Bulletin of the World Health Organization

Differences in prevalence of pre-existing morbidity between injured and non-injured populations

C.M. Cameron, D.M. Purdie, E.V. Kliewer, & R.J. McClure

ABSTRACT

Objective

To identify and examine differences in pre-existing morbidity between injured and non-injured population-based cohorts.

Methods

Administrative health data from Manitoba, Canada, were used to select a population-based cohort of injured people and a sample of non-injured people matched on age, gender, Aboriginal status and geographical location of residence at the date of injury. All individuals aged 18–64 years who had been hospitalized between 1988 and 1991 for injury ( International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) code 800–995) ( n = 21 032), were identified from the Manitoba discharge database. The matched non-injured comparison group comprised individuals randomly selected 1:1 from the Manitoba population registry. Morbidity data for the 12 months prior to the date of the injury were obtained by linking the two cohorts with all hospital discharge records and physician claims.

Findings

Compared to the non-injured group, injured people had higher Charlson Comorbidity Index scores, 1.9 times higher rates of hospital admissions and 1.7 times higher rates of physician claims in the year prior to the injury. Injured people had a rate of admissions to hospital for a mental health disorder 9.3 times higher, and physician claims for a mental health disorder 3.5 times higher, than that of non-injured people. These differences were all statistically significant ( P < 0.001).

Conclusion

Injured people were shown to differ from the general non-injured population in terms of pre-existing morbidity. Existing population estimates of the attributable burden of injury that are obtained by extrapolating from observed outcomes in samples of injured cases may overestimate the magnitude of the problem.

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