Socioeconomic Outcomes Following Spinal Cord Injury and the Role of No-fault Compensation: Longitudinal Study

Transcription

1 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

2 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, Sarah Derrett, Peter Herbison & Carolyn Beaver With: Sue McAllister, project manager & interviewers

3 Aims: The SCI Study 1) To explore relationships between body, self and society for people with SCI 2) Investigate how entitlement to rehabilitation and 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

4 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)

5 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 by ACC) 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:

6 New Zealand s Two Spinal Units Auckland Spinal Rehabilitation Unit Burwood Spinal Unit Sullivan, Paul, Herbison, Tamou, Derrett, Crawford (2010) A longitudinal study of the life histories of people with spinal cord injury. Injury Prevention; 16:e3

7 Recruitment People admitted to spinal units over a twoyear period ( ) First SCI Neurological damage Aged years Exclusions: Could not participate in an interview, prognosis of death 6 months, non-new Zealand resident

8 Nurses: Process 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

9 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 nontraumatic spinal cord impairment in New Zealand: incidence and characteristics of people admitted to spinal units. Injury Prevention; 18:

10 Today N=186 aged 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-months 91 (77%) to 30- months

11 ACC and non-acc Of n=118 participants: n=93 covered by ACC n=25 not covered by ACC

12 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, Household income adequacy

13 Comparing ACC & non-acc groups Pre-SCI characteristics: Sociodemographic (age p=0.006, sex p=0.08, ethnicity, relationship status, education) Personal income, Material standard of living, Household income adequacy Employment status Post-SCI characteristics: ASIA Impairment Scale (A-D) General health status (EQ-5D)

14 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: /sc

15 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: /sc

16 Return to work by 18 months? Those in paid employment pre-sci (n=84/118) By 18 months 42% ACC group had returned to work & 39% non-acc group arr* of RTW for the non-acc group=0.88 ( ) By 30 months 49% ACC groups and 29% non-acc group had returned to work arr* non-acc group=0.57 ( ) arr** non-acc group=0.58 ( ) *= adjusted for age, sex and AIS **= adjusted for age, sex, AIS and cognitive status

17 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%

18 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: /sc Standard of living

19 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: /sc Household income

20 Median personal income 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: /sc

21 Summary Overall, personal income, standard of living and 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

22 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 to less 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

23 Conclusion Most people retain their pre-injury SCI and return to work rates are high (overall 49%) Reason for both findings appears to be the provision of no-fault compensation to those covered by ACC Helps prevent a downward spiral into poverty Such no-fault compensation schemes should be seen as a model for rehabilitation after SCI for all traumatic and non-traumatic SCI