Examining Occupational Traumatic Brain Injury in Ontario

Abstract

raumatic brain injury (TBI) is a leading cause of death and disability worldwide. It is a very serious and often overlooked health care issue. Victims are often young, and survivors of TBI often live with devastating consequences, including temporary or permanent impairments, partial or total functional disability, psychosocial maladjustments and associated economic burdens. 1 Even mild injuries can have long-term consequences. 2 An examination of coroners' files in Ontario showed that approximately half of all workplace fatalities involved a brain injury. 3 In a study by Kim et al. 4 based on severe injuries identified from the Ontario Trauma Registry, it was found that hospitalizations involving workrelated traumatic brain injuries increased by 12.4% from 1993 to 2001. Information obtained from the Workplace Safety and Insurance Board (WSIB) of Ontario revealed that the number of occupational TBI claims has nearly doubled over a span of eight years. 5 Previous studies have examined severe/fatal 3,4 or mild cases separately. 6 To date, no recent study has investigated occupational TBI across levels of severity. Because of the number of negative repercussions associated with occupational TBI and the apparent rise in its occurrence, a comprehensive examination of occupational TBI across levels of severity is needed in the Canadian context. Additionally, men continue to represent the majority of fatal and seriously injured, 3,4 therefore we hypothesize that men will display a more detrimental profile of occupational TBIs than women. Thus the objectives of this study were to provide an overview of occupational TBIs that includes factors associated with the injury, the implication being that the results may assist in better targeting the prevention of work-related TBI, such as through sex-specific prevention. METHODSA case series design was used to examine all WSIB claims with an injury date in the year 2004 and categorized by the WSIB as either "intracranial injury" or "concussion". All fatalities categorized as "traumatic" were also examined, for evidence of traumatic brain injury. The WSIB data are based on approximately 70% of the total Ontario workforce and were abstracted using a form that drew upon Haddon's Matrix. 7 In total, just over 1,500 non-fatal claim files were examined. Of those claims, 1,006 qualified as TBIs. Only claims with a confirmed

Examining the epidemiology of work-related traumatic brain injury through a sex/gender lens: analysis of workers’ compensation claims in Victoria, Australia

“…Unlike studies using trauma registry or death records,4 6 7 14 in which females accounted for <10% of wrTBI cases, over one-third (36.4%) of wrTBIs were sustained by females in our study. This is most comparable to an Ontario-based study, in which 42% of claims for wrTBI across a range of severity levels involved females 9. Additionally, in agreement with previous findings,4 10 14 30 we showed that males were at higher risk of wrTBI than females (RR 1.4).…”

“…While male cases were concentrated in occupations or industries normally associated with physical labour and/or hazardous work conditions, most female cases occurred in service industries, such as healthcare and education. These findings are similar to those of the Ontario study,9 although direct comparisons are difficult due to differences in workforce composition, workers’ compensation systems and industry classifications. Moreover, consistent with a US study exploring gender differences in work-related injuries/illnesses,18 we found that males were at higher risk of wrTBI than females across most industry sectors.…”

“…Based on previous wrTBI studies,4 6 9 we grouped the variables into three main categories: preinjury demographic characteristics, injury characteristics and outcomes.…”

“…Given its impacts on workers and society, wrTBI has received little attention in the peer-reviewed literature until recent years, with several studies describing its epidemiology in the USA5 11–14 and Canada 4 6 9 10 15. However, to our knowledge, no study has specifically examined the epidemiology of wrTBI in the Australian context.…”

“…Workers’ compensation claims data have been increasingly used to examine the incidence and impact of work-related injuries across a wide range of severity levels 9–11 15 18 19 22. Specifically, Colantonio et al 9 showed that over 40% of claims for wrTBI in Ontario involved females, with notable sex differences by industry and injury mechanism. These findings warrant further investigation in a larger wrTBI population that allows for detailed stratification by gender.…”