Anita Berglund

Effect of Eliminating Compensation for Pain and Suffering on the Outcome of Insurance Claims for Whiplash Injury

BACKGROUND AND METHODS The incidence and prognosis of whiplash injury from motor vehicle collisions may be related to eligibility for compensation for pain and suffering. On January 1, 1995, the tort-compensation system for traffic injuries, which included payments for pain and suffering, in Saskatchewan, Canada, was changed to a no-fault system, which did not include such payments. To determine whether this change was associated with a decrease in claims and improved recovery after whiplash injury, we studied a population-based cohort of persons who filed insurance claims for traffic injuries between July 1, 1994, and December 31, 1995. RESULTS Of 9006 potentially eligible claimants, 7462 (83 percent) met our criteria for whiplash injury. The six-month cumulative incidence of claims was 417 per 100,000 persons in the last six months of the tort system, as compared with 302 and 296 per 100,000, respectively, in the first and second six-month periods of the no-fault system. The incidence of claims was higher for women than for men in each period; the incidence decreased by 43 percent for men and by 15 percent for women between the tort period and the two no-fault periods combined. The median time from the date of injury to the closure of a claim decreased from 433 days (95 percent confidence interval, 409 to 457) to 194 days (95 percent confidence interval, 182 to 206) and 203 days (95 percent confidence interval, 193 to 213), respectively. The intensity of neck pain, the level of physical functioning, and the presence or absence of depressive symptoms were strongly associated with the time to claim closure in both systems. CONCLUSIONS The elimination of compensation for pain and suffering is associated with a decreased incidence and improved prognosis of whiplash injury.

The influence of prognostic factors on neck pain intensity, disability, anxiety and depression over a 2-year period in subjects with acute whiplash injury

&NA; The influence of potential prognostic factors (occupant‐ and crash‐related factors, initial neck pain intensity and headache, whiplash injury severity, helplessness, locus of control, socioeconomic status) on neck pain intensity (VAS), disability (DRI), anxiety and depression (HADS) was estimated in a cohort of 3704 subjects with whiplash injury following a motor vehicle crash. Questionnaires were administered (baseline, 1‐, 6‐, 12‐, 24‐month follow‐ups). VAS was trichotomized; “low” (0–30), “moderate” (31–54), “severe” (55–100). A cumulative logit model with a proportional odds assumption was applied. Results regarding depression differed somewhat from the other outcomes. Overall, initial neck pain intensity was an important prognostic factor, but acted also as an evident effect modifier. Females had slightly increased odds for all outcomes but depression, for which no gender differences were shown. Injury severity was associated with all outcomes, but was most pronounced regarding disability among those who perceived numbness/pain in arms/hands and also had severe initial neck pain (proportional odds ratio [OR] 6.5; 95% confidence interval [CI] 2.5–17.0). Initial headache influenced all outcomes. Income was not related to any of the outcomes, whereas a lower level of education was associated with all outcomes but depression. Locus of control was not a factor of importance. In contrast, helplessness was related to all outcomes, but was most pronounced regarding neck pain intensity and depression for subjects with severe initial neck pain (OR 4.8; 95% CI 2.9–7.8; OR 6.6; 95% CI 2.6–17.0). Associations seem to be established early, and then to be relatively constant over time.

The association between exposure to a rear-end collision and future neck or shoulder pain: a cohort study.

Neck pain is the most frequently reported feature in connection with whiplash injury, but it is also a common complaint in the general population. Therefore it is crucial to include an unexposed comparison group when evaluating the association between neck pain and a previous motor vehicle crash (MVC). To determine whether exposure to a rear-end collision, without or with whiplash injury, is associated with future neck or shoulder pain, a cohort study was conducted. The study population consisted of persons covered by traffic insurance at one of the largest insurance companies in Sweden. Claim reports were collected from the period November 1987 to April 1988. Drivers exposed to a rear-end collision were divided into two subgroups, without reported whiplash injury (n = 204) and with reported whiplash injury (n = 232). Two comparison groups, unexposed to MVCs, consisting of 1599 and 2089 persons, were selected with consideration taken to the age and gender distribution in the exposed subgroups. A questionnaire concerning neck or shoulder pain and other subjective health complaints was mailed to all the study subjects at follow-up in 1994, 7 years after the rear-end collision. The relative risk of neck or shoulder pain at follow-up was 1.3 (95% CI 0.8-2.0) in the exposed subjects without whiplash injury compared with the unexposed. The corresponding relative risk in subjects with whiplash injury was 2.7 (95% CI 2.1-3. 5). We conclude that there is no increased risk of future neck or shoulder pain in drivers who did not report whiplash injury in connection with a rear-end collision 7 years earlier. In drivers with reported whiplash injury, the risk of neck or shoulder pain 7 years after the collision was increased nearly three-fold compared with that in unexposed subjects.

Low back pain after traffic collisions: A population-based cohort study

Study Design. A population-based, incidence cohort study was conducted. Objective. To measure the incidence and prognosis for collision-related low back pain before and after a change in the insurance compensation system. Summary of Background Data. Low back pain is a common and costly occupational injury. It also occurs after traffic collisions, but less is known about its frequency and recovery in this setting. Methods. An incidence cohort of 4473 low back pain injury claims was formed between July 1, 1994 and December 31, 1995 in Saskatchewan. On January 1, 1995 the public insurance system changed from a tort system to a no-fault system, eliminating compensation for pain and suffering. The incidence of claims and the time to claim closure were calculated before and after this change. Prognostic models were built using baseline and follow-up data. Results. The 6-month incidence of claims decreased from 256 to 176 per 100,000 after the insurance change. The median time to claim closure dropped from 505 days for tort claims to 210 days and 216 days for claims made during the first and second 6 months of the no-fault period. Improvements in bodily pain and physical functioning and the absence of depressive symptoms were associated with faster claim closure. High pain intensity, female gender, full-time employment, concentration problems, and lawyer involvement early in the claim process delayed claim closure. Conclusions. Low back pain is a common traffic injury with a prolonged recovery. Its incidence and prognosis are affected by multiple factors, including the type of compensation system. Our study suggests that biopsychosocial factors are important in determining prognosis.

Occupant- and Crash-Related Factors Associated with the Risk of Whiplash Injury

PURPOSE Given that a motor vehicle crash (MVC) had occurred, to evaluate whether occupant- and crash-related factors, such as age, gender, seating position and type of MVC are associated with the risk of whiplash injury. METHODS A study of occupants in cars covered by motor insurance at one of the largest insurance companies in Sweden, was undertaken during a one-year period. The study population comprised all occupants in cars exposed to an MVC in which at least one occupant was injured (n = 7120). Adjusted estimates of the relative risk of whiplash injury, associated with the different factors, were calculated by means of binomial regression analysis. RESULTS Considering different MVCs, rear-end collisions were associated with the highest relative risk of whiplash injury when compared with side impacts (1.82; 95% CI 1.68-1.96), while drivers showed the strongest association with respect to seating position when compared with passengers in the rear seat (1.78; 95% CI 1.60-1.97). Females had a somewhat higher relative risk of whiplash injury than males (1.20; 95% CI 1.16-1.25). Regarding age, the relative risk was moderately increased across the different age groups when compared with the oldest age group. No interaction was observed on the additive scale. CONCLUSIONS Given that an MVC had occurred, subjects exposed to a rear-end collision and drivers had a substantial increased risk of whiplash injury, while age and gender were of minor importance.

Association of interleukin 8 with myocardial infarction: Results from the Stockholm Heart Epidemiology Program

BACKGROUND Interleukin 8 (IL8) has been contradictorily associated with the risk of myocardial infarction (MI). AIM To investigate the association of IL8 serum levels with the risk of MI and the association of the IL8 (IL8) and IL8 receptors (CXCR1 and CXCR2) genetic variants with IL8 levels and MI risk in a large case control study, the Stockholm Heart Epidemiology Program. METHODS AND RESULTS IL8 levels (pg/mL) were divided into quartiles and the MI risk was calculated by logistic regression and expressed as odds ratio (OR) and 95% CI. Two IL8 SNPs (rs4073A/T, rs2227306C/T) and three SNPs tagging CXCR1 and CXCR2 (rs4674258C/T, rs1008563C/T, rs6723449T/C) were analyzed for association with IL8 levels and with MI risk. Multivariate adjusted ORs for MI risk by IL8 levels in the highest quartiles indicated reduced point estimates in both women (OR 0.37; 95% CI 0.2-0.8) and men when compared to the lowest quartile. In female cases, IL8 levels decreased progressively in the six months after MI (p=0.03). IL8, CXCR1 and CXCR2 genetic variants were not associated with IL8 levels. In men, the T allele at the IL8 SNP rs4073 was associated with a slight increase in the MI risk under an additive and a recessive model of inheritance. CONCLUSIONS IL8 serum levels were associated with a reduced occurrence of MI among women, whereas IL8 was associated with a slightly increased risk among men, possibly through different mechanisms. These data suggest that the biological effects of IL8 on MI risk may vary over time and warrant further cohort studies with repetitive IL8 measurements.

Does menopausal hormone therapy reduce myocardial infarction risk if initiated early after menopause? : A population-based case-control study

ObjectiveThis study aims to assess whether the timing of menopausal hormone therapy initiation in relation to onset of menopause and hormone therapy duration is associated with myocardial infarction risk. MethodsThis study was based on the Stockholm Heart Epidemiology Program, a population-based case-control study including 347 postmenopausal women who had experienced a nonfatal myocardial infarction and 499 female control individuals matched for age and residential area. Odds ratios (with 95% CIs) for myocardial infarction were calculated using logistic regression. ResultsEarly initiation of hormone therapy (within 10 y of onset of menopause or before age 60 y), compared with never use, was associated with an odds ratio of 0.87 (95% CI, 0.58-1.30) after adjustments for lifestyle factors, body mass index, and socioeconomic status. For late initiation of hormone therapy, the corresponding odds ratio was 0.97 (95% CI, 0.53-1.76). For hormone therapy duration of 5 years or more, compared with never use, the adjusted odds ratio was 0.64 (95% CI, 0.35-1.18). For hormone therapy duration of less than 5 years, the odds ratio was 0.97 (95% CI, 0.63-1.48). ConclusionsNeither the timing of hormone therapy initiation nor the duration of therapy is significantly associated with myocardial infarction risk.

Estimating incidence and prevalence from population registers: example from myocardial infarction:

Aim: To illustrate how the fundamental epidemiological measures, incidence rate and prevalence proportion, can be estimated based on Swedish population registers using acute myocardial infarction (MI) as an example, together with a discussion about the analytical decisions. Methods: All individuals in Sweden aged 60–89 (born 1904–1954) during the study period 1994–2014 were identified through the Total Population Register. Cases of MI were defined and identified from information on hospital admissions and causes of death. Incidence rates of all, first, and recurrent MI were calculated together with prevalence proportions. Results: The incidence rate of all, first, and recurrent MI declined over the study period. While the incidence rates of first MI are lower for women than men, the incidence rates of recurrent MI are considerably higher but similar for men and women. The prevalence calculated with duration of disease set at 28 days also declined. This was despite improved survival from MI and increased life expectancy over the same period meaning that the decline in incidence was large enough to compensate for increased survival. Conclusions: Calculating incidence and prevalence of diseases using population registers requires detailed and well-reasoned definitions. The definitions will affect both the study population and the number of disease events and it is essential that the cases and the study population are defined in a coherent way. Different measures of disease occurrence contribute with different aspects of the disease panorama and a joint interpretation contributes to a thorough understanding of the disease development in a population.

Duffy antigen receptor genetic variant and the association with Interleukin 8 levels.

UNLABELLED The aim of this study is to identify loci associated with circulating levels of Interleukin 8 (IL8). We investigated the associations of 121,445 single nucleotide polymorphisms (SNPs) from the Illumina 200K CardioMetabochip with IL8 levels in 1077 controls from the Stockholm Heart Epidemiology Program (SHEEP) study, using linear regression under an additive model of inheritance. Five SNPs (rs12075A/G, rs13179413C/T, rs6907989T/A, rs9352745A/C, rs1779553T/C) reached the pre-defined threshold of genome-wide significance (p<1.0×10(-5)) and were tested for in silico replication in three independent populations, derived from the PIVUS, MDC-CC and SCARF studies. IL8 was measured in serum (SHEEP, PIVUS) and plasma (MDC-CC, SCARF). The strongest association was found with the SNP rs12075 A/G, Asp42Gly (p=1.6×10(-6)), mapping to the Duffy antigen receptor for chemokines (DARC) gene on chromosome 1. The minor allele G was associated with 15.6% and 10.4% reduction in serum IL8 per copy of the allele in SHEEP and PIVUS studies respectively. No association was observed between rs12075 and plasma IL8. CONCLUSION rs12075 was associated with serum levels but not with plasma levels of IL8. It is likely that serum IL8 represents the combination of levels of circulating plasma IL8 and additional chemokine liberated from the erythrocyte DARC reservoir due to clotting. These findings highlight the importance of understanding IL8 as a biomarker in cardiometabolic diseases.

Patterns of background factors related to early RA patients' conceptions of the cause of their disease.

The aim of the present study was to identify patterns of background factors related to the early RA patients’ conceptions of the cause of the disease. Conceptions from a qualitative study formed the basis for the stratification of 785 patients from the Swedish EIRA study answering a question about their own thoughts about the cause to RA. Logistic regression analyses were used to explore the associations between patients’ conceptions and relevant background factors: sex, age, civil status, educational level, anti-cyclic citrullinated peptide antibody (anti-CCP) and smoking habits. The results were presented as odds ratios (OR) with 95% confidence intervals (CI). A conception of family-related strain was strongly associated with being young (OR 0.50; 95% CI 0.33–0.78 for age 58–70 vs. 17–46), female (OR 0.38; 95% CI 0.25–0.60 for male vs. female) and having a high level of education (OR 2.15; 95% CI 1.54–3.01 for university degree vs. no degree). A conception of being exposed to climate changes was associated with being male (OR 1.99; 95% CI 1.24–3.22 for male vs. female), having a low level of education (OR 0.33; 95% CI 0.18–0.58 for university degree vs. no degree) and positive Anti-CCP (OR 1.72; 95% CI 1.03–2.87 for positive vs. negative Anti-CCP). Linking patients’ conceptions of the cause of their RA to background factors potentially could create new opportunities for understanding the complexity of the aetiology in RA. Furthermore, this information is important and relevant in the care of patients with early RA.