title: The association between chronological age, age at injury and employment: Is there a mediating effect of secondary health conditions?
abstract: METHODS
  Cross-sectional observational study with data from the 2012 community-based survey of the Swiss Spinal Cord Injury Cohort Study.
  
  
  OBJECTIVE
  To examine the relationships between chronological age, age at injury, secondary health conditions (SHCs) and paid employment.
  
  
  METHODS
  Community setting in Switzerland.
  
  
  METHODS
  A total of 1159 individuals of working age (16-63 years for women and 64 years for men) with traumatic or non-traumatic spinal cord injury (SCI) were included in the study. Direct and indirect (via SHCs) effects of chronological age and age at injury on paid employment were tested using a decomposition method for logistic regression models.
  
  
  RESULTS
  Both chronological age groups (age 35-49 and 50-63/64 years) and the group with age at injury beyond 40 years showed negative direct effects on employment status. A partial indirect effect (mediation) via chronic pain was found in the group with the highest chronological age (>50 years). Furthermore, pressure ulcer, pain and urinary tract infection were negatively related with employment in both models, that is, chronological age and employment and age at injury and employment.
  
  
  CONCLUSIONS
  Being older and having a higher age at injury directly affects whether an individual is employed. Pain is mediating the relation between chronological age and employment. Furthermore, pressure ulcer, chronic pain and urinary tract infection directly reduce the likelihood to be employed and, therefore, represent important intervention targets in efforts to maintain or engage in employment of individuals with SCI.
authors.affiliation: Swiss Paraplegic Research (SPF), Nottwil, Switzerland.|Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Marti
authors.affiliation: Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Boes
authors.affiliation: Swiss Paraplegic Research (SPF), Nottwil, Switzerland.
authors.forename: V
authors.initials: V
authors.lastname: Lay
authors.forename: R
authors.initials: R
authors.lastname: Escorpizo
authors.affiliation: Swiss Paraplegic Research (SPF), Nottwil, Switzerland.|Department of Rehabilitation and Movement Science, The University of Vermont, Burlington, VT, USA.
authors.forename: P T
authors.initials: PT
authors.lastname: Reuben Escorpizo
authors.affiliation: Swiss Paraplegic Research (SPF), Nottwil, Switzerland.|Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Trezzini
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000150:complications*; D013557:Switzerland; D055815:Young Adult