title: The Cumulative Burden of Mental, Substance Use, and General Medical Disorders and Rehospitalization and Mortality After an Injury.
abstract: OBJECTIVE
  Each year in the United States, 1.5-2.5 million individuals require hospitalization for an injury. Multiple mental, substance use, and chronic general medical disorders are endemic among injury survivors with and without traumatic brain injury (TBI), yet few studies have assessed the association between the cumulative burden of these conditions and health care outcomes. This study of patients hospitalized for an injury assessed associations between comorbid mental, substance use, and general medical disorders, TBI, and violent events or suicide attempts and the postinjury outcomes of recurrent hospitalization and death.
  
  
  METHODS
  Recurrent hospitalization and all-cause mortality were examined in this population-based retrospective cohort study. A total of 76,942 patients hospitalized for an injury in Washington State during 2006-2007 were followed for five years. ICD-9-CM codes identified conditions prior to or at the index injury admission. Index admissions related to injuries from firearms, assaultive violence, suicide attempts, and overdoses were identified through E-codes.
  
  
  RESULTS
  Adjusted regression analyses demonstrated a significant, dose-response relationship between an increasing cumulative burden of disorders and an increasing risk of recurrent hospitalization (four or more conditions, relative risk=3.89, 95% confidence interval [CI]=3.66-4.14). Adjusted Cox proportional hazard regression demonstrated a similar relationship between increasing cumulative burden of disorders and all-cause mortality (four or more conditions, hazard ratio=5.33, CI=4.71-6.04).
  
  
  CONCLUSIONS
  Increasing cumulative burden of disorders was associated with greater postinjury risk of recurrent hospitalization and death. Orchestrated investigative and policy efforts could introduce screening and intervention procedures that target this spectrum of comorbidity.
authors.affiliation: Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: dzatzick@uw.edu ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated.
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Zatzick
authors.affiliation: Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: dzatzick@uw.edu ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated.
authors.forename: Ali
authors.initials: A
authors.lastname: Rowhani-Rahbar
authors.affiliation: Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: dzatzick@uw.edu ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated.
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.affiliation: Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: dzatzick@uw.edu ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated.
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.affiliation: Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: dzatzick@uw.edu ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated.
authors.forename: Doyanne
authors.initials: D
authors.lastname: Darnell
authors.affiliation: Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: dzatzick@uw.edu ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated.
authors.forename: Leah
authors.initials: L
authors.lastname: Ingraham
authors.affiliation: Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: dzatzick@uw.edu ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated.
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Whiteside
authors.affiliation: Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: dzatzick@uw.edu ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Guiney
authors.affiliation: Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: dzatzick@uw.edu ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated.
authors.forename: Margot Kelly
authors.initials: MK
authors.lastname: Hedrick
authors.affiliation: Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: dzatzick@uw.edu ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology; D002423:Cause of Death; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology*; D017741:Survivors / Q000523:psychology*; D014861:Washington / Q000453:epidemiology; D014947:Wounds and Injuries / Q000145:classification / Q000401:mortality* / Q000523:psychology*; D055815:Young Adult
keywords: Alcohol &amp; drug abuse, Depression, Hospitalization, Posttraumatic stress disorder (PTSD), Utilization patterns &amp; review