Socioeconomic Outcomes Following Spinal Cord

Injury and the Role of No-fault Compensation:

Longitudinal Study
Sarah Derrett
School of Health and Social Services, College of Health

Longitudinal Study of Spinal Cord Injury

Funded by the Health Research Council
Supported by the Burwood Academy of Independent
Living (BAIL)
Auckland & Burwood Spinal Units mgt/clinical teams
Nurses Karla and Karen
Research team: Martin Sullivan, Charlotte Paul, Sarah
Derrett, Peter Herbison & Carolyn Beaver
With: Sue McAllister, project manager & interviewers

The SCI Study

Aims:
1) To explore relationships between body, self and society for
people with SCI

2) Investigate how entitlement to rehabilitation

and compensation affects socioeconomic
and health outcomes

Sullivan, Paul, Herbison, Tamou, Derrett, Crawford (2010) A longitudinal study of the
life histories of people with spinal cord injury. Injury Prevention; 16:e3

Those covered by ACC and those not

New Zealands compensation insurer (ACC)
funds those whose SCI results from:

Injury

Compensation: 80% of pre-injury income, lump sum payments,

support services, home and vehicle modifications

Non-injury SCI (e.g. tumours; infections)

Receive in-unit rehabilitation & health services; may

have access to means-tested benefits

Other non-ACC-covered (e.g. living outside

New Zealand)

Previously in New Zealand

Compared those with an injury (n=429;
covered by ACC) from the Prospective
Outcomes of Injury Study (POIS) compared to
those with a stroke (n=109; not covered by
ACC)
Median income declined by 13% & 60%
Return to work higher among injury group
McAllister S, Derrett S, Audas R, Herbison P, Paul C. (2013) Do different types of
financial support after illness or injury affect socio-economic outcomes? A natural
experiment in New Zealand. Social Science and Medicine; 85: 93-102

New Zealands Two Spinal Units

Auckland Spinal Rehabilitation Unit

Burwood Spinal Unit

Sullivan, Paul, Herbison, Tamou, Derrett, Crawford (2010) A longitudinal study of the
life histories of people with spinal cord injury. Injury Prevention; 16:e3

Recruitment
People admitted to spinal units over a twoyear period (2007-2009)
First SCI
Neurological damage
Aged 16-64 years
Exclusions: Could not participate in an
interview, prognosis of death 6 months,
non-New Zealand resident

Process
Nurses:
Identified eligible participants for interviews
Provided study information to potential
participants
Collected demographic and clinical information
from clinical records for all people admitted

Interviewers:
Met potential participants
Scheduled 1st interview

Incidence all ages (n=230)

Estimated annual incidence (all ages): 30/M
Age-adjusted rates:

New Zealand European=29/M

Mori=46/M
Pacific=70/M
Other ethnicities=16/M

Derrett, Beaver, Sullivan, Herbison, Acland, Paul. (2012) Traumatic and nontraumatic spinal cord impairment in New Zealand: incidence and characteristics of
people admitted to spinal units. Injury Prevention; 18:343-346

Today
N=186 aged 16-64 years
N= 162 were eligible for participation in
longitudinal study

15 declined
29 were non-contactable
118 (73%) participated in first interview

103 (87%) followed

to 18-months

91 (77%) to 30months

ACC and non-ACC

Of n=118 participants:
n=93 covered by ACC
n=25 not covered by ACC

 Pre-SCI characteristics:

Sociodemographic (age, sex, ethnicity, relationship

status, education)
Personal income, Material standard of living,
Household income adequacy
Employment status

Post-SCI characteristics:

ASIA Impairment Scale (A, B, C & D)

General health status (EQ-5D + cognitive)

Outcomes

Return to work
Personal income, Material standard of living,
Household income adequacy

Comparing ACC & non-ACC groups

Pre-SCI characteristics:

Sociodemographic (age p=0.006, sex p=0.08, ethnicity,

relationship status, education)
Personal income, Material standard of living,
Household income adequacy
Employment status

Post-SCI characteristics:

ASIA Impairment Scale (A-D)

General health status (EQ-5D)

General health status compared

Paul, Derrett, McAllister, Herbison,

Beaver, Sullivan. (2013) Socioeconomic
outcomes following spinal cord injury and
the role of no-fault compensation:
longitudinal study. Spinal Cord; Advance
on-line; doi:10.1038/sc.2013.110

General health status compared

Paul, Derrett, McAllister, Herbison,

Beaver, Sullivan. (2013) Socioeconomic
outcomes following spinal cord injury and
the role of no-fault compensation:
longitudinal study. Spinal Cord; Advance
on-line; doi:10.1038/sc.2013.110

Return to work by 18 months?

Those in paid employment pre-SCI (n=84/118)
By 18 months 42% ACC group had returned to
work & 39% non-ACC group

aRR* of RTW for the non-ACC group=0.88 (0.45-1.70)

By 30 months 49% ACC groups and 29% non-ACC

group had returned to work

aRR* non-ACC group=0.57 (0.27-1.19)

aRR** non-ACC group=0.58 (0.27-1.24)

*= adjusted for age, sex and AIS

**= adjusted for age, sex, AIS and cognitive status

Return to Work & Ethnicity

Pre-injury proportions in paid employment;
Mori/Pacific compared to other: 82% & 84%
18 months post-SCI: 32% & 45%
30 months post-SCI: 44% & 53%

Standard of living

Paul, Derrett, McAllister, Herbison,

Beaver, Sullivan. (2013) Socioeconomic
outcomes following spinal cord injury and
the role of no-fault compensation:
longitudinal study. Spinal Cord; Advance
on-line; doi:10.1038/sc.2013.110

Household income

Paul, Derrett, McAllister, Herbison,

Beaver, Sullivan. (2013) Socioeconomic
outcomes following spinal cord injury and
the role of no-fault compensation:
longitudinal study. Spinal Cord; Advance
on-line; doi:10.1038/sc.2013.110

Median personal income

Paul, Derrett, McAllister, Herbison,

Beaver, Sullivan. (2013) Socioeconomic
outcomes following spinal cord injury and
the role of no-fault compensation:
longitudinal study. Spinal Cord; Advance
on-line; doi:10.1038/sc.2013.110

Summary
Overall, personal income, standard of living
and adequacy of household income
decreased slightly to 18 months and then
stabilised by 30 months
Increase in return to work for those who
were in paid employment pre-SCI: 42% by 18
months & 49% by 30 months
Return to work lower among Mori & Pacific
participants

And
Return to work rates higher among ACC group
Median income for ACC group remained similar
to pre-SCI through to 30 months
Among non-ACC group median income fell to
less than half that of ACC group
aRR of reporting not enough/just enough
income was ~20% lower among non-ACC group
Difference was less for material standard of
living

Conclusion
Most people retain their pre-injury SCI and
return to work rates are high (overall 49%)
Reason for both findings appears to be the
provision of no-fault compensation to those
covered by ACC
Helps prevent a downward spiral into poverty
Such no-fault compensation schemes should
be seen as a model for rehabilitation after SCI
for all traumatic and non-traumatic SCI