26th July 2019, Volume 132 Number 1499

Emma Wyeth, Michelle Lambert, Ari Samaranayaka, Helen Harcombe, Gabrielle Davie, Sarah Derrett

Injury is the leading cause of disability worldwide.1,2 Post-injury burden can be further exacerbated by subsequent injuries (ie, injuries that occur after, but not necessarily because of, an earlier ‘sentinel’…

Subscriber content

The full contents of this page is only available to subscribers.

To view this content please login or subscribe

Summary

Māori, the indigenous population of New Zealand, experience a disproportionate burden of injury compared to non-Māori. The impact of injury can be exacerbated by subsequent injuries, ie, injuries that occur after, but not necessarily because of, an earlier injury. Using interview, ACC and hospital discharge data, this study aimed to describe subsequent injuries experienced by Māori to determine: the number and timing of subsequent injury claims reported to ACC in the 24 months following an earlier injury; the proportions of Māori experiencing subsequent injuries; and the nature of subsequent injuries. Findings show that 62% of Māori participants who had already experienced a profound injury went on to experience a subsequent injury that reported to ACC within a 24-month period. This suggests that the subsequent injury burden for Māori is considerable, and that preventive opportunities are potentially being missed.

Abstract

Aim

Māori, the indigenous population of New Zealand, experience a disproportionate burden of injury compared to non-Māori. Injury burden can be exacerbated by subsequent injuries (injuries that occur after, but not necessarily because of, an earlier or ‘sentinel’ injury). Despite obligations under New Zealand’s Treaty of Waitangi, it appears no published studies have investigated subsequent injuries among Māori. This study aims to describe subsequent injuries experienced by Māori and reported to New Zealand’s no-fault injury Accident Compensation Corporation (ACC), and determine: the number and timing of subsequent injury (SI) claims reported to ACC in 24 months following a sentinel injury; the proportions experiencing ≥1 SI; and the nature of SIs.

Method

The Subsequent Injury Study analysed interview, ACC and hospital discharge data. SIs were classified as injury events involving an ACC claim within 24 months of a sentinel injury.

Results

Of 566 participants, 349 (62%) experienced ≥1 SI in the 24 months post-sentinel injury. Those with moderate/high alcohol use, or cognitive difficulties, before the sentinel injury were more likely to experience SIs. Fewer SIs occurred between 0–3 months after a sentinel injury compared to later periods. Spine dislocations/sprains/strains were the most common SI type.

Conclusion

Despite their descriptive nature, our findings point to both the complexity of SI and the need for a greater research, ACC and health service focus on SI if the burden of injury for Māori is to be truly addressed. That 62% of Māori who had already experienced a profound sentinel injury went on to experience ≥1 SIs reported to ACC within a 24-month period suggests that the burden is considerable, and that preventive opportunities are being missed. Additional analyses are now underway to investigate factors predicting SI, while accounting for potential confounders, in order to assist in the development of SI prevention initiatives for Māori at multiple points in the complex post-injury pathway.

Author Information

Emma Wyeth, Senior Lecturer-Māori Health and Director, Te Roopū Rakahau Hauora Māori o Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin; Michelle Lambert, Research Fellow-Māori Health, Te Roopū Rakahau Hauora Māori o Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin;
Ari Samaranayaka, Senior Research Fellow, Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin; Helen Harcombe, Lecturer, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin; Gabrielle Davie, Senior Research Fellow, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin;
Sarah Derrett, Professor, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin.

Acknowledgements

The authors are grateful to the study participants for sharing their information with us. The Subsequent injury Study was funded by the Health Research Council of New Zealand (HRC 15/091; 2015–2017). The Prospective Outcomes of Injury Study was funded by the Health Research Council of New Zealand (HRC 10/052; 2007–2013) and the Accident Compensation Corporation of New Zealand (2007–2010). The views and conclusions in the article are of the authors and may not represent those of the funders.

Correspondence

Dr Emma H Wyeth, Senior Lecturer-Māori Health and Director, Te Roopū Rakahau Hauora Māori o Kāi Tahu (Ngāi Tahu Māori Health Research Unit), Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin.

Correspondence Email

emma.wyeth@otago.ac.nz

Competing Interests

Dr Derrett, Dr Wyeth and Dr Samaranayaka report grants from Health Research Council of New Zealand during the conduct of the study.

References

  1. Derrett S, Wilson S, Samaranayaka A, et al. Prevalence and Predictors of Disability 24-Months After Injury for Hospitalised and Non-Hospitalised Groups: Results from a Longitudinal Cohort Study in New Zealand. PLoS One 2013; 8(11):e80194.
  2. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet 2012; 380(9859):2163–96.
  3. Derrett S, Harcombe H, Wyeth E, et al. Subsequent Injury Study (SInS): Improving outcomes for injured New Zealanders. Injury Prevention 2017; 23(429):429–34.
  4. Harcombe H, Derrett S, Samaranayaka A, et al. Factors predictive of subsequent injury in a longitudinal cohort study. Injury Prevention 2014; 20(6):393–400.
  5. Ruseckaite R, Collie A. Repeat workers’ compensation claims: risk factors, costs and work disability. BMC Public Health 2011; 11(1):492–99.
  6. Lipscomb H, Cameron W, Silverstein B. Incident and recurrent work injuries among union carpenters. Occupational and Environmental Medicine 2008; 65(12):827–34.
  7. Ministry of Health, Accident Compensation Corporation. Injury-related Health Loss: A report from the New Zealand Burden of Diseases, Injuries and Risk Factors Study 2006–2016. Wellington: Ministry of Health, 2013.
  8. Ministry of Health. Tatau Kahukura: Māori Health Chart Book 2015 (3rd edition). Wellington: Ministry of Health, 2015. 
  9. Maclennan B, Wyeth E, Hokowhitu B, et al. Injury Severity and 3-Month Outcomes Among Māori: Results From a New Zealand Prospective Cohort Study. N Z Med J 2013; 126(1379):39–49.
  10. Maclennan B, Wyeth H E, Davie G, et al. Twelve-month post-injury ouctomes for Maori and non-Maori: findings from a New Zealand cohort study. Australian and New Zealand Journal of Public Health 2014; 38(3):227–33.
  11. Hedges BE, Dimsdale JE, Hoyt DB, et al. Characteristics of Repeat Trauma Patients, San Diego County. American Journal of Public Health 1995; 85(7):1008–10.
  12. Wyeth EH, Derrett S, Hokowhitu B, et al. Rangatiratanga and Ōritetanga: Responses to the Treaty of Waitangi in a New Zealand study. Ethnicity & Health 2010; 15(3):303–16.
  13. Health Research Council of New Zealand. Guidelines for Researchers on Health Research Involving Māori. Auckland: Health Research Council of New Zealand, 2008.
  14. Parliamentary Counsel Office. New Zealand Public Health and Disability Act 2000 Public Act. Wellington: Parliamentary Counsel Office, 2000.
  15. Wyeth E, Derrett S, Hokowhitu B, et al. Indigenous injury outcomes: life satisfaction among injured Maori in New Zealand three months after injury. Health Qual Life Outcomes 2013; 11(1):120–28.
  16. Accident Compensation Corporation. Investing in New Zealanders - ACC Annual Report 2017. Wellington: Accident Compensation Corporation, 2017.
  17. Harcombe H, Davie G, Wyeth E, et al. Injury upon injury: a prospective cohort study examining subsequent injury claims in the 24 months following a substantial injury. Injury Prevention 2017; 24:460–67.
  18. Black JA, Herbison GP, Lyons RA, et al. Recovery after injury: an individual patient data meta-analysis of general health status using the EQ-5D. J Trauma 2011; 71(4):1003–10.
  19. Derrett S, Langley J, Hokowhitu B, et al. Prospective Outcomes of Injury Study. Injury Prevention 2009; 15(5):e3.
  20. Statistics New Zealand. New Zealand Census of Population and Dwellings - Individual Form. Wellington: Statistics New Zealand, 2006.
  21. Derrett S, Samaranayaka A, Wilson S, et al. Prevalence and Predictors of Sub-Acute Phase Disability after Injury among Hospitalised and Non-Hospitalised Groups: A Longitudinal Cohort Study. PLoS One 2012; 7(9):e44909.
  22. Langley J, Derrett S, Davie G, et al. A cohort study of short-term functional outcomes following injury: the role of pre-injury socio-demographic and health characteristics, injury and injury-related healthcare. Health Qual Life Outcomes 2011; 9:68–79.
  23. Wyeth EH, Samaranayaka A, Davie G, et al. Prevalence and predictors of disability for Māori 24 months after injury. Australian and New Zealand Journal of Public Health 2017; 41(3):262–68.
  24. Statistics New Zealand. New Zealand Standard Classification of Occupations. Wellington: Statistics New Zealand, 2001.
  25. Ministry of Social Development. Direct Measurement of Living Standards: The New Zealand ELSI Scale - Survey of Working Age People in 2000. Wellington: Ministry of Social Development, 2000.
  26. Maclennan B, Wyeth E, Davie G, et al. Twelve-month post-injury outcomes for Māori and non-Māori: Findings from a New Zealand cohort study. ANZJPH 2014; 38(3):227–33.
  27. Langley J, Davie G, Wilson S, et al. Difficulties in Functioning 1 Year After Injury: The Role of Preinjury Sociodemographic and Health Characteristics, Health Care and Injury-Related Factors. Archives of physical medicine and rehabilitation 2013; 94(7):1277–86.
  28. American Psychiatric Association Committee of Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorder-3rd Edition (DSM-3). Washington, DC: American Psychiatric Association 1980.
  29. Üstün T, Kostanjsek N, Chatterji S, et al. Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0). Malta: WHO Press 2010.
  30. EuroQol Group. EQ-5D A standardised instrument for use as a measure of health outcome: http://www.euroqol.org/; 2008 [Available from: http://www.euroqol.org/.
  31. Bradley KA, DeBenedetti AF, Volk RJ, et al. AUDIT-C as a Brief Screen for Alcohol Misuse in Primary Care. Alcoholism: Clinical and Experimental Research 2007; 31(7):1208–17.
  32. Stevenson M, Segui-Gomez M, Lescohier I, et al. An overview of the injury severity score and the new injury severity score. Injury Prevention 2001; 7(1):10–13.
  33. Wilson SJ, Derrett S, Cameron ID, et al. Prevalence of poor outcomes soon after injury and their association with the severity of the injury. Injury Prevention 2014; 20(1):57–61.
  34. Ministry of Health. National Minimum Dataset (hospital events) 2012 [cited 2015 10 February 2015]. Available from: http://www.health.govt.nz/nz-health-statistics/national-collections-and-surveys/collections/national-minimum-dataset-hospital-events accessed 10 October 2018.
  35. Accident Compensation Corporation. ACC Treatment Provider Handbook 2017. Wellington: Accident Compensation Corporation, 2017.
  36. Stata Statistical Software: Release 14 [program]. College Station, Texas: StataCorp LP, 2015.
  37. Mokdad AH, Ballestros K, Echko M, et al. The State of US Health, 1990–2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA 2018; 319(14):1444–72.
  38. Connor J, Kydd R, Shield K, et al. Alcohol-attributable burden of disease and injury in New Zealand : 2004 and 2007 : research report commissioned by the Health Promotion Agency. Wellington: Health Promotion Agency, 2013.
  39. McPherson A, Nagai T, Webster K, et al. Risk of Lower Extremity Musculoskeletal Injury after Concussion: A Meta-Analysis. Medicine & Science in Sports & Exercise 2018; 50:2.
  40. Hamilton MG, Meeuwisse HW, Emery AC, et al. Subsequent Injury Definition, Classification, and Consequence. Clinical Journal of Sport Medicine 2011; 21(6):508–14.
  41. Worrell SS, Koepsell DT, Sabath RD, et al. The Risk of Reinjury in Relation to Time Since First Injury: A Retrospective Population-Based Study. The Journal of Trauma: Injury, Infection, and Critical Care 2006; 60(2):379–84.
  42. Statistics New Zealand. He hauā Māori Findings from the 2013 Disability Survey. Wellington: Statistics New Zealand, 2015.
  43. Mauri Ora Associates. Māori Experience of ACC: Mauri Ora Associates Final Report for Department of Labour: Department of Labour, 2010.

Download

The downloadable PDF version of this article is only available to subscribers.

To view this content please login or subscribe