{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T01:55:04Z","timestamp":1790992504216,"version":"4.1.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec id=\"ab-soi240073-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Employment and personal income loss after traumatic brain injury is a major source of postinjury stress and a barrier to societal reintegration. The magnitude of labor market ramifications following traumatic brain injury remains largely unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240073-5\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To quantify the 3-year postinjury labor market consequences following traumatic brain injury in Canada. To also estimate the incurred national labor market cost over the study period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240073-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This retrospective quasi-experimental, pan-Canadian observational cohort study used linked administrative health and federal taxation data obtained between 2007 and 2017. Mixed-effects difference-in-difference regressions were constructed to estimate the annualized magnitude of the personal income and employment loss during each of the 3 years following injury, respectively, relative to preinjury baseline. Participants included tax-filing adult (19 to 61 years old) traumatic brain injury survivors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240073-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Traumatic brain injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240073-8\">\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Coprimary outcomes were personal income loss and the proportion of newly unemployed individuals per annum. Secondary objectives were to quantify income and employment loss within mild, moderate, and severe traumatic brain injury subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240073-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 18\u202f050 patients with traumatic brain injury between 2007 and 2017 were identified (mean age, 38.0 [SD, 12.4] years; 13\u202f360 male [74.0%]), each of whom was followed up with for 3 consecutive fiscal years. Mean income was CAD $42\u202f600 (US $31\u202f083) in the fiscal year prior to injury and 82% were employed at time of injury. The adjusted mean loss of personal income was CAD $7635 (US $5650) in the first year after injury (Y+1) and CAD $5000 (US $3700) in the third year after injury (Y+3) relative to uninjured controls. In each of the 3 postinjury years, 7.8% individuals were newly unemployed compared with the preinjury baseline. The adjusted average personal income loss for mild, moderate, and severe traumatic brain injury subgroups were CAD $3354 (US $2482), CAD $6750 (US $4995), and CAD $17\u202f375 (US $12\u202f859), respectively, at Y+3; the proportion of unemployed individuals increased by 5.8%, 9.2%, and 20% across the same groups at Y+3 after injury relative to preinjury baseline. The estimated total reduction in personal income aggregated over the 3 postinjury years for the affected participants was CAD $588 million (US $435 million).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240073-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This work represents national cohort data quantifying the labor market implications of traumatic brain injury. These results may be used to inform economic evaluations and social service resource allocation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamasurg.2024.4285","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T11:22:34Z","timestamp":1728472954000},"page":"1415","source":"Crossref","is-referenced-by-count":18,"title":["Unemployment and Personal Income Loss After Traumatic Brain Injury"],"prefix":"10.1001","volume":"159","author":[{"given":"Armaan K.","family":"Malhotra","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Unity Health Toronto, Toronto Ontario, Canada"},{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael H.","family":"Jaffe","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Unity Health Toronto, Toronto Ontario, Canada"},{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Husain","family":"Shakil","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Unity Health Toronto, Toronto Ontario, Canada"},{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francois","family":"Mathieu","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Unity Health Toronto, Toronto Ontario, Canada"},{"name":"Interdepartmental Division of Critical Care, University of Toronto, Ontario, Canada"},{"name":"Department of Critical Care, Unity Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avery B.","family":"Nathens","sequence":"additional","affiliation":[{"name":"Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Division of General Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhaya V.","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calvin","family":"Diep","sequence":"additional","affiliation":[{"name":"Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia, Unity Health Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva Y.","family":"Yuan","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Unity Health Toronto, Toronto Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim S.","family":"Ladha","sequence":"additional","affiliation":[{"name":"Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia, Unity Health Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Coyte","sequence":"additional","affiliation":[{"name":"Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jefferson R.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Unity Health Toronto, Toronto Ontario, Canada"},{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter P.","family":"Wodchis","sequence":"additional","affiliation":[{"name":"Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute for Better Health, Trillium Health Partners, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D.","family":"Witiw","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Unity Health Toronto, Toronto Ontario, Canada"},{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"11","key":"soi240073r1","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1016\/S1474-4422(22)00309-X","article-title":"Traumatic brain injury: progress and challenges in prevention, clinical care, and research.","volume":"21","author":"Maas","year":"2022","journal-title":"Lancet Neurol"},{"key":"soi240073r2","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/1471-2377-12-76","article-title":"Direct cost associated with acquired brain injury in Ontario.","volume":"12","author":"Chen","year":"2012","journal-title":"BMC Neurol"},{"issue":"3","key":"soi240073r3","doi-asserted-by":"publisher","first-page":"875","DOI":"10.3171\/2019.5.JNS19459","article-title":"Costs and predictors of 30-day readmissions after craniotomy for traumatic brain injury: a nationwide analysis.","volume":"133","author":"Hoffman","year":"2019","journal-title":"J Neurosurg"},{"key":"soi240073r4","doi-asserted-by":"publisher","DOI":"10.1017\/S2045796020000906","article-title":"Employment is a critical mental health intervention.","volume":"29","author":"Drake","year":"2020","journal-title":"Epidemiol Psychiatr Sci"},{"issue":"3","key":"soi240073r5","doi-asserted-by":"publisher","first-page":"541","DOI":"10.2105\/AJPH.2011.300401","article-title":"Association of returning to work with better health in working-aged adults: a systematic review.","volume":"102","author":"Rueda","year":"2012","journal-title":"Am J Public Health"},{"issue":"1","key":"soi240073r6","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1097\/SLA.0000000000003879","article-title":"Important issues to severe trauma survivors: a qualitative study.","volume":"275","author":"James","year":"2022","journal-title":"Ann Surg"},{"issue":"1","key":"soi240073r7","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1001\/jamasurg.2020.4599","article-title":"Association of severe trauma with work and earnings in a national cohort in canada.","volume":"156","author":"Haas","year":"2021","journal-title":"JAMA Surg"},{"issue":"6","key":"soi240073r8","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.19444","article-title":"Employment and economic outcomes of participants with mild traumatic brain injury in the TRACK-TBI study.","volume":"5","author":"Gaudette","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"2","key":"soi240073r9","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1053\/apmr.2003.50097","article-title":"Financial and vocational outcomes 1 year after traumatic brain injury.","volume":"84","author":"Johnstone","year":"2003","journal-title":"Arch Phys Med Rehabil"},{"issue":"3","key":"soi240073r12","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1093\/ije\/dyy038","article-title":"Data resource profile: the Canadian Hospitalization and Taxation Database (C-HAT).","volume":"47","author":"Sanmartin","year":"2018","journal-title":"Int J Epidemiol"},{"issue":"89","key":"soi240073r14","first-page":"1","article-title":"Proposed framework for presenting injury data using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Diagnosis Codes.","author":"Hedegaard","year":"2016","journal-title":"Natl Health Stat Report"},{"issue":"6","key":"soi240073r15","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1016\/j.jamcollsurg.2010.08.014","article-title":"Survival of the fittest: the hidden cost of undertriage of major trauma.","volume":"211","author":"Haas","year":"2010","journal-title":"J Am Coll Surg"},{"issue":"22","key":"soi240073r16","doi-asserted-by":"publisher","first-page":"2401","DOI":"10.1001\/jama.2014.16153","article-title":"Methods for evaluating changes in health care policy: the difference-in-differences approach.","volume":"312","author":"Dimick","year":"2014","journal-title":"JAMA"},{"issue":"6","key":"soi240073r17","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.18468","article-title":"Traumatic cervical spinal cord injury and income and employment status.","volume":"7","author":"Jaffe","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"1","key":"soi240073r18","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1177\/1536867X1601600108","article-title":"Diff: simplifying the estimation of difference-in-differences treatment effects.","volume":"16","author":"Villa","year":"2016","journal-title":"Stata J"},{"issue":"1","key":"soi240073r19","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/S0001-4575(02)00131-8","article-title":"Injury and risk-taking behavior-a systematic review.","volume":"36","author":"Turner","year":"2004","journal-title":"Accid Anal Prev"},{"issue":"7","key":"soi240073r20","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1093\/aje\/kwz093","article-title":"Performance of matching methods as compared with unmatched ordinary least squares regression under constant effects.","volume":"188","author":"Vable","year":"2019","journal-title":"Am J Epidemiol"},{"issue":"2","key":"soi240073r21","doi-asserted-by":"publisher","first-page":"195.e1","DOI":"10.1016\/j.ajog.2020.08.007","article-title":"Impact of Medicaid expansion on women with gynecologic cancer: a difference-in-difference analysis.","volume":"224","author":"Albright","year":"2021","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"soi240073r22","doi-asserted-by":"publisher","first-page":"2555","DOI":"10.1093\/restud\/rdad018","article-title":"A more credible approach to parallel trends.","volume":"90","author":"Rambachan","year":"2023","journal-title":"Rev Econ Stud"},{"issue":"2","key":"soi240073r23","doi-asserted-by":"publisher","first-page":"e2034898","DOI":"10.1001\/jamanetworkopen.2020.34898","article-title":"Analysis of patient income in the 5 years following a fracture treated surgically.","volume":"4","author":"O\u2019Hara","year":"2021","journal-title":"JAMA Netw Open"},{"key":"soi240073r25","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.3389\/fneur.2018.01051","article-title":"Employment probability trajectories up to 10 years after moderate-to-severe traumatic brain injury.","volume":"9","author":"Howe","year":"2018","journal-title":"Front Neurol"},{"issue":"2","key":"soi240073r26","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1007\/s00068-018-0920-0","article-title":"Analysis of quality of life after major trauma: a Spanish follow-up cohort study.","volume":"45","author":"Llaquet Bayo","year":"2019","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"5","key":"soi240073r27","doi-asserted-by":"publisher","first-page":"423","DOI":"10.3109\/09638288.2015.1044034","article-title":"Participation in the workforce after a traumatic brain injury: a matter of control.","volume":"38","author":"Johansson","year":"2016","journal-title":"Disabil Rehabil"},{"issue":"11","key":"soi240073r28","doi-asserted-by":"publisher","first-page":"2473","DOI":"10.3390\/jcm10112473","article-title":"The association of post-concussion and post-traumatic stress disorder symptoms with health-related quality of life, health care use and return-to-work after mild traumatic brain injury.","volume":"10","author":"van der Vlegel","year":"2021","journal-title":"J Clin Med"},{"issue":"3","key":"soi240073r29","doi-asserted-by":"publisher","first-page":"2421","DOI":"10.1007\/s00068-021-01781-2","article-title":"Health-related quality of life and return to work 1 year after major trauma from a network perspective.","volume":"48","author":"van Ditshuizen","year":"2022","journal-title":"Eur J Trauma Emerg Surg"},{"key":"soi240073r30","doi-asserted-by":"publisher","first-page":"S16","DOI":"10.1097\/BOT.0000000000001621","article-title":"Valuing the recovery priorities of orthopaedic trauma patients after injury: evidence from a discrete choice experiment within 6 weeks of injury.","volume":"33","author":"O'Hara","year":"2019","journal-title":"J Orthop Trauma"},{"issue":"5","key":"soi240073r31","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1370\/afm.2286","article-title":"Employment interventions in health settings: a systematic review and synthesis.","volume":"16","author":"Pinto","year":"2018","journal-title":"Ann Fam Med"},{"issue":"1","key":"soi240073r32","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.1097\/HTR.0000000000000772","article-title":"Workplace factors associated with return to work after mild-to-moderate traumatic brain injury.","volume":"38","author":"Fure","year":"2023","journal-title":"J Head Trauma Rehabil"},{"issue":"1","key":"soi240073r33","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1053\/apmr.2002.27470","article-title":"Return to productive activity after traumatic brain injury: relationship with measures of disability, handicap, and community integration.","volume":"83","author":"Wagner","year":"2002","journal-title":"Arch Phys Med Rehabil"},{"issue":"2","key":"soi240073r34","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1097\/00001199-200503000-00001","article-title":"Productive work and employment for persons with traumatic brain injury: what have we learned after 20 years?","volume":"20","author":"Wehman","year":"2005","journal-title":"J Head Trauma Rehabil"},{"issue":"6","key":"soi240073r35","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1016\/j.apmr.2012.01.018","article-title":"A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury.","volume":"93","author":"Grauwmeijer","year":"2012","journal-title":"Arch Phys Med Rehabil"},{"key":"soi240073r10","unstructured":"Statistics Canada. Technical reference guide for the annual income estimates for census families, individuals and seniors, T1 family file. Accessed September 3, 2024. https:\/\/www150.statcan.gc.ca\/n1\/en\/catalogue\/72-212-X"},{"key":"soi240073r11","unstructured":"Canadian Institute for Health Information. Discharge abstract database (DAD) metadata. Accessed September 3, 2024. https:\/\/www.cihi.ca\/en\/discharge-abstract-database-dad-metadata"},{"key":"soi240073r13","unstructured":"Statistics Canada. Census of population. Accessed September 3, 2024. https:\/\/www12.statcan.gc.ca\/census-recensement\/index-eng.cfm"},{"key":"soi240073r24","unstructured":"Bank of Canada. Consumer price index.? https:\/\/www.bankofcanada.ca\/rates\/price-indexes\/cpi\/)"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2824629\/jamasurgery_malhotra_2024_oi_240073_1733854581.42509.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T15:33:30Z","timestamp":1733931210000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2824629"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,1]]},"references-count":35,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,12,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2024.4285","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2024,12,1]]}}}