Factors influencing hospitalisation and associated hospital costs of Belgian elderly traffic victims

Introduction: Road traffic accidents place a high burden on public health. Their associated utilisation of health care services imposes an economic burden on society. Increases in longevity demand a special focus on the relationship between elderly involved in traffic accidents and their hospitalisation risk and associated costs. The objectives of the present study are to examine the relationship between injury characteristics and type of roadway user and risk for hospital admission and hospital charges for elderly traffic victims (?60 years) compared to younger victims.
Methods: We performed a retrospective analysis with demographic, clinical and financial data from the emergency department and the hospital covering the period 2008-2011, within a single hospital design. Financial data contained all claims charged to patients, health and/or other insurances (expressed in EURO 2011). The main outcomes were hospitalisation risk and charges for emergency- and hospital care per patient. T-tests and chi-square tests were conducted to compare type of roadway user, demographic (gender and age) and clinical characteristics (nature and location of the injury) of in- and outpatients. A multiple logistic regression was used to model the probability of hospitalisation. To model the skewed cost data, a generalised linear model (GLM) with a gamma distribution and a log link was employed.
Results: Overall, 5103 traffic victims were identified and 4650 were included in the final analysis of which 949 (20.41%) were hospitalised. In total, 489 (10.74%) elderly were included of which 159 (32.52%) were hospitalised. The median (interquartile range) total cost for inpatients was EURO3307 (EURO1743 - EURO9005) for the total sample. For an elderly person however, this was EURO7921 (EURO2898 - EURO14560). A bath-tub relationship existed between age and hospitalisation probability. Controlled for gender, type of roadway user, nature -, and location of injury, younger traffic victims were significantly less likely to be admitted to a hospital compared to the elderly (17-29 years: OR 0.41, 95% CI 0.30-0.57; 30-44 years: OR 0.59, 95% CI 0.43-0.83). The age group 45-59 years old was less likely to be hospitalised, whereas children (0-16 years) were more likely to be hospitalised. However, these differences were not significant. Regarding hospital costs, the gamma model showed that elderly incurred significantly higher hospital costs compared to all other age groups. Among other findings, the analysis revealed that men, pedestrians, fractures, internal or intracranial injuries, or open wounds located at the vertebrae or spine or lower extremities were all associated with higher hospital costs.
Discussion: Elderly who sustain a traffic injury have a higher risk of hospitalisation and their hospital stay incurs higher costs compared to younger traffic victims. Moreover, as the mean distance travelled daily among Belgian elderly shows a steady increase, combined with rising longevity, this will result in a significant increase in exposure of road traffic accidents in this age group. Consequently, an increase in economic burden to society is to be expected. These results should inform policy makers in road safety and help to set priorities in the current difficult financial climate.