背景:脑震荡可能导致持续的脑震荡后症状影响工作能力和就业。这项研究研究了脑震荡急性期后个人可以经历的劳动力市场状态之间的转变。目的是描述不同劳动力市场状态之间有利和不利转变的发生率(例如,employment,病假)与脑震荡个体相对于匹配对照的社会经济和健康特征有关。
方法:这项基于丹麦全国注册的队列研究从丹麦国家患者注册(ICD-10S06.0)中提取了2003-2007年间18-60岁脑震荡患者。对照组在年龄上匹配,性别,和市政当局。患者和对照组在受伤后三个月开始随访5年。排除标准是神经系统损伤和在纳入期(2003-2007年)和受伤前5年(1998-2002年)无法进入劳动力市场。劳动力市场状态是根据丹麦边际化评估登记册中的转移收入数据定义的。在多状态模型中分析了这些劳动力市场状态之间转换的发生率。过渡被捆绑在劳动力市场状态之间的有利和不利过渡中,并且使用Cox回归模型的风险比评估了脑震荡个体相对于匹配对照的发病率差异。
结果:脑震荡患者(n=15.580)的有利转变发生率较低(HR0.88,CI0.86-0.90),而不良转变发生率较高(HR1.30,CI1.27-1.35),相对于匹配的对照(n=16.377)。脑震荡的影响取决于健康和社会经济特征。值得注意的是,30-39岁的个体(HR0.83,CI0.79-0.87),高收入个人(200.000-300.000丹麦克朗)(HR0.83,CI0.80-0.87),与对照组相比,具有管理经验的工薪阶层(HR0.60,CI0.44-0.81)的有利过渡发生率明显较低。此外,与对照组相比,高收入人群的不良转变发生率也较高(HR1.46,CI1.34~1.58).
结论:脑震荡与劳动力市场状态之间不利转变的风险增加和有利转变的发生率降低有关,表明工作残疾,可能是由于持续的脑震荡后症状。一些年龄组,高收入的人,有管理经验的员工可能会受到更大的影响。
Concussion may lead to persisting post-concussive symptoms affecting work ability and employment. This study examined the transitions between labour market states an individual can experience after the acute phase of concussion. The aim was to describe the incidence of favourable and adverse transitions between different labour market states (e.g., employment, sick leave) in relation to socioeconomic and health characteristics in individuals with concussion relative to matched controls.
This Danish nationwide register-based cohort study extracted 18-60-year-old individuals between 2003-2007 with concussion from the Danish National Patient Register (ICD-10 S06.0). Controls were matched on age, sex, and municipality. Patients and controls were followed for 5 years starting three months after injury. Exclusion criteria were neurological injuries and unavailability to the labour market in the inclusion period (2003-2007) and 5-years before injury (1998-2002). Labour market states were defined from transfer income data in the Danish Register for Evaluation of Marginalization. Incidence rates of transitions between these labour market states were analysed in multistate models. Transitions were bundled in favourable and adverse transitions between labour market states and the difference in incidence rates between individuals with concussion relative to matched controls were assessed with hazard ratios from Cox regression models.
Persons with concussion (n = 15.580) had a lower incidence of favourable transitions (HR 0.88, CI 0.86-0.90) and a higher incidence of adverse transitions (HR 1.30, CI 1.27-1.35), relative to matched controls (n = 16.377). The effect of concussion differed depending on health and socioeconomic characteristics. Notably, individuals between 30-39 years (HR 0.83, CI 0.79-0.87), individuals with high-income (200.000-300.000 DKK) (HR 0.83, CI 0.80-0.87), and wage earners with management experience (HR 0.60, CI 0.44-0.81) had a markedly lower incidence of favourable transitions compared to controls. Additionally, individuals with high income also had a higher incidence of adverse transitions (HR 1.46, CI 1.34-1.58) compared to controls.
Concussion was associated with enhanced risk of adverse transitions between labour market states and lower occurrence of favourable transitions, indicating work disability, potentially due to persistent post-concussive symptoms. Some age groups, individuals with high income, and employees with management experience may be more affected.