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Can the provision of a minor home help service for the elderly population reduce the incidence of fall-related injuries?: A quasi-experimental study of the community-level effects on hospital admissions in Swedish municipalities
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety. Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences. (Centre for Public Safety)ORCID iD: 0000-0002-1189-9950
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.ORCID iD: 0000-0003-4840-6424
Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences. (Centrum för Personsäkerhet)ORCID iD: 0000-0002-6928-0683
2016 (English)In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 22, no 6, p. 412-419Article in journal (Refereed) Published
Abstract [en]

Background

Fall-related injuries are a global public health problem, especially in elderly populations. The effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention mainly involves the performance of complicated tasks and hazards assessment by a trained assessor, and has been adopted gradually over the last decade by 191 of 290 Swedish municipalities.   

Methods

A quasi-experimental design was used where intention-to-treat effect estimates were derived using panel regression analysis and a regression-discontinuity (RD) design. The outcome measure was the incidence of fall-related hospitalizations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years).

Results

We found no statistically significant reductions in injury incidence in the panel regression (IRR 1.01 [95% CI: 0.98-1.05]) or RD (IRR 1.00 [95% CI: 0.97-1.03]) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters.

Conclusions

It is unclear whether the absence of an effect is due to a low efficacy of the services provided, or a result of low adherence. Additional studies of the effects on other quality of life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help service programs.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2016. Vol. 22, no 6, p. 412-419
Keywords [en]
falls, injury prevention, quasi-experiment, time series analysis, econometric analysis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Risk and Environmental Studies; Public Health Science
Identifiers
URN: urn:nbn:se:kau:diva-41145DOI: 10.1136/injuryprev-2015-041848ISI: 000390591200007PubMedID: 27016460OAI: oai:DiVA.org:kau-41145DiVA, id: diva2:915078
Funder
Swedish Civil Contingencies AgencyAvailable from: 2016-03-29 Created: 2016-03-29 Last updated: 2018-05-22Bibliographically approved
In thesis
1. Assessing the effects of societal injury control interventions
Open this publication in new window or tab >>Assessing the effects of societal injury control interventions
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Injuries have emerged as one of the biggest public health issues of the 21th century. Yet, the causal effects of injury control strategies are often questioned due to a lack of randomized experiments. In this thesis, a set of quasi-experimental methods are applied and discussed in the light of causal inference theory and the type of data commonly available in injury surveillance systems. I begin by defining the interrupted time series design as a special case of the regression-discontinuity design, and the method is applied to two empirical cases. The first is a ban on the sale and production of non-reduced ignition propensity (RIP) cigarettes, and the second is a tightening of the licensing rules for mopeds. A two-way fixed effects model is then applied to a case with time-varying starting dates, attempting to identify the causal effects of municipality-provided home help services for the elderly. Lastly, the effect of the Swedish bicycle helmet law is evaluated using the comparative interrupted time series and synthetic control methods. The results from the empirical studies suggest that the stricter licensing rules and the bicycle helmet law were effective in reducing injury rates, while the home help services and RIP cigarette interventions have had limited or no impact on safety as measured by fatalities and hospital admissions. I conclude that identification of the impact of injury control interventions is possible using low cost means. However, the ability to infer causality varies greatly by empirical case and method, which highlights the important role of causal inference theory in applied intervention research. While existing methods can be used with data from injury surveillance systems, additional improvements and development of new estimators specifically tailored for injury data will likely further enhance the ability to draw causal conclusions in natural settings. Implications for future research and recommendations for practice are also discussed.

Abstract [en]

Injuries have emerged as one of the biggest public health issues of the 21th century. Yet, the causal effects of injury control strategies are rarely known due to a lack of randomized experiments. In this thesis, a set of quasi-experimental methods are discussed in the light of causal inference theory and the type of data commonly available in injury surveillance systems. I begin by defining the identifying assumptions of the interrupted time series design as a special case of the regression-discontinuity design, and the method is applied to two empirical cases. The first is a ban on the sale and production of non-fire safe cigarettes and the second is a tightening of the licensing rules for mopeds. A fixed effects panel regression analysis is then applied to a case with time-varying starting dates, attempting to identify the causal effects of municipality-provided home help services for the elderly. Lastly, the causal effect of the Swedish bicycle helmet law is evaluated using a comparative interrupted time series design and a synthetic control design. I conclude that credible identification of the impact of injury control interventions is possible using simple and cost-effective means. Implications for future research and recommendations for practice are discussed.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2016. p. 59
Series
Karlstad University Studies, ISSN 1403-8099 ; 2016:23
Keywords
causal inference, epidemiology, injury, time series analysis, impact evaluation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Risk and Environmental Studies
Identifiers
urn:nbn:se:kau:diva-41204 (URN)978-91-7063-701-8 (ISBN)
External cooperation:
Public defence
2016-05-19, Eva Erikssonsalen, 21A342, Karlstad, 13:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Civil Contingencies Agency
Available from: 2016-04-29 Created: 2016-04-01 Last updated: 2016-08-25Bibliographically approved

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Bonander, CarlGustavsson, JohannaNilson, Finn

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