Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
Vehicle Safety Division, Department of Applied Mechanics, Chalmers University of Technology, Gothenburg, Sweden.
BMC Public Health. 2020 Nov 16;20(1):1710. doi: 10.1186/s12889-020-09788-x.
Bicyclists are the road user group with the highest number of severe injuries in the EU, yet little is known about sickness absence (SA) and disability pension (DP) following such injuries.
To explore long-term patterns of SA and DP among injured bicyclists, and to identify characteristics associated with the specific patterns.
A longitudinal register-based study was conducted, including all 6353 individuals aged 18-59 years and living in Sweden in 2009, who in 2010 had incident in-patient or specialized out-patient healthcare after a bicycle crash. Information about sociodemographic factors, the injury, SA (SA spells > 14 days), and DP was obtained from nationwide registers. Weekly SA/DP states over 1 year before through 3 years after the crash date were used in sequence and cluster analyses. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for factors associated with each identified sequence cluster.
Seven clusters were identified: "No SA or DP" (58.2% of the cohort), "Low SA or DP" (7.4%), "Immediate SA" (20.3%), "Episodic SA" (5.9%), "Long-term SA" (1.7%), "Ongoing part-time DP" (1.7%), and "Ongoing full-time DP" (4.8%). Compared to the cluster "No SA or DP", all other clusters had higher ORs for women, and higher age. All clusters but "Low SA and DP" had higher ORs for inpatient healthcare. The cluster "Immediate SA" had a higher OR for: fractures (OR 4.3; CI 3.5-5.2), dislocation (2.8; 2.0-3.9), sprains and strains (2.0; 1.5-2.7), and internal injuries (3.0; 1.3-6.7) compared with external injuries. The cluster "Episodic SA" had higher ORs for: traumatic brain injury, not concussion (4.2; 1.1-16.1), spine and back (4.5; 2.2-9.5), torso (2.5; 1.4-4.3), upper extremities (2.9; 1.9-4.5), and lower extremities (3.5; 2.2-5.5) compared with injuries to the head, face, and neck (not traumatic brain injuries). The cluster "Long-term SA" had higher ORs for collisions with motor vehicles (1.9;1.1-3.2) and traumatic brain injury, not concussion (18.4;2.2-155.2).
Sequence analysis enabled exploration of the large heterogeneity of SA and DP following a bicycle crash. More knowledge is needed on how to prevent bicycle crashes and especially those crashes/injuries leading to long-term consequences.
在欧盟，自行车使用者是重伤人数最多的道路使用者群体，但对于此类伤害后的病假（SA）和残疾抚恤金（DP）知之甚少。
探讨受伤自行车使用者的长期 SA 和 DP 模式，并确定与特定模式相关的特征。
进行了一项纵向基于登记的研究，包括所有 2009 年年龄在 18-59 岁之间且居住在瑞典的 6353 人，他们在 2010 年因自行车事故后出现门诊或专科门诊医疗的住院或专门门诊医疗。从全国登记处获得了关于社会人口因素、伤害、SA（病假> 14 天）和 DP 的信息。使用从事故日期前 1 年到 3 年后的每周 SA/DP 状态进行顺序和聚类分析。使用多项逻辑回归估计与每个识别的序列聚类相关的因素的优势比（OR）和 95%置信区间（CI）。
确定了七个聚类：“无 SA 或 DP”（队列的 58.2%）、“低 SA 或 DP”（7.4%）、“即时 SA”（20.3%）、“发作性 SA”（5.9%）、“长期 SA”（1.7%）、“持续兼职 DP”（1.7%）和“持续全职 DP”（4.8%）。与“无 SA 或 DP”聚类相比，所有其他聚类的女性和年龄较高的 OR 更高。除“低 SA 和 DP”外，所有聚类的住院医疗 OR 更高。“即时 SA”聚类的优势比（OR）更高：骨折（4.3；3.5-5.2）、脱位（2.8；2.0-3.9）、扭伤和拉伤（2.0；1.5-2.7）和内部损伤（3.0；1.3-6.7）与外部损伤相比。“发作性 SA”聚类的 OR 更高：创伤性脑损伤，无脑震荡（4.2；1.1-16.1）、脊柱和背部（4.5；2.2-9.5）、躯干（2.5；1.4-4.3）、上肢（2.9；1.9-4.5）和下肢（3.5；2.2-5.5）与头部、面部和颈部受伤（非创伤性脑损伤）相比。“长期 SA”聚类的优势比（OR）更高：与机动车辆碰撞（1.9；1.1-3.2）和创伤性脑损伤，无脑震荡（18.4；2.2-155.2）。
序列分析使我们能够探索自行车事故后 SA 和 DP 的大量异质性。需要更多关于如何预防自行车事故，特别是那些导致长期后果的事故/伤害的知识。
