ImportanceEmployment and personal income loss after traumatic brain injury is a major source of postinjury stress and a barrier to societal reintegration. The magnitude of labor market ramifications following traumatic brain injury remains largely unknown.ObjectivesTo quantify the 3-year postinjury labor market consequences following traumatic brain injury in Canada. To also estimate the incurred national labor market cost over the study period.Design, Setting, and ParticipantsThis retrospective quasi-experimental, pan-Canadian observational cohort study used linked administrative health and federal taxation data obtained between 2007 and 2017. Mixed-effects difference-in-difference regressions were constructed to estimate the annualized magnitude of the personal income and employment loss during each of the 3 years following injury, respectively, relative to preinjury baseline. Participants included tax-filing adult (19 to 61 years old) traumatic brain injury survivors.ExposureTraumatic brain injury.Main Outcome MeasuresCoprimary outcomes were personal income loss and the proportion of newly unemployed individuals per annum. Secondary objectives were to quantify income and employment loss within mild, moderate, and severe traumatic brain injury subgroups.ResultsA total of 18 050 patients with traumatic brain injury between 2007 and 2017 were identified (mean age, 38.0 [SD, 12.4] years; 13 360 male [74.0%]), each of whom was followed up with for 3 consecutive fiscal years. Mean income was CAD $42 600 (US $31 083) in the fiscal year prior to injury and 82% were employed at time of injury. The adjusted mean loss of personal income was CAD $7635 (US $5650) in the first year after injury (Y+1) and CAD $5000 (US $3700) in the third year after injury (Y+3) relative to uninjured controls. In each of the 3 postinjury years, 7.8% individuals were newly unemployed compared with the preinjury baseline. The adjusted average personal income loss for mild, moderate, and severe traumatic brain injury subgroups were CAD $3354 (US $2482), CAD $6750 (US $4995), and CAD $17 375 (US $12 859), respectively, at Y+3; the proportion of unemployed individuals increased by 5.8%, 9.2%, and 20% across the same groups at Y+3 after injury relative to preinjury baseline. The estimated total reduction in personal income aggregated over the 3 postinjury years for the affected participants was CAD $588 million (US $435 million).Conclusions and RelevanceThis work represents national cohort data quantifying the labor market implications of traumatic brain injury. These results may be used to inform economic evaluations and social service resource allocation.

中文翻译：

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创伤性脑损伤后的失业和个人收入损失


重要性创伤性脑损伤后的就业和个人收入损失是受伤后压力的主要来源，也是重新融入社会的障碍。创伤性脑损伤后对劳动力市场的影响程度在很大程度上仍然未知。目的量化加拿大创伤性脑损伤后 3 年受伤后劳动力市场的影响。还估计研究期间产生的全国劳动力市场成本。设计、设置和参与者这项回顾性准实验、泛加拿大观察性队列研究使用了 2007 年至 2017 年间获得的相互关联的行政健康和联邦税收数据。构建混合效应双重差分回归，分别估计受伤后 3 年中每年相对于受伤前基线的个人收入和就业损失的年化幅度。参与者包括报税成人（19 至 61 岁）创伤性脑损伤幸存者。暴露创伤性脑损伤。主要结局指标共同结局是个人收入损失和每年新失业者的比例。次要目标是量化轻度、中度和重度创伤性脑损伤亚组的收入和就业损失。结果共确定 2007 年至 2017 年间 18 050 例创伤性脑损伤患者 （平均年龄 38.0 [SD， 12.4] 岁;13 360 例男性 [74.0%]），每位患者连续 3 个会计年度随访。受伤前财政年度的平均收入为 42 600 加元（31 083 美元），82% 的人在受伤时就业。 相对于未受伤的对照组，受伤后第一年 （Y+1） 调整后的平均个人收入损失为 7635 加元（5650 美元），受伤后第三年 （Y+3） 为 5000 加元（3700 美元）。在受伤后的 3 年中，与受伤前基线相比，每年都有 7.8% 的人新失业。轻度、中度和重度创伤性脑损伤亚组的调整后平均个人收入损失分别为 3354 加元（2482 美元）、6750 加元（4995 美元）和 17375 加元（12859 美元），Y+3;相对于受伤前基线，受伤后 Y+3 年同一组的失业人数比例增加了 5.8% 、 9.2% 和 20%。据估计，受影响参与者在受伤后 3 年的个人收入总减少量为 5.88 亿加元（4.35 亿美元）。结论和相关性这项工作代表了量化创伤性脑损伤对劳动力市场影响的全国队列数据。这些结果可用于为经济评估和社会服务资源分配提供信息。