Disability in subjects who survive road traffic injuries in 2 regions of southwest Colombia: A causal mediation analysis.

Abstract

Purpose: The objective of the study was to determine the causal interrelationships between sociodemography, clinic, and injury characteristics, and to access to rehabilitation services that generate disability in road traffic injury survivors in 2 regions of Southwest Colombia during the 2018-2021 period.

Methods: An ambispective cohort study included 261 survivors from road traffic in 2 regions of Southwest Colombia (Cauca and Valle del Cauca) between April 19, 2021 and June 03, 2022. These survivors accepted treatment in 3 high-level comprehensive health institutions in Cali, Colombia, which are regional referral centers for trauma in the region. Patients (1) with hospitalization time ≥12 h, (2) aged ≥18 years, and (3) having the ability to understand the research questionnaires by themselves or their legal representatives, were included. Those with a history of deficiency before the road traffic injury were excluded. A structural equation model of causal pathways of disability was established to estimate exposure variables that are sociodemography, clinic, and access to rehabilitation services. The main outcome variable was disability, estimated by the World Health Organization Disability Assessment Schedule 2.0. Exposure variables related to clinical characteristics were measured through medical record review. The variables of access to rehabilitation services and disability were measured through a telephone-based survey. Structural equation analysis was performed, estimating the mediating effects of disability. The analyses were conducted in the software R Studio® y Mplus®.

Results: The study found a significant gender difference in disability, with women presenting a significantly higher disability than men (β: 6.21; p = 0.041). Disability was also associated with clinical conditions, such as injury severity score (β: 0.67; p < 0.001) and length of hospitalization (β: 0.28; p < 0.001). Regarding access to health services, the risk of disability was higher among those who were readmitted to the health institution (β: 4.96; p < 0.001).

Conclusions: Disability caused by road traffic injuries must be conceived as a complex phenomenon to be studied, involving the non-linear interaction between the individual's deficiencies and contextual factors.