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. 2021 Feb 1;4(2):e2034898.
doi: 10.1001/jamanetworkopen.2020.34898.

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

Nathan N O'Hara  1   2 , Gerard P Slobogean  1 , Niek S Klazinga  2 , Dionne S Kringos  2
Affiliations

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

Nathan N O'Hara et al. JAMA Netw Open. .

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Mr O’Hara reported owning stock options from Arbutus Medical Inc outside the submitted work. Dr Slobogean reported receiving grant funding from the National Institute of Arthritis and Muscloskeletal and Skin Diseases (No. K24 AR076445-01) during the conduct of the study; he reported receiving research funding from the Patient-Centered Outcomes Research Institute, the US Department of Defense, and the National Institutes of Health outside the submitted work. Dr Slobogean also reported serving as a paid consultant with Smith & Nephew, Nuvasive Orthopedics, Bayer AG, and Zimmer Biomet outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Annual Individual Earnings, Household Income, and Social Security Benefits From 3 Years Prior to Injury to 5 Years After Injury
Figure 2.
Figure 2.. Relative Difference From Counterfactual Individual Earnings Associated With a Fracture
The blue dotted line indicates the mean percent change in postinjury wage earnings for the overall sample.
Figure 3.
Figure 3.. Relative Difference From Counterfactual Social Security Benefits Associated With a Fracture
The blue dotted line indicates the mean percent change in postinjury Social Security benefits for the overall sample.
See this image and copyright information in PMC

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References

    1. Bhashyam AR, McGovern MM, Mueller T, Heng M, Harris MB, Weaver MJ. The personal financial burden associated with musculoskeletal trauma. J Bone Joint Surg Am. 2019;101(14):1245-1252. doi:10.2106/JBJS.18.01114 - DOI - PubMed
    1. O’Hara NN, Isaac M, Slobogean GP, Klazinga NS. The socioeconomic impact of orthopaedic trauma: a systematic review and meta-analysis. PLoS One. 2020;15(1):e0227907. doi:10.1371/journal.pone.0227907 - DOI - PMC - PubMed
    1. Morrison ER, Gupta A, Olson L, Cook L, Keenan H. Health and financial fragility: evidence from car crashes and consumer bankruptcy. University of Chicago Coase-Sandor Institute for Law & Econ Research Paper No. 655. Published November 13, 2013. doi:10.2139/ssrn.2353328 - DOI
    1. Sullivan D, von Wachter T. Job displacement and mortality: an analysis using administrative data. Q J Econ. 2009;124(3):1265-1306. doi:10.1162/qjec.2009.124.3.1265 - DOI
    1. Pool LR, Burgard SA, Needham BL, Elliott MR, Langa KM, Mendes de Leon CF. Association of a negative wealth shock with all-cause mortality in middle-aged and older adults in the United States. JAMA. 2018;319(13):1341-1350. doi:10.1001/jama.2018.2055 - DOI - PMC - PubMed

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