Bulletin of the World Health Organization

Ten-year health service use outcomes in a population-based cohort of 21 000 injured adults: the Manitoba Injury Outcome Study

CM Cameron, DM Purdie, EV Kliewer, & RJ McClure



To quantify long-term health service use (HSU) following non-fatal injury in adults.


A retrospective, population-based, matched cohort study identified an inception cohort (1988–91) of injured people who had been hospitalized (ICD-9-CM 800-995) aged 18–64 years (n = 21 032) and a matched non-injured comparison group (n = 21 032) from linked administrative data from Manitoba, Canada. HSU data (on hospitalizations, cumulative length of stay, physician claims and placements in extended care services) were obtained for the 12 months before and 10 years after the injury. Negative binomial and Poisson regressions were used to quantify associations between injury and long-term HSU.


Statistically significant differences in the rates of HSU existed between the injured and non-injured cohorts for the preinjury year and every year of the follow-up period. After controlling for pre-injury HSU, the attributable risk percentage indicated that 38.7% of all post-injury hospitalizations (n = 25 183), 68.9% of all years spent in hospital (n = 1031), 21.9% of physician claims (n = 269 318) and 77.1% of the care home placements (n = 189) in the injured cohort could be attributed to being injured.


Many people who survive the initial period following injury, face long periods of inpatient care (and frequent readmissions), high levels of contact with physicians and an increased risk of premature placement in institutional care. Population estimates of the burden of injury could be refined by including long-term non-fatal health consequences and controlling for the effect of preinjury comorbidity.