Health service use in major trauma survivors: a population-based cohort study from Ontario, Canada.

Abstract

Little is known about how major trauma survivors access health services in the years following their injury. Our study sought to characterize patterns of health services use in trauma survivors following discharge from a provincial trauma centre and to identify sociodemographic factors associated with service utilization. We conducted a population-based retrospective case-control study using linked administrative data on trauma survivors' population-based controls between April 1, 2011, to March 31, 2021. For each major trauma survivor, we matched four cases based on age and sex. The primary outcome was the composite rate (sum) of health service use episodes including outpatient visits to family physicians and specialists, emergency department (ED) visits, and acute care hospital admissions during the five-year period following discharge from the trauma centre. We used multivariate regression to compute rate ratios comparing the rates of health service use in trauma survivors versus controls and to assess for associations between sociodemographic variables and health services use. The study cohort consisted of a total of 273,406 individuals: 55,060 trauma survivors and 218,346 controls. Trauma survivors were predominately males (71%) with a median age of 46 years (IQR: 26-65 years). Health service use in trauma survivors peaked within a year of hospital discharge but remained increased throughout the follow up period. Trauma survivorship was associated with a 56% increase in overall health services use (Adjusted Rate Ratio 1.56, 95% CI: 1.55-1.57), including an 88% increase in hospital admissions (Adjusted Rate Ratio 1.88, 95% CI: 1.85-1.92). Male sex and rural residence were associated with a reduced overall use of health services but greater use of ED services. Major trauma survivors have long-term health services needs that persist for years after discharge from the trauma centre. Future research should focus on the understanding why trauma survivors have prolonged health services requirements and ensure care needs are aligned with service delivery. Retrospective cohort study, Level IV.