Sickness absence and disability pension among injured car occupants, and associations with injury and car safety factors: A prospective cohort study.

OBJECTIVE: Knowledge regarding sickness absence (SA) and disability pension (DP) following a road traffic injury, is lacking. The aim of this study was to investigate SA and DP among injured car occupants before and after a crash, accounting for permanent medical impairment (PMI). Further, to explore associations between injured body region, car model year of introduction (MYI), and European New Car Assessment Programme (Euro NCAP) safety rating and number of SA/DP days in year two and four following the crash date. METHODS: A longitudinal cohort study including 63,358 individuals injured when aged 17-62, in crashes occurring 2001-2013 and involving a car insured by the Folksam Insurance Group. Mean numbers of SA/DP net days per year were calculated, in total and by injury diagnosis category, for all, for those with SA or DP with the same diagnosis as the initial injury, and for those with and those without injuries resulting in PMI. Logistic regressions were performed to calculate odds ratios with 95% confidence intervals for having 90-180 or ≥181 combined SA/DP days, respectively, among those with injury diagnoses, in year two and four after the crash. Associations with injured body region, car model introduction year, and Euro NCAP star ratings, was investigated, with adjustments made for sociodemographics. RESULTS: The mean number of SA/DP days/year was higher in the years following the crash (56-50 days) compared to the year prior (41). In year one and two the increase in days was mainly with SA due to injury diagnoses and musculoskeletal diagnoses, and in year three and four, with DP due to injury diagnoses, musculoskeletal diagnoses, and mental diagnoses, respectively. Individuals whose injuries resulted in PMI had more future SA/DP days compared to those without PMI. Individuals with injuries to the torso/back and with multiple injuries were more likely to have > 180 SA/DP days both year two (2.9 and 2.2 times, respectively) and year four (2.0 and 1.6 times), compared to individuals with head injuries. Injured occupants in Euro NCAP 2-3-star rated cars as well as in untested cars, were more likely to have > 180 days in year four (1.4 and 2.0 times, respectively), compared to 4-5 stars. CONCLUSION: Higher levels of SA/DP remained throughout the four years following the crash, with substantial differences between those with PMI and those with no PMI. Low overall car safety level, injuries to the torso/back, and multiple injuries were associated with high SA/DP.

Bicycle crashes and sickness absence - a population-based Swedish register study of all individuals of working ages.

BACKGROUND: In recent years, bicycle injuries have increased, yet little is known about the impact of such injures on sickness absence (SA) and disability pension (DP). The aim was to explore SA and DP among individuals of working ages injured in a bicycle crash. METHOD: A nationwide register-based study, including all individuals aged 16-64 years and living in Sweden, who in 2010 had in- or specialized out-patient healthcare (including emergency units) after a bicycle crash. Information on age, sex, sociodemographics, SA, DP, crash type, injury type, and injured body region was used. We analyzed individuals with no SA or DP, with ongoing SA or full-time DP already at the time of the crash, and with new SA > 14 days in connection to the crash. Crude and adjusted odds ratios (OR) with 95% confidence intervals for new SA were estimated by logistic regression. RESULTS: In total, 7643 individuals had healthcare due to a new bicycle crash (of which 85% were single-bicycle crashes). Among all, 10% were already on SA or full-time DP at the time of the crash, while 18% had a new SA spell. The most common types of injuries were external injuries (38%) and fractures (37%). The body region most frequently injured was the upper extremities (43%). Women had higher OR (1.40; 1.23-1.58) for new SA than men, as did older individuals compared with younger (OR 2.50; 2.02-3.09, for ages: 55-64 vs. 25-34). The injury types with the highest ORs for new SA, compared with the reference group external injuries was fractures (8.04; 6.62-9.77) and internal injuries (7.34; 3.67-14.66). Individuals with traumatic brain injury and injuries to the vertebral column and spinal cord had higher ORs for SA compared with other head, face, and neck injuries (2.72; 1.19-6.22 and 3.53; 2.24-5.55, respectively). CONCLUSIONS: In this explorative nationwide study of new bicycle crashes among individuals of working ages, 18% had a new SA spell in connection to the crash while 10% were already on SA or DP. The ORs for new SA were higher among women, older individuals, and among individuals with a fracture.

Sickness absence, disability pension and permanent medical impairment among 64 000 injured car occupants of working ages: A two-year prospective cohort study.

OBJECTIVE: There is a lack of knowledge regarding sickness absence (SA) and disability pension (DP) as consequences of road traffic injuries, and on the association between DP and permanent medical impairment (PMI). Therefore, the aim of this study was to investigate SA, DP, and PMI among injured passenger car occupants two years after a crash, and how they are associated, accounting for sociodemographics, crash-related factors, and previous SA/DP. METHODS: This prospective cohort study included 64 007 injured car occupants aged 17-62 years at the time of a crash occurring in 2001-2013, involving a car insured at Folksam Insurance Group in Sweden. Information on sociodemographics, crash-related factors, SA (in SA spells >14 days) and DP status at inclusion and at two-year follow-up, and PMI assessed by the insurance company was used. PMI grades were categorized as 1-4, 5-9, 10-19, or >19%. Logistic regression was performed to calculate odds ratios (OR) with 95% confidence intervals (CI) for DP at follow-up and for PMI, respectively. RESULTS: At the time of the crash 13% were already on SA or DP. At follow-up two years after the crash, 6% among those not already on SA/DP at the time of the crash were on SA and 2% on DP. Furthermore, 8% of the total cohort had a determined PMI. Among those not already on DP at the crash, 3% with no PMI had DP at follow-up. This proportion was higher the higher PMI grade. Among individuals without already ongoing DP at the crash date, 10% of those with a PMI 1-4 ha d DP, compared to 76% among PMI ≥ 20. Already ongoing SA at the time of the crash (OR = 39.16, 95% CI 34.89-43.95) and PMI grade (PMI ≥ 5 OR = 27.44, 95% CI 23.88-31.52, reference group PMI 0) were found to be associated with DP at two years after crash. The factor most strongly associated with PMI was the model year of the car. The older the car, the higher the risk of PMI (Model year ≤ 1990 OR = 3.36, 95% CI 2.67-4.23, reference group model year 2006-2010). An association with the same direction was also found between the model year of the car and DP at follow-up. CONCLUSIONS: The association between PMI grade and DP status at follow-up among occupants not on DP at the crash date indicates that both could be used to measure long-term consequences of road traffic injury. In this cohort, already ongoing SA at the crash date was associated with DP at the two-year follow-up, emphasizing the importance of accounting for this factor in future research.