2015 for all ages admitted with an injury. Consent was sought and participants were followed at 1, 2, 4 and 12 months after injury; face to face or telephonic interviews collected data on socio-demographics, circumstances of injury, cost associated with injury, disability, function and health related quality of life. Interim analysis for 4 months is reported below, with 12 months interviews underway. Results: 2950 (90% of eligible) participants were recruited, with a follow-up rate of 74% (2180) at 4 months. Road traffic injuries (1622/55%) followed by falls (914/31%) and burns (383/13%) were the leading cause of injury; 86% were males, 79.5% were in paid employment at the time of injury. The average out of pocket expenditure per hospitalisation and up to 4 months post discharge was USD 388 (95% CI: 332–441) and USD 946 (95% CI: 771–1021) respectively. The prevalence of catastrophic expenditure was 30% (95% CI: 26.95–31.05), which was significantly associated with lower income quartile (OR 23.3 [95% CI: 5.7–73.9]; p < 0·01), inpatient stay greater than 7 days (OR 8.8 [95% CI: 3.8–20.6); p < 0.01), major surgery (OR 4.9 [95% CI: 2.7–8.4]; p < 0.01), and occupation as wage labourers (OR 8.1 [95% CI: 1.6–24.6]; p = 0.01). Conclusions: Injury has a substantial impact with a high proportion of patients sustaining catastrophic health expenditure, particularly the poor. Measures aimed at increasing public health spending for sustained prevention programs and providing financial risk protection to those injured deserve urgent priority in India.