Tibæk Maiken, Kammersgaard Lars Peter, Johnsen Søren P, Dehlendorff Christian, Forchhammer Hysse B
National Study of Young Survivors of Brain Injury, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Research Unit on Brain Injury Rehabilitation Copenhagen, Department of Neurorehabilitation, TBI Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Front Neurol. 2019 Jan 14;9:1180. doi: 10.3389/fneur.2018.01180. eCollection 2018.
(1) To determine patterns of return to work (RTW) after traumatic brain injury and other causes of acquired brain injury (ABI) among young adults aged 19-30 years and (2) to compare the stability of long-term labor-market attachment (LMA) to the background population. Nationwide registry-based inception cohort study of 10 years weekly data of employment status. Patients ( = 8,496) aged 19-30 years with first-ever diagnosis of TBI, stroke, subarachnoid hemorrhage, encephalopathy, brain tumor, or CNS infections during 1999-2015. For comparison, a general population cohort ( = 206,025) individually matched on age, sex, and municipality was identified. The main outcome was RTW, which was defined as time to LMA, i.e., a week without public assistance benefits except education grants/leave. Stable labor-market attachment (sLMA) was defined as LMA for at least 75% over 52 weeks. The cumulative incidence proportions of RTW and stable RTW in the ABI cohort were estimated with the Aalen-Johansen estimator with death as a competing event. Twelve weeks after diagnosis 46.9% of ABI cohort had returned to stable RTW, which increased to 57.4% 1 year after, and 69.7% 10 years after. However, compared to controls fewer had sLMA 1 year (OR: 0.25 [95% CI 0.24-0.27]) and 10 years after diagnosis (OR: 0.35 [95% CI: 0.33-0.38]). Despite significant variations, sLMA was lower compared to the control cohort for all subtypes of ABI and no significant improvements were seen after 2-5 years. Despite relatively fast RTW only a minor proportion of young patients with ABI achieves sLMA.
(1) 确定19至30岁年轻成年人创伤性脑损伤及其他后天性脑损伤（ABI）病因后的重返工作（RTW）模式，以及(2) 比较长期劳动力市场依恋（LMA）与背景人群的稳定性。基于全国登记处的起始队列研究，采用10年每周就业状况数据。1999年至2015年期间首次诊断为创伤性脑损伤、中风、蛛网膜下腔出血、脑病、脑肿瘤或中枢神经系统感染的19至30岁患者（n = 8496）。作为对照，确定了一个在年龄、性别和直辖市方面进行个体匹配的普通人群队列（n = 206025）。主要结局是RTW，定义为达到LMA的时间，即除教育补助金/休假外无公共援助福利的一周。稳定劳动力市场依恋（sLMA）定义为在52周内至少75%的时间处于LMA状态。采用Aalen-Johansen估计器，将死亡作为竞争事件，估计ABI队列中RTW和稳定RTW的累积发病率。诊断后12周，46.9%的ABI队列患者恢复到稳定RTW，1年后增至57.4%，10年后增至69.7%。然而，与对照组相比，诊断后1年（OR：0.25 [95% CI 0.24 - 0.27]）和10年（OR：0.35 [95% CI：0.33 - 0.38]）时具有sLMA的患者较少。尽管存在显著差异，但所有ABI亚型的sLMA均低于对照队列，且2至5年后未见显著改善。尽管RTW相对较快，但只有一小部分ABI年轻患者实现了sLMA。
