Analysis of Patient Income in the 5 Years Following a Fracture Treated Surgically.

ABSTRACT:

Importance

Orthopedic injury is assumed to bear negative socioeconomic consequences. However, the magnitude and duration of a fracture's impact on patient income and social insurance benefits remain poorly quantified.

Objective

To characterize the association between orthopedic injury and patient income using state tax records.

Design, setting, and participants

This cohort study included adult patients surgically treated for an orthopedic fracture at a US academic trauma center from January 2003 through December 2014. Hospital data were linked to individual-level state tax records using a difference-in-differences analysis performed from November 2019 through August 2020. The control group comprised of data resampled from fracture patients at least 6 years prior to injury.

Exposures

An operatively treated fracture of the appendicular skeleton.

Main outcomes and measures

The primary outcome was individual annual earnings up to 5 years postinjury. Secondary outcomes included annual household income and US Social Security benefits for 5 years postinjury and catastrophic wage loss within 2 years of injury.

Results

A total of 9997 fracture patients (mean [SD] age, 44.6 [18.9] years; 6725 [67.3%] men) to 34?570 prefracture control participants (mean [SD] age, 40.0 [20.5] years; 21?666 [62.7%] men). The median (interquartile range) of preinjury wage earnings was $16?847 ($0 to $52?221). The mean annual decline in individual earnings during the 5 years following injury was $9865 (95% CI, -$10?686 to -$8862). Annual household income declined by $5259 (95% CI, -$6337 to -$4181) over the same period. A fracture was associated with a $206 (95% CI, $147 to $265) mean annual increase in Social Security benefits in the 5 years after injury. An injury increased the risk of catastrophic wage loss by 11.6% (95% CI, 10.5% to 12.7%). Substantial relative income loss was observed in patients with preinjury earnings in the top 3 quartiles, but changes in income were negligible for patients with preinjury earnings in the bottom quartile (19%; 95% CI, -4% to 48%).

Conclusions and relevance

In this cohort study of patients surgically treated for an orthopedic fracture at a US academic trauma center, fractures were associated with substantial individual and household income loss up to 5 years after injury, and 1 in 5 patients sustained catastrophic income loss in the 2 years after fracture. Gains in Social Security benefits offset less than 10% of annual income losses.

SUBMITTER: O'Hara NN 

PROVIDER: S-EPMC7871192 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature