Socioeconomic Outcomes Following Spinal Cord Injury and the Role of No-fault Compensation Sarah...

7/17/2019 Socioeconomic Outcomes Following Spinal Cord Injury and the Role of No-fault Compensation Sarah Derrett ACHRF 2013

http://slidepdf.com/reader/full/socioeconomic-outcomes-following-spinal-cord-injury-and-the-role-of-no-fault 1/23

Socioeconomic Outcomes Following Spinal Cord

Injury and the Role of No-fault Compensation:Longitudinal Study

Sarah Derrett

School of Health and Social Services, College of Health



Longitudinal Study of Spinal Cord Injury

• Funded by the Health Research Council

• Supported by the Burwood Academy of Independent

Living (BAIL)

• Auckland & Burwood Spinal Units mgt/clinical teams

• Nurses – Karla and Karen

• Research team: Martin Sullivan, Charlotte Paul, SarahDerrett, Peter Herbison & Carolyn Beaver

• With: Sue McAllister, project manager & interviewers



The SCI Study

Aims:1) To explore relationships between body, self and society for

people with SCI

2) Investigate how entitlement to rehabilitationand compensation affects socioeconomic

and health outcomes

Sullivan, Paul, Herbison, Tamou, Derrett, Crawford (2010) A longitudinal study of the

life histories of people with spinal cord injury. Injury Prevention; 16:e3



Those covered by ACC and those not

• New Zealand’s compensation insurer (ACC)funds those whose SCI results from:

• Injury

• Compensation: 80% of pre-injury income, lump sum payments,

support services, home and vehicle modifications

• Non-injury SCI (e.g. tumours; infections)

• Receive in-unit rehabilitation & health services; may

have access to means-tested benefits

• Other non-ACC-covered (e.g. living outside

New Zealand)



Previously in New Zealand

• Compared those with an injury (n=429;covered by ACC) from the Prospective

Outcomes of Injury Study (POIS) compared to

those with a stroke (n=109; not covered byACC)

• Median income declined by 13% & 60%

• Return to work higher among injury group

McAllister S, Derrett S, Audas R, Herbison P, Paul C. (2013) Do different types of

financial support after illness or injury affect socio-economic outcomes? A natural

experiment in New Zealand. Social Science and Medicine; 85: 93-102



Sullivan, Paul, Herbison, Tamou, Derrett, Crawford (2010) A longitudinal study of the

life histories of people with spinal cord injury. Injury Prevention; 16:e3

Burwood Spinal Unit

Auckland Spinal Rehabilitation Unit

New Zealand’s Two Spinal Units

http://www.google.co.nz/url?sa=i&source=images&cd=&cad=rja&docid=OYyMWLL7-Cv-BM&tbnid=6Odkr0qV32sYtM:&ved=0CAgQjRwwAA&url=http%3A%2F%2Fwww.mkiwi.com%2Fmaps%2FNew_Zealand_map.html&ei=NYtTUoO9BcmwiQLnjIHIDg&psig=AFQjCNHQhwnL35KgTQpaTAVLSq54GP52Xw&ust=1381293237140333



Recruitment

• People admitted to spinal units over a two-year period (2007-2009)

• First SCI

• Neurological damage

• Aged 16-64 years

• Exclusions: Could not participate in an

interview, prognosis of death ≤6 months,

non-New Zealand resident



Process

• Nurses:

• Identified eligible participants for interviews

• Provided study information to potential

participants• Collected demographic and clinical information

from clinical records for all people admitted

• Interviewers:• Met potential participants

• Scheduled 1st interview



Incidence – all ages (n=230)

Estimated annual incidence (all ages): 30/M

Age-adjusted rates:

• New Zealand European=29/M

• Māori=46/M

• Pacific=70/M

• Other ethnicities=16/M

Derrett, Beaver, Sullivan, Herbison, Acland, Paul. (2012) Traumatic and non-

traumatic spinal cord impairment in New Zealand: incidence and characteristics of

people admitted to spinal units. Injury Prevention; 18:343-346



Today

• N=186 aged 16-64 years

• N= 162 were eligible for participation in

longitudinal study

• 15 declined

• 29 were non-contactable

• 118 (73%) participated in first interview

103 (87%) followed

to 18-months91 (77%) to 30-

months



ACC and non-ACC

• Of n=118 participants:

• n=93 covered by ACC

• n=25 not covered by ACC



• Pre-SCI characteristics:

• Sociodemographic (age, sex, ethnicity, relationship

status, education)• Personal income, Material standard of living,

Household income adequacy

• Employment status

• Post-SCI characteristics:• ASIA Impairment Scale (A, B, C & D)

• General health status (EQ-5D + cognitive)

• Outcomes• Return to work

• Personal income, Material standard of living,




• Pre-SCI characteristics:• Sociodemographic (age p=0.006, sex p=0.08, ethnicity,

relationship status, education)

• Personal income, Material standard of living,


• Employment status

• Post-SCI characteristics:

• ASIA Impairment Scale (A-D)• General health status (EQ-5D)

Comparing ACC & non-ACC groups



General health status compared

Paul, Derrett, McAllister, Herbison,

Beaver, Sullivan. (2013) Socioeconomic

outcomes following spinal cord injury and

the role of no-fault compensation:

longitudinal study. Spinal Cord ; Advance

on-line; doi:10.1038/sc.2013.110



General health status compared






on-line; doi:10.1038/sc.2013.110



Return to work by 18 months?

• Those in paid employment pre-SCI (n=84/118)

• By 18 months 42% ACC group had returned towork & 39% non-ACC group

• aRR* of RTW for the non-ACC group=0.88 (0.45-1.70)

• By 30 months 49% ACC groups and 29% non-ACCgroup had returned to work

• aRR* non-ACC group=0.57 (0.27-1.19)

• aRR** non-ACC group=0.58 (0.27-1.24)

*= adjusted for age, sex and AIS

**= adjusted for age, sex, AIS and cognitive status



Return to Work & Ethnicity

• Pre-injury proportions in paid employment;

Māori/Pacific compared to other: 82% & 84%

• 18 months post-SCI: 32% & 45%

• 30 months post-SCI: 44% & 53%



Standard of living






on-line; doi:10.1038/sc.2013.110



Household income






on-line; doi:10.1038/sc.2013.110



Median personal income






on-line; doi:10.1038/sc.2013.110



Summary

• Overall, personal income, standard of livingand adequacy of household income

decreased slightly to 18 months and then

stabilised by 30 months• Increase in return to work for those who

were in paid employment pre-SCI: 42% by 18

months & 49% by 30 months• Return to work lower among Māori & Pacific

participants



And…

• Return to work rates higher among ACC group

• Median income for ACC group remained similar

to pre-SCI through to 30 months

• Among non-ACC group median income fell toless than half that of ACC group

• aRR of reporting “not enough/just enough”

income was ~20% lower among non-ACC group

• Difference was less for material standard of

living



Conclusion

• Most people retain their pre-injury SCI andreturn to work rates are high (overall 49%)

• Reason for both findings appears to be the

provision of no-fault compensation to thosecovered by ACC

• Helps prevent a downward spiral into poverty

• Such no-fault compensation schemes shouldbe seen as a model for rehabilitation after SCI

for all – traumatic and non-traumatic SCI

Date post:	08-Jan-2016
Category:	Documents
Upload:	iscrr
View:	213 times
Download:	0 times

Socioeconomic Outcomes Following Spinal Cord Injury and the Role of No-fault Compensation Sarah...

Documents