Long-term return to work and income trajectories after major trauma: a 10-year nationwide retrospective cohort study in Taiwan.

Abstract

The financial impact on trauma patients can be devastating. Although Taiwan has universal health insurance coverage, medical bill reimbursement cannot compensate for the damage to a person's ability to work. The aim of this study was to investigate personal financial outcomes after major trauma. A retrospective cohort study. Nationwide data from Taiwan's National Health Insurance Research Database. This study included all patients with major trauma (injury severity score ≥16) in Taiwan from 2003 to 2007, and a 10-year follow-up was conducted. Patients aged 18-70 were enrolled. Patients who returned to work after trauma (RTW) and those who did not return to work (non-RTW) were compared. Basic demographics and short-term outcomes were analysed, and the 10-year trend of income variation was calculated. The primary outcomes are the ratio of non-RTW after major trauma, and the independent risk factors for non-RTW. The secondary outcome is the 10-year trend of income variation of major trauma patients. 5965 patients were included, with 4741 (79.5%) in the RTW group and 1224 (20.5%) in the non-RTW group. Hospital-acquired pneumonia, urinary tract infection, prolonged intensive care unit length of stay (LOS) and prolonged hospital LOS were identified as independent risk factors for future non-RTW. The mean monthly income of all patients declined in the three consecutive years postinjury and slowly returned to the preinjury level 9 years after the injury. Loss of working ability was noted in 20.5% of major trauma patients, and the income level for all patients did not recover to the preinjury level until 9 years after the injury. Further welfare planning beyond the extent of the National Health Insurance programme should be made to protect the financial shortcomings experienced by these patients. ISRCTN18269986.