Koehoorn Mieke, Breslin F Curtis, Xu Fan
Department of Health Care & Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada.
J Adolesc Health. 2008 Nov;43(5):466-73. doi: 10.1016/j.jadohealth.2008.04.012. Epub 2008 Jul 23.
To investigate the longer-term health consequences of work injuries among youth aged 15-24 years using a population-based, longitudinal study (1991-2001) of merged health care and workers' compensation records.
A group-based modeling approach was used (1) to identify unique trajectories of health care use defined by general practitioner visits among the study sample stratified by gender, and (2) to determine the injury factors that predict a youth's membership in a trajectory, adjusted for sociodemographic factors.
Four long-term trajectories of health care use were identified among young injured workers, for both males and females. Similar trajectories were observed among a comparison, noninjured sample but the magnitude of health care use was consistently higher among the injured worker cohort, especially for females (attributable to general practitioner [GP] visits for symptoms, signs and ill-defined diagnoses), and a notable "spike" in health care use occurred in the year immediately after a work injury for both males and females that was not observed in the comparison population during the matched year (attributable to GP visits for musculoskeletal and injury diagnoses). For males, the type of work injury mattered with an increased odds of belonging to the higher health care trajectories associated with a musculoskeletal injury (odds ratio [OR] = 1.57, 95% CI = .76, 3.23; and OR = 1.61, 95% CI 1.08, 2.41 for the postinjury trajectories), adjusted for age, occupation, socioeconomic status, and geographic location.
Persistent use of health care services may represent a cumulative burden of morbidity over the life course as a result of a work-related injury in general among young women and as a result of musculoskeletal injuries in particular among males.
利用一项基于人群的纵向研究（1991 - 2001年），该研究合并了医疗保健和工伤赔偿记录，以调查15 - 24岁青年工伤的长期健康后果。
采用基于群体的建模方法：（1）在按性别分层的研究样本中，确定由全科医生就诊定义的独特医疗保健使用轨迹；（2）确定预测青年在某一轨迹中的成员资格的损伤因素，并对社会人口统计学因素进行调整。
在年轻受伤工人中，无论男性还是女性，都确定了四种长期医疗保健使用轨迹。在未受伤的对照样本中观察到了类似的轨迹，但受伤工人队列中的医疗保健使用量一直较高，尤其是女性（归因于因症状、体征和不明确诊断进行的全科医生就诊），并且在工伤后的次年，男性和女性的医疗保健使用量都出现了显著的“峰值”，在对照人群的匹配年份中未观察到这种情况（归因于因肌肉骨骼和损伤诊断进行的全科医生就诊）。对于男性，工伤类型很重要，与肌肉骨骼损伤相关的属于更高医疗保健轨迹的几率增加（比值比[OR]=1.57，95%置信区间=.76，3.23；工伤后轨迹的OR = 1.61，95%置信区间1.08，2.41），对年龄、职业、社会经济地位和地理位置进行了调整。
持续使用医疗保健服务可能代表了由于一般工伤导致的青年女性终生发病的累积负担，以及特别是男性因肌肉骨骼损伤导致的终生发病的累积负担。
