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Socio-economic status and co-morbidity as risk factors for trauma

  • INJURY EPIDEMIOLOGY
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Abstract

Clinical experience and previous studies indicate that low socioeconomic positions are overrepresented in trauma populations. The reason for this social variation in injury risk is likely to be multifactorial. Both individual and environmental sources of explanation are plausible to contribute. We investigated the impact of the influence of socioeconomic factors and co-morbidity on the risk of becoming a trauma victim in a case–control study including 7,382 trauma patients matched in a one to five ratio with controls matched by age-, gender- and municipality from a level 1 trauma centre. Data from the trauma cohort were linked to national registries. Associations between socioeconomic factors and co-morbidity were estimated by conditional logistic regression. The trauma patients had been treated for psychiatric, substance abuse and somatic diagnoses to a higher extent than the controls. In the conditional logistic regression analysis a low level of education and income as well as co-morbidity (divided into psychiatric, substance abuse and somatic diagnoses) were all independent risk factors for trauma. Analysing patients with an injury severity score >15 separately did not alter the results, except for somatic diagnoses not being a risk factor. Recent treatment for substance abuse significantly increased the risk for trauma. Low level of education and income as well as psychiatric, substance abuse and somatic co-morbidity were all independent risk factors for trauma. Active substance abuse strongly influenced the risk for trauma and had a time dependent pattern. These insights can facilitate future implementation of injury prevention strategies tailored to specific risk groups.

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Abbreviations

AIS:

Abbreviated injury scale

CI:

Confidence intervals

ICD-10:

International classification of diseases

IQR:

Interquartile ranges

ISS:

Injury severity score

LISA:

The Longitudinal integration database for health insurance and labour market studies

NBHW:

Swedish national board of health and welfare

SES:

Socioeconomic status

WHO:

World health organization

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Acknowledgments

We are sincerely grateful to our trauma registry nurses Lisbeth Bergendal, Lena Jansson and Katarina Ramsberg-Enegren and Tina Friberg for their invaluable work with the trauma registry. We also thank Dr Timothy Baker for providing linguistic expertise. This study was supported by the Laerdal Foundation, the Magn Bergvall Foundation, the LPS Medical Foundation, the Cancer and Traffic Injury Fund, The Swedish Carnegie Hero Funds, Funds from Karolinska Institutet and the Swedish Society of Medicine. Financial support was also provided through the regional agreement on medical and clinical research (ALF) between Stockholm County Council and Karolinska Institutet.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden

    Olof Brattström, Mikael Eriksson, Emma Larsson & Anders Oldner

  2. Department of Anaesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden

    Olof Brattström, Mikael Eriksson, Emma Larsson & Anders Oldner

Authors
  1. Olof Brattström
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  2. Mikael Eriksson
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  3. Emma Larsson
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  4. Anders Oldner
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Correspondence to Olof Brattström.

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Brattström, O., Eriksson, M., Larsson, E. et al. Socio-economic status and co-morbidity as risk factors for trauma. Eur J Epidemiol 30, 151–157 (2015). https://doi.org/10.1007/s10654-014-9969-1

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  • DOI: https://doi.org/10.1007/s10654-014-9969-1

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