title: Longitudinal assessment of injury recidivism among adults in the United States: findings from a population-based sample.
abstract: BACKGROUND
  Repeated injuries, as known as injury recidivism, pose a significant burden on population health and healthcare settings. Therefore, identifying those at risk of recidivism can highlight targeted populations for primary prevention in order to improve health and reduce healthcare expenditures. There has been limited research on factors associated with recidivism in the U.S. Using a population-based sample, we aim to: 1) identify the prevalence and risk factors for injury recidivism among non-institutionalized adults; 2) investigate the trend in nationwide recidivism rates over time.
  
  
  METHODS
  Using the Medical Expenditure Panel Survey (MEPS), 19,134 adults with at least one reported injury were followed for about 2 years. Reported injuries were those associated with healthcare utilization, disability days or any effects on self-reported health. The independent associations between risk factors for recidivism were evaluated incorporating a weighted logistic regression model.
  
  
  RESULTS
  There were 4,136 recidivists representing over nine million individuals in the U.S. over a 2-year follow-up. About 44 % of recidivists sustained severe injuries requiring a hospitalization, a physician's office visit or an emergency department visit. Compared with those who sustained a single injury, recidivists were more likely to be white, unmarried, reside in metropolitan areas, and report a higher prevalence of chronic conditions. Age, sex, race/ethnicity, marital status, urbanicity, region, diabetes, stroke, asthma and depression symptoms were significant predictors of recidivism. Significant interaction effects between age and gender suggested those in the 18-25 age group, the odds of being a recidivist were 1.45 higher among males than females adjusting for other covariates. While having positive screens for depression in both follow-up years was associated with 1.46 (95 % CI = 1.21-1.77) higher odds of recidivisms than the reference group adjusting for other variables.
  
  
  CONCLUSIONS
  We observed a higher recidivism rate among injured individuals in this study than previously reported. Our findings emphasize the pressing need for injury prevention to reduce the burden of repeated injuries. Preventative efforts may benefit from focusing on males between 18 and 25 years of age and those with comorbidities such as diabetes, stroke and depression.
authors.affiliation: King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, KAIMRC, KSAU-HS, Riyadh, Saudi Arabia. ghnams@ngha.med.sa.|Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, HH 598 624 N. Broadway, Baltimore, MD, 21205, USA. ghnams@ngha.med.sa.
authors.forename: Suliman
authors.identifier: http://orcid.org/0000-0001-5817-0481
authors.initials: S
authors.lastname: Alghnam
authors.affiliation: Department of Surgery, Christiana Care Health System, Newark, DE, 19718, USA.
authors.forename: Glen H
authors.initials: GH
authors.lastname: Tinkoff
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, HH 598 624 N. Broadway, Baltimore, MD, 21205, USA.
authors.forename: Renan
authors.initials: R
authors.lastname: Castillo
keywords: Injury burden; MEPS; Recidivism; Repeated injuries