The 130th Annual Meeting of APHA

Abstract #49268

Shanthi N. Ameratunga, MBChB, MPH¹, Robyn N. Norton, PhD, MPH², Jennie L. Connor, MBChB, MPH¹, Elizabeth Robinson, MSc³, Ian Civil, FRACS⁴, John H. Coverdale, MBChB, MD⁵, and Rod T. Jackson, FAFPHM, PhD¹. (1) Division of Community Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand, +64-9-3737599 ext 6354, s.ameratunga@auckland.ac.nz, (2) Institute for International Health, University of Sydney, PO Box 576, Newtown, Sydney, NSW 2042, Australia, (3) Division of Community Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand, Private Bag 92019, Auckland, New Zealand, (4) Trauma Service, Auckland Public Hospital, Park Road, Grafton, Auckland, New Zealand, (5) Department of Psychiatry and Behavioral Science, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030

Previous estimates of disability due to car crashes have largely relied on uncontrolled studies of injured survivors. This population-based prospective cohort study from Auckland, New Zealand, aims to determine the independent effect of serious non-fatal crashes on the long-term health of hospitalised and non-hospitalised drivers.

Of 292 drivers surviving car crashes where at least one occupant was admitted to hospital between October 1998 and July 1999, and 368 "controls" (a representative sample of driving over the same period), 245 (84%) and 285 (75%), respectively, were re-interviewed five months post-crash, and 218 (75%) and 254 (69%) at eighteen months. The self-report study instrument included the Short Form-36. At eighteen months, 37% of "crash" drivers (42% of those hospitalised and 21% of those not) compared with 7% of "controls" reported deteriorated overall health relative to baseline (pre-crash) health (OR 5.0; 95% CI: 3.5-6.5). While hospitalised drivers reported greater reductions in physical function, role-physical and bodily pain scales than non-hospitalised drivers, these scores improved from five to eighteen months. In contrast, hospitalised and non-hospitalised drivers with deteriorated health reported declining general and mental health throughout follow-up, with significantly greater reductions in mental health among non-hospitalised drivers.

Our findings suggest a major component of long-term adverse health following car crashes is unrelated to physical injury, and non-hospitalised drivers with impaired health overall experience greater declines in mental health than hospitalised drivers. Studies from clinical settings may substantially underestimate and distort the burden of disability and adverse health among crash survivors.

Learning Objectives:

At the conclusion of this presentation, the participant (learner) will be able to
• define the probability and magnitude of disability among drivers surviving serious car crashes
• describe the potential similarities and differences in adverse health experienced by hospitalised and non-hospitalised survivors
• discuss the implications of estimating disability and clinic-based versus population-based epidemiologic studies, and
• articulate the importance of targetting the reduced quality as well as quantity of life due to car crashes, as a public health priority.

Keywords: Injury, Disability

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.