Labour market attachment after mild traumatic brain injury: nationwide cohort study with 5-year register follow-up in Denmark

• Published in: BMJ open Vol. 9; no. 4; p. e026104
• Main Authors: Graff, Heidi Jeannet, Siersma, Volkert, Møller, Anne, Kragstrup, Jakob, Andersen, Lars L, Egerod, Ingrid, Malá Rytter, Hana
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 11.04.2019; BMJ Publishing Group
• Subjects: Adolescent; Adult; Attachment; Brain Injuries, Traumatic - economics; Brain Injuries, Traumatic - epidemiology; Cohort analysis; Collaboration; Concussion; Consciousness; Denmark - epidemiology; Employment - statistics & numerical data; Female; Follow-Up Studies; Head injuries; Hospitals; Humans; Incidence; Labor market; Male; Middle Aged; Mortality; Neurology; Patients; Population Surveillance; Psychiatry; Public health; Registries; Retrospective Studies; Return to Work - trends; Sick leave; Sick Leave - statistics & numerical data; Time Factors; Traumatic brain injury; Unemployment - statistics & numerical data; Young Adult; Denmark; sickness absence; unemployment; post-concussive symptoms; mild traumatic brain injury; labour market attachment
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-026104

ObjectivesSickness absence after mild traumatic brain injury (mTBI) is frequent due to postconcussive symptoms. We examined labour market attachment following mTBI up to 5 years postinjury.Design and settingNationwide cohort study with register follow-up.ParticipantsPatients between 18 and 60 years with mTBI (International Classification of Diseases, version 10 diagnosis S06.0) were extracted from the Danish National Patient Register (n=19 732). Controls were matched on sex, age and municipality (n=18 640). Patients with spinal cord and column injuries, traumatic brain injury and concussions 5 years preinjury or as secondary diagnosis to the concussion in the inclusion period were excluded.Primary and secondary outcome measuresData were extracted from the Danish Register for Evaluation of Marginalization. Primary outcome was ‘not attending ordinary work’ defined as receiving any social transfer payment. Secondary outcomes were health-related benefits, limited attachment to the labour market, permanent lack of attachment to the labour market and death.Results5 years after diagnosis, 43% of patients were not attending ordinary work. The odds increased from 6 months (OR 1.30, 95% CI 1.24 to 1.36) to 5 years (OR 1.54, 95% CI 1.45 to 1.63). The odds of health-related benefits were 32% (OR 1.32, 95% CI 1.22 to 1.42) at 6 months and 22% (OR 1.22, 95% CI 1.12 to 1.33) at 5 years. Limited attachment to the labour market showed increased odds at 5 years (OR 1.38, 95% CI 1.27 to 1.51) and the odds of permanent lack of attachment to the labour market were higher for patients compared with controls (OR 2.59, 95% CI 2.30 to 2.92). Death was more than two times higher at 5 years postinjury (OR 2.62, 95% CI 2.10 to 3.26).Conclusions43% of concussed patients were not attending ordinary work 5 years postinjury and received health and social transfer benefits. We conclude that mTBI has a long-term impact on labour market attachment. Prevention and treatment of persisting postconcussive symptoms should be considered.Trial registration numberNCT03214432; Results