Injury severity and increased socioeconomic differences: A population-based cohort study. Issue 6 (June 2022)

• Record Type: Journal Article
• Authors: Madsen, Christian; Gabbe, Belinda J; Holvik, Kristin; Alver, Kari; Grøholt, Else Karin; Lund, Johan; Lyons, Jane; Lyons, Ronan A; Ohm, Eyvind
• Is Part Of: Injury. Volume 53:Issue 6(2022)
• Page Start: 1904
• Page End: 1910
• Publication Date: 2022-06
• Subjects: Risk-adjusted severity -- ICISS -- Injury-VIBES -- Injury -- Hospitalization -- Socioeconomic status; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2022.03.039
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Key Messages. Message 1: The risk of acute hospitalization is increased for the part of the population with lower socioeconomic status, both when assessing severity as threat-to-life or as threat of long-term disability. Message 2: The increased risk in the part of the population with lower socioeconomic status was more pronounced for injuries of high severity than for injuries of low severity. Message 3: Future studies measuring burden of the socioeconomic distribution of injuries, should have a focus on injury severity. Abstract: Background: Several studies have documented an inverse gradient between socioeconomic status (SES) and injury mortality, but the evidence is less consistent for injury morbidity. The aim of this study was to investigate the association between SES and injury severity for acute hospitalizations in a nationwide population-based cohort. Methods: We conducted a registry-based cohort study of all individuals aged 25–64 years residing in Norway by 1st of January 2008. This cohort was followed from 2008 through 2014 using inpatient registrations for acute hospitalizations due to all-cause injuries. We derived two measures of severity: threat-to-life using the International Classification of Disease-based Injury Severity Score (ICISS), and threat of disability using long-term disability weights from the Injury-VIBES project. Robust Poisson regression models, with adjustment for age, sex, marital status, immigrant status, municipality population size and healthcare region of residence, were used to calculate incidence rate ratios (IRRs) by SES measured as an index of education, income, and occupation. Results: We identified 177, 663 individuals (7% of the population) hospitalized with at least one acute injury in the observation period. Two percent ( n = 4, 186) had injuries categorized with high threat-to-life, while one quarter ( n = 43, 530) had injuries with high threat of disability. The overall adjusted IRR of hospitalization among people with low compared to high SES was 1.57 (95% CI 1.55, 1.60). Comparing low to high SES, injuries with low threat-to-life were associated with an IRR of 1.56 (95% CI 1.54, 1.59), while injuries with high threat-to-life had an IRR of 2.25 (95% CI 2.03, 2.51). Comparing low to high SES, injuries with low, medium, and high threat of disability were associated with IRRs of respectively, 1.15 (95% CI 1.11, 1.19), 1.70 (95% CI 1.66, 1.73) and 1.99 (95% CI 1.92, 2.07). Discussion: We observed an inverse gradient between SES and injury morbidity, with the steepest gradient for the most severe injuries. This suggests a need for targeted preventive measures to reduce the magnitude and burden of severe injuries for patients with low socioeconomic status.