S. Shah1, S. S. Al Rafai1, J. P. Herrera-Escobar1, M. Jarman1, A. Geada2, J. M. Lee3, K. Brasel4, H. M. Kaafarani3, G. Kasotakis2, G. Velmahos3, A. Salim1, A. H. Haider1, D. Nehra1 1Brigham And Women’s Hospital,Boston, MA, USA 2Boston University,Boston, MA, USA 3Massachusetts General Hospital,Boston, MA, USA 4Oregon Health And Science University,Portland, OR, USA
Introduction: It has been hypothesized that educational level is associated with long-term outcomes after trauma. Patients with a lower level of education may be at risk for less involved follow-up care and may feel less empowered to seek all possible avenues for functional recovery. Our objective was to determine the association between education and both physical and mental composites of quality of life 6 or 12 months after injury.
Methods: Trauma patients with an Injury Severity Score (ISS) ≥9 were identified using the institutional trauma registries of three Level I trauma centers and contacted 6- or 12-months post-injury to participate in a telephone interview. Patients were asked to complete the Short-Form 12 (SF-12) questionnaire which is a validated Health-related Quality of Life tool used to assess both mental and physical health. SF-12 scores are represented as t-scores with a population mean of 50 and a standard deviation of 10, in which 0 represents the lowest level of health and 100 the highest. Multivariate logistic regression models adjusted for age, sex, insurance, number of comorbidities, ICU admission, placement on ventilator, injury cause, ISS, alcoholism, smoking status and discharge were used to determine the effect of a low (high school or lower, LE) as compared to high (higher than high school, HE) education on long-term physical and mental health.
Results: A total of 555 patients were included in this study of whom 254 (46%) had a LE. Mean age of patients with a LE was 50 (SD 20.9) and 58 (SD 20) for patients with a HE. Mean ISS was 14 for both groups. Upon adjusted analyses, mean SF-12 physical composite score was lower for patients with a LE [38.9 (SD: 11.6)] as compared to patients with a HE [44.3 (SD: 10.9)] (p value: 0.001). Similarly, mean SF-12 mental composite score was lower for patients with a LE [47.4 (SD: 11.8)] as compared to patients with a HE [51.7 (SD: 11)] (p value: 0.001). After adjusting for confounders, educational level was found to be an independent predictor of long-term physical and mental health; specifically, patients with a LE had significantly lower SF-12 physical [β: -6.16 (95% CI: -8.01 to -4.31)] and mental [β: -2.48 (95% CI: -4.60 to -0.35)] composite scores compared to patients with a HE.
Conclusion: A lower educational level at the time of traumatic injury is associated with poor long-term mental and physical health. This finding deserves suggests that there may be a role for adapting the available resources (i.e., rehabilitation, financial and family support programs) to the capacity and needs including educational level of individual patients.