Quantification of Complaint and Compensation Cases by Introducing a Danish Translated and Cross-Cultural Adapted Edition of the Healthcare Complaints Analysis Tool.

PURPOSE: The study aimed to translate and cross-culturally adapt the English version of the HCAT to produce a Danish HCAT version and to test the Danish version's reliability. METHODS: We used best-practice guidelines for linguistic translations and cultural adaptations. For cross-cultural adaptation, we conducted forward and back translation followed by expert committee review. Subsequently, two researchers assessed 140 complaint cases to test intra- and inter-rater reliability of the Danish HCAT version. We used descriptive statistics for distributions and tested for differences between English and Danish editions Intra- and inter-rater reliability used Gwet's AC1 statistics, applying quadratic weights to assign more weight to large discrepancies. RESULTS: The back translations showed both semantic and conceptual differences, and the expert committee thus discussed the meaning of the wording in the HCAT guide and coding form to ensure that the Danish version would be conceptually similar to the English version but also culturally appropriate for Danish settings. There was discussion about how to use the coding form to graduate problem severity, and this led to some altered wording. Pilot testing revealed the need for two new categories of "hospital-acquired infection" and "involvement of patients' relatives". The problem categories of the HCAT-DK showed "substantial" intra- and inter-rater reliability (0.79, and 0.79 to 0.85). In addition, there was a "substantial" agreement (0.70 to 0.73) between the original HCAT and the HCAT-DK version. CONCLUSION: The study translated and cross-culturally adapted the English HCAT version to produce a Danish HCAT version. Cultural and conceptual differences led to adjustments and to addition of two extra items in the HCAT-DK. The Danish version showed "substantial" intra- and inter-rater reliability and is considered suitable for coding complaint and compensation cases in Danish health care.

Healthcare inequality in compensation claims concerning acute hospital services: a Danish register-based study.

OBJECTIVE: Although citizens' equal right to acute healthcare of appropriate quality is an oft-cited goal for modern societies, healthcare disparities may persist. We aimed to investigate inequality in compensation claims and compensation payments regarding acute healthcare services. DESIGN AND SETTING: We conducted a cross-sectional study of compensation claim patterns using the Danish Patient Compensation Association (DPCA) registries. PARTICIPANTS, INTERVENTIONS AND MAIN OUTCOME MEASURES: We used register data on all cases managed by DPCA relating to acute hospital healthcare for adults (aged > 18 years) from 2007 to 2017. RESULTS: In total, the DPCA had 5556 compensation claims for injuries caused by acute care services during the years 2007-2017. Age group of 50-64 years (odds ratio (OR) = 1.37 compared with those aged 18-49 years; P < 0.001), marriage (OR = 1.14; P < 0.001), higher income (OR = 1.55; P < 0.001) and Danish origin (OR = 1.49; P < 0.001) were statistically associated with higher odds for filing a compensation claim; men (OR = 0.83; P < 0.001) and those with many co-morbidities were much less represented (OR = 0.24; P < 0.001). Male gender (OR = 1.25; P < 0.001) and higher age (OR = 2.55 (80+ years); P < 0.001) were associated with higher odds for a compensation award. Failed diagnosis was also more often at stake in men (OR = 1.38; P < 0.001) and in patients aged 50-64 years (OR = 1.17; P < 0.001) but occurred less often in patients with multiple morbidities (OR = 0.68; P < 0.001). CONCLUSIONS: Findings from our Danish material suggest some inequality in compensation claims and compensation payments regarding acute healthcare services.

Changes in compensation claim contents following reorganization of emergency hospital care.

OBJECTIVES: To study the effects of the reorganization on patient compensation claim contents relating to health care quality and patient safety. DESIGN AND SETTINGS: Danish emergency care has developed considerably over the past decades, including a major reorganization to improve health care quality and patient safety through ensuring easier access to specialist treatment. Analysis of compensation claim patterns is used to evaluate the effects of such health care system changes. PARTICIPANTS, INTERVENTIONS AND MAIN OUTCOME MEASURES: A sample of 1613 compensation claims to the Danish Patient Assurance organization was reviewed using a standardized taxonomy (the Healthcare Complaints Analysis Tool [HCAT]). Using trend analysis, we compared the proportions of claims categorized under HCAT domains, problem categories and sub-categories before and after the reorganization, with particular emphasis on the 'Clinical problems' domain covering health care quality and patient safety issues. RESULTS: We observed a baseline increase in claims relating to clinical problems (P < 0.01), but this increase was less pronounced following the reorganization. This appeared to be driven mainly by a decrease in claims about clinician skills (P = 0.03) and health care neglects (P = 0.01). However, claims about diagnostic errors and patient outcomes showed a tendency (insignificant) to increase. CONCLUSIONS: Emergency care reorganization apparently has been followed by a shift in claim contents towards fewer claims about health care neglect and staff competencies, although claims about other matters may have become more common. Present analyses of compensation claim trends should be supplemented by effect studies using traditional outcome measures such as mortality and readmission rates.

No-Fault Compensation From the Patient Compensation Association in Denmark After Primary Total Hip Replacement in Danish Hospitals 2005-2017.

BACKGROUND: There is an annually rising number of performed total hip arthroplasty (THA) surgeries in Denmark and this is expected to become even more common. However, there are still risks of adverse events, which become the basis for compensation claims. In Denmark, there are no studies available concerning filed claims after THA. The aims of this study are to determine the incidence of claims related to THAs in Denmark, the reasons to claim, which claims lead to compensation, the amount of compensation, and trends over time. METHODS: In this observational study, we analyzed all closed claims between 2005 and 2017 from the Danish Patient Compensation Association (DPCA). With the intention to contribute to prevention, we have identified the number and outcome of claims. RESULTS: There were 2924 cases (ie, 2.5% of all THAs performed in this period). The approval rate was 54%. The number of claims filed was stagnant over time, except for a spike of metal-on-metal (MoM) prosthesis cases. The total payout was USD 29,591,045, and 87% of this was due to nerve damage (USD 9,106,118), infection (USD 6,046,948), MoM prosthesis (USD 4,624,353), insufficient or incorrect treatment (USD 472,500), and fracture (USD 2,088,110). CONCLUSION: In total, 2.5% of all THAs performed between 2005 and 2017 lead to a claim submission at the DPCA. One of 2 claims were approved. The majority of payouts were due to nerve damage, infection, MoM prosthesis, insufficient or incorrect treatment, and fracture. Although DPCA manages claims for patients, the data can also provide beneficial feedback to arthroplasty surgeons with the aim of improving patient care.

Complications and technical failures are rare in knee ligament reconstruction: analyses based on 31,326 reconstructions during 10 years in Denmark.

PURPOSE: Knowledge about treatment injuries (technical failures and complications) in relation to knee ligament reconstructions is sparse. Our purpose was to describe treatment injuries to knee ligament reconstruction in Denmark during a 10-year period and to suggest initiatives to reduce the risk for treatment injuries. METHODS: Treatment injuries after knee ligament reconstructions reported to the Danish Patient Compensation Association (DPCA) 2005-2014 were analyzed and compared to information from the Danish Kneeligament Reconstruction Register and Danish National Patient Register. RESULTS: The number of knee ligament reconstructions in Denmark 2005-2014, including revisions, was 31,326. Of the 704 cases claimed to DPCA, 371 were approved as treatment injuries (1.42% of all operations). Tunnel malpositioning (135 = 0.43% of all operations), deep infection (0.27%), nerve injury (0.17%), pain (0.12%) and unrecognized combined instability (0.11%) were the most common. Patients operated with anteromedial technique for femoral tunnel placement had a lower incidence (p < 0.0001) of tunnel malpositioning compared to other techniques. Public and private hospitals had the same risk of treatment injures. Hospitals that performed the largest number of reconstructions/year had the smallest risk of a treatment injury (p < 0.001). The total compensation was 7.6 m EURO, which equals 243 EURO/performed knee ligament reconstruction. CONCLUSION: Treatment injuries as defined in this study were rare, with tunnel malpositioning being the most common. Analyses of the results indicate that it may be clinically relevant to reduce the number of treatment injures that knee ligament reconstructions are concentrated in clinics with high volume. Also, malpositioning might be reduced by routine documentation of K-wire position before tunnels are drilled. LEVEL OF EVIDENCE: III.

Why tibial plateau fractures are overlooked.

BACKGROUND: Tibial plateau fractures (TPFs) are sometimes overlooked in the emergency room (ER). Using a national register covering 18 years we aimed to find out why and to evaluate if use of a specific radiographic decision rule, Pittsburgh Knee Rules (PKRs), could have reduced the number of overlooked TPFs. METHODS: Medical records for 137 patients, prospectively registered during 18 years by the Danish Patient Compensation Association (DPCA) (a national register), were studied. The inclusion criterion was a delayed diagnosis of a fracture in the knee following a trauma. Case records, legal assessments, and evaluations by specialist doctors were reviewed, and the consequences of the delayed diagnosis for outcome and treatment were registered. RESULTS: Only 58 patients (42%) had been evaluated according to PKRs. In 53 patient cases, the fracture was not diagnosed on radiographs obtained at the first medical contact. However, in 84% of these cases, the fracture was visible or was suspected by retrospective evaluation. 50 out of 79 patients, for whom X-rays were not obtained, were candidates for radiographs according to PKRs, 17 cases lacked information to evaluate by PKRs and 12 cases were not candidates. In 53% of all cases, it was evaluated that the fracture position had worsened at the time of diagnosis. A significant disability compensation was granted in 36% of cases due to the delayed identification of fractures, totaling 841,000 EUR. CONCLUSIONS: The major reasons for overlooking TPFs were 1) difficulty in recognizing the fractures on X-rays and 2) that X-ray decision rules were not employed. Two thirds of the patients, for whom a radiograph had not been prescribed, would have had an X-ray, if the PKRs had been used. Overlooking TPFs significantly increased patient disability in one third of cases. We recommend that healthcare professionals in the ER use X-ray decision rules in addition to clinical examination to avoid overlooking TPFs. When standard radiographs are evaluated as normal in patients that are clinically suspect of a TPF, oblique X-rays, magnetic resonance imaging (MRI) or Computed Tomography (CT)-scan should be considered.

Well Leg Compartment Syndrome After Abdominal Surgery.

BACKGROUND: Well leg compartment syndrome (WLCS) is a complication to abdominal surgery. We aimed to identify risk factors for and outcome of WLCS in Denmark and literature. METHODS: Prospectively collected claims to the Danish Patient Compensation Association (DPCA) concerning WLCS after abdominal operations 1996-2013 and cases in literature 1970-2013 were evaluated. Cases of fasciotomy within 2 weeks after abdominal surgery 1999-2008 were extracted from the Danish National Patient Register (DNPR). RESULTS: There were 40 cases in DPCA and 124 in literature. In 68 % legs were supported under the knees during surgery. Symptoms of WLCS presented within 2 h after surgery in 56 % and in only 3 cases after 24 h. Obesity was not confirmed as risk factor for WLCS. The mean diagnostic delay was 10 h. One-third of fasciotomies were insufficient. The diagnostic delay increased with duration of the abdominal surgery (p = 0.04). Duration of the abdominal surgery was 4 times as important as the diagnostic delay for severity of the final outcome. DNPR recorded 4 new cases/year, and half were reported to DPCA. CONCLUSION: The first 24 h following abdominal surgery of >4 h' duration with elevated legs observation for WLCS should be standard. Pain in the calf is indicative of WLCS, and elevated serum CK can support the diagnosis. Mannitol infusion and acute four-compartment fasciotomy of the lower leg is the treatment. The risk of severe outcome of WLCS increases with duration of the primary operation. A broad support and change of legs' position during surgery are suggested preventative initiatives.

No-fault compensation for treatment injuries in Danish public hospitals 2006-12.

OBJECTIVE: We aimed to determine the incidence rate and time trend of approved treatment injuries in Danish public hospitals from 2006 to 2012 and also to identify independent predictors of severe treatment injuries among patient and system factors and characterize the injuries. DESIGN AND SETTING: We performed a nationwide, historical observational study on data from the Danish Patient Compensation Association, which receives all compensation claims from Danish health care. All approved closed claims of treatment injuries occurring in public hospitals 2006-12 were included. Health care activity information was obtained through Statistics Denmark. MAIN OUTCOME MEASURES: Incidence rates were determined as treatment injuries per year by population and by public hospital contacts. By using a multivariable logistic regression model, we calculated mutually adjusted odds ratios to assess the association between potential predictors and severe injuries among approved claims. RESULTS: We identified 10,959 approved treatment injury claims in 2006-12. The total payout was USD 339 million. The mean incidence rate medians were 27.9 injuries/100,000 inhabitants/year and 0.21 injuries/1000 public hospital contacts/year. These did not increase overtime. Severe injuries and preventable cases comprised 11.0 and 41.0%, respectively. Predictors of severe injury included age 0 and above 40 years, male gender and higher level of comorbidity. CONCLUSION: The incidence rate of approved closed claims at Danish public hospitals appears stable. A high proportion of injuries are preventable and both patient- and system-related factors may predict severe injuries.

Exploratory survey study of long-term users of nicotine replacement therapy in Danish consumers.

BACKGROUND: Long-term use of nicotine replacement therapy (NRT) has been approved in several countries for smokers who are unable or unwilling to quit smoking. However, information on basic characteristics, degree of nicotine dependence, health status and contentment with long-term use of NRT is scarce. The aim of this study was to collect information on the characteristics of long-term NRT users, having used NRT for at least 12 months, reasons for, and contentment with, their continued use of NRT including reasons for wishing to quit or sustain use and an estimation of their degree of nicotine dependence. METHOD: Through advertisements in three national Danish newspapers, long-term NRT users were recruited to answer a short questionnaire about basic characteristics, health status and satisfaction with using NRT. A modified version of the Heaviness of Smoking Index (HSI) questionnaire was applied to estimate nicotine dependence. Linear regression was used to test association between time to first NRT and daily dosage of NRT. RESULTS: A total of 92 respondents were included in the data analysis. A majority of 88% wished to quit NRT for the following reasons: costs of NRT, being tired of feeling addicted and fear of adverse health effects. Scoring on the modified HSI scale was 22.0% low, 68.0% moderate and 9.3% high dependent. Of the respondents, 67.0% used NRT within the first 30 min after waking. A validation check found a significant linear association between the two items in the modified HSI. CONCLUSION: A significant majority of users wished to quit NRT because of the cost of products, being tired of feeling addicted and fear of adverse health consequences. The majority of these users were moderate to high nicotine dependent. The strong association found between time to first NRT and NRT dosages used per day gives reason to believe the validity of the modified HSI. Further studies are required for confirmation. Better counselling of long-term users on the benefits of using NRT compared to smoking should be provided, for those who are chronically dependent, as well as support to stop long-term use of NRT if wanted.

Existing data sources for clinical epidemiology: the Danish Patient Compensation Association database.

Any patient in the Danish health care system who experiences a treatment injury can make a compensation claim to the Danish Patient Compensation Association (DPCA) free of charge. The aim of this paper is to describe the DPCA database as a source of data for epidemiological research. Data to DPCA are collected prospectively on all claims and include information on patient factors and health records, system factors, and administrative data. Approval of claims is based on injury due to the principle of treatment below experienced specialist standard or intolerable, unexpected extensiveness of injury. Average processing time of a compensation claim is 6-8 months. Data collection is nationwide and started in 1992. The patient's central registration system number, a unique personal identifier, allows for data linkage to other registries such as the Danish National Patient Registry. The DPCA data are accessible for research following data usage permission and make it possible to analyze all claims or specific subgroups to identify predictors, outcomes, etc. DPCA data have until now been used only in few studies but could be a useful data source in future studies of health care-related injuries.

Epidemiology of 411 140 cataract operations performed in public hospitals and private hospitals/clinics in Denmark between 2004 and 2012.

PURPOSE: To study the epidemiology and mortality in patients who had cataract surgery in public hospitals and private hospitals/clinics in Denmark between 2004 and 2012 and to assess the validity of the Danish cataract registries. METHODS: Register- and chart-based study. RESULTS: A total of 411 140 cataract operations were performed in 243 856 patients. Patients who had cataract surgery in public hospitals had an overall statistically significantly 62% higher mortality compared to patients who had cataract surgery in private hospitals/clinics. The decrease in mean age at first eye cataract surgery in private hospitals/clinics was statistically significantly greater compared to the decrease in mean age at first eye cataract surgery in public hospitals (p < 0.001). The median time interval between first and second eye cataract surgery decreased statistically significantly during the study period (p < 0.001) and was statistically significantly shorter in all calendar years for patients operated in private hospitals/clinics compared to patients operated in public hospitals (p < 0.001). In all, 46% of the cataract operations performed in private hospitals/clinics that led to cases of postoperative endophthalmitis were not registered in any registry. CONCLUSION: In general, patients who had cataract surgery in private hospitals/clinics were healthier, had first eye cataract surgery at an increasingly younger age and had a reduced time interval between cataract surgeries in the two eyes compared to patients who had cataract surgery in public hospitals. The lack of registration of cataract surgery by the private hospitals/clinics limits the quality of the registries.

Work environment influences adverse events in an emergency department.

INTRODUCTION: The psychosocial work environment has been recognised as a factor that contributes to the occurrence of errors and adverse events at hospitals. There has been a strong focus on stress factors at intensive care units and emergency departments. The purpose of this study was to investigate the occurrence of adverse events and to examine the relationship between work-related stressors, safety culture and adverse events at an emergency department. MATERIAL AND METHODS: A total of 98 nurses and 26 doctors working in an emergency department at a Danish regional hospital filled out a questionnaire on the occurrence and pattern of adverse events, psychosocial work environment factors, safety climate and learning culture. RESULTS: The participants had experienced 742 adverse events during the previous month. The most frequent event types were lack of documents, referrals not performed, blood tests not available and lack of documentation. Problems related to reporting and learning and insufficient follow-up and feedback after serious events were the most frequent complaints. A poor patient safety climate and increased cognitive demands were significantly correlated to adverse events. CONCLUSION: This study supports previous findings of severe underreporting to the mandatory national reporting system. The issue of reporting bias related to self-reported data should be born in mind. Among work environment issues, the patient safety climate and stress factors related to cognitive demands had the highest impact on the occurrence of adverse events. FUNDING: The project was funded by Trygfonden (grant no 7-10-0949). TRIAL REGISTRATION: not relevant.

Validating the Danish adaptation of the World Health Organization's International Classification for Patient Safety classification of patient safety incident types.

OBJECTIVE: Validation of a Danish patient safety incident classification adapted from the World Health Organizaton's International Classification for Patient Safety (ICPS-WHO). DESIGN: Thirty-three hospital safety management experts classified 58 safety incident cases selected to represent all types and subtypes of the Danish adaptation of the ICPS (ICPS-DK). OUTCOME MEASURES: Two measures of inter-rater agreement: kappa and intra-class correlation (ICC). RESULTS: An average number of incident types used per case per rater was 2.5. The mean ICC was 0.521 (range: 0.199-0.809) and the mean kappa was 0.513 (range: 0.193-0.804). Kappa and ICC showed high correlation (r = 0.99). An inverse correlation was found between the prevalence of type and inter-rater reliability. Results are discussed according to four factors known to determine the inter-rater agreement: skill and motivation of raters; clarity of case descriptions; clarity of the operational definitions of the types and the instructions guiding the coding process; adequacy of the underlying classification scheme. CONCLUSIONS: The incident types of the ICPS-DK are adequate, exhaustive and well suited for classifying and structuring incident reports. With a mean kappa a little above 0.5 the inter-rater agreement of the classification system is considered 'fair' to 'good'. The wide variation in the inter-rater reliability and low reliability and poor discrimination among the highly prevalent incident types suggest that for these types, precisely defined incident sub-types may be preferred. This evaluation of the reliability and usability of WHO's ICPS should be useful for healthcare administrations that consider or are in the process of adapting the ICPS.

Protocol for a mixed-methods study on leader-based interventions in construction contractors' safety commitments.

BACKGROUND: Owing to high injury rates, safety interventions are needed in the construction industry. Evidence-based interventions tailored to this industry are, however, scarce. Leader-based safety interventions have proven more effective than worker-based interventions in other industries. OBJECTIVE: To test a leader-based safety intervention for construction sites. The intervention consists of encouraging safety coordinators to provide feedback on work safety to the client and line management. The intention is to increase communication and interactions regarding safety within the line management and between the client and the senior management. It is hypothesised that this, in turn, will lead to increased communication and interaction about safety between management and coworkers as well as an increased on-site safety level. SETTING: A group-randomised double-blinded case study of six Danish construction sites (three intervention sites and three control sites). The recruitment of the construction sites is performed continuously from January 2010 to June 2010. The investigation of each site lasts 20 continuous weeks. METHODS: Confirmatory statistical analysis is used to test if the safety level increased, and if the probability of safety communications between management and coworkers increases as a consequence of the intervention. The data collection will be blinded. Qualitative methods are used to evaluate if communication and interactions about safety at all managerial levels, including the client, increase. OUTCOME MEASURES: (1) The proportion of safety-related communications out of all studied communications between management and coworkers. (2) The safety level index of the construction sites.

Industry and injury related hospital contacts: a follow-up study of injuries among working men in Denmark.

OBJECTIVES: To estimate proportions of injuries that are attributable to the work environment (excess fractions) among economically active men and to identify industries associated with an elevated injury risk. METHODS: A follow-up study was conducted among all economically active men in Denmark aged 20-59 yr 1 January 1999 (N=1,315,772) for first hospital contacts in the period 1999-2003 due to injury in five body regions. Age standardised hospital treatment ratios (SHR) were calculated by industry and excess fractions were estimated. RESULTS: The excess fractions by body region attributable to the work environment were: 22% (95% CI 18-26%) for lower extremities, 29% (95% CI 24-34%) for head and neck, 31% (95% CI 25-37%) for thorax, 36% (95% CI 30-43%) for upper extremities, and 39% (CI: 32-46%) for back injuries. We identified eight industries associated with significantly elevated risks for injuries to each of the five body regions. These were: "road contractors", "bricklayer, joiner, and carpentry work", "finishing (construction work)", "transport of goods", "fire service and salvage corps", "stone-works, pottery, and glass industry", "cleaning, laundries, and dry cleaners", and "slaughterhouse industry". CONCLUSIONS: There are substantial industrial inequalities in injury rates among male workers in Denmark. The size of the inequalities differs between body regions.

Hospital contacts due to injuries among male drivers working for road goods-transport contractors in Denmark.

OBJECTIVES: To establish a detailed picture of injury pattern among professional goods-transport drivers in Denmark. METHODS: For each calendar year over the period of 1995-2003, the age-standardized hospital contact ratios (SHRs) for injury were calculated for male drivers working for road goods-transport contractors in Denmark. The reference population was the male skilled/semiskilled subpopulation of the general workforce in Denmark. RESULTS: No differences in the rate of injury-related hospital contact could be found between male goods-transport drivers and the reference population between 1995 and 1999. However, in the following period of 2000-2003, elevated rates of injury-related hospital contact were noted among goods-transport drivers, compared with the reference population. Furthermore, the injury-related SHR of goods-transport drivers showed a significant increase throughout the period of 1995-2003. Injuries to ankles/feet/toes were prominent among goods-transport drivers. Compared with the reference population, male goods-transport drivers had elevated rates of superficial injuries, dislocations/sprains/strains, fractures, and concussion. The superficial injuries were sustained most frequently in the ankles/feet/toes, open wounds in head/neck, dislocations/sprains/strains in ankles/feet/toes, and fractures in wrists/hands/fingers and ankles/feet/toes. CONCLUSION: There is a clear need for efforts to prevent work injuries among goods-transport drivers. Special attention should be paid to preventing fractures in wrists/hands/fingers and ankles/feet/toes, dislocations/sprains/strains in ankles/feet/toes, open wounds in head/neck, and concussion.

Work injuries among drivers in the goods-transport branch in Denmark.

BACKGROUND: Goods-transport drivers in Denmark had an elevated rate of hospital contact due to injury compared with the skilled/semiskilled workforce in general in recent years. There is a need to elucidate the causes of their work injuries. METHODS: We analyzed the Danish National Work Injury Register for the 10-year period 1993-2002. RESULTS: The vast majority (92.6%) of the work injuries among goods-transport were sustained under non-traffic activities, that is, collecting, loading, unloading, and delivering goods. They fell from height (22.3%), suffered from overexertion (14.2%), got caught between/under objects (12.6%), collided with objects (12.0%), slipped/tripped (10.6%), or got struck by falling objects (9.0%). CONCLUSIONS: There is a clear need for efforts to prevent work injuries under non-traffic activities among goods-transport drivers in Denmark. For this end, it is necessary to involve not only the drivers' employers for reinforcement of safety procedures, but also the employers' customers for improvement of the physical environment, in which drivers collect, load, unload, and deliver goods.

Prospective analysis of disability retirement as a consequence of injuries in a labour force population.

UNLABELLED: The aim of the present work was to investigate the influence of different types of injury on the risk for disability retirement among economically active people in Denmark. MATERIAL AND METHODS: In this prospective study, all people in the Danish labour force aged 21-54 years 1 January 1997 (N = 2 211 057) were followed for disability retirement during 1997-2001. Age and gender standardised incidence ratios (SIR) were calculated to compare retirement rates among those who received treatment for an injury during 1996 (N = 252 468, including both work-related and non-work related types) with the rates in the total labour force. Life-table methodology was used to calculate years of lost economically active life (YLEAL) by injury type. RESULTS: Among the injured people we observed a total number of 5580 cases of subsequent disability retirement and 45% of these could be statistically attributed to the injury. The SIR for disability retirement by injury type ranged from 1.38 to 7.00. The least severe types, superficial injuries and dislocations, sprains, and strains, were most prevalent and generated the highest numbers of YLEALs. CONCLUSION: The high frequency of injuries and their influence on retirement rates suggest that injury prevention is a highly relevant approach to reduce future costs from disability retirement. YLEAL calculations can be used to set priorities.

Industrial sectors with high risk of women's hospital-treated injuries.

BACKGROUND: Women's occupational injury rates are converging with those of males. Associations between female workers' hospital treated injury rates, industrial sector and injured body area were analyzed to provide for better-focused injury prevention of women's hazardous jobs. METHODS: Females' standardized hospital treatment ratios (SHR) and the excess fraction for five body regions (head/neck, thorax, back, upper and lower extremities) were calculated for 58 industrial sectors for 1999-2003. RESULTS: Five industrial sectors, "Cleaning, laundries and dry cleaners," "Transport of passengers," "Hotels and restaurants," "Hospitals" and "Transport of goods" had significantly high SHRs for all five body regions. The excess fraction for upper extremity injuries revealed that 14%-27% of injuries could theoretically have been avoided. CONCLUSIONS: There is strong evidence for an association between women's hospital treated injuries and industrial sector. The results justify the need for gender-sensitive analyses to orient injury prevention programs.