Introduction

Pain and mental health conditions account for a significant proportion of the public health burden of injury, and treatment patterns can vary by neighbourhood area. We aimed to (a) characterise geographic variations in treatment for pain and mental health conditions across local government areas (LGAs); and (b) examine the relationship between treated condition prevalence and LGA socioeconomic advantage and disadvantage.

Methods

The data comprised adults (18+ years) with an accepted claim (N = 73,796) with the Victorian transport injury compensation scheme from 2008-2013, living in Victoria, Australia, who survived to 24-months post-injury. Exclusions were: no claim payments within 84-days post-injury, surgery >6 weeks post-injury and catastrophic injury. Treated conditions were identified 3–24 months post-injury using previously developed criteria from administrative records of funded medications and clinician-based treatments. Geospatial patterns of treated conditions were examined using hierarchical Bayesian spatial logistic regression models.

Results

Treated condition incidence was higher in metropolitan LGAs (pain: 7.0%, 96.45 per 100,000; mental health: 3.4%, 46.82 per 100,000) than regional LGAs (pain: 3.8%, 53.27 per 100,000; mental health: 2.2%, 29.63 per 100,000). In metropolitan LGAs, higher neighbourhood disadvantage was associated with higher prevalence of treated pain (r² = −0.50, 95%CI:-0.72,-0.17) and mental health (r² = −0.63, 95%CI:-0.81,-0.36). In regional LGAs, higher neighbourhood disadvantage was correlated with lower prevalence of treated pain (r² = 0.39, 95%CI:0.11,0.62), but not mental health (r² = 0.15, 95%CI: −0.15,0.44).

Conclusions

Strategies to support timely and equitable treatment for pain and mental health post-injury must account for the potential role of social and geographic determinants of treatment use, which will vary between regional and metropolitan areas.

中文翻译：

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道路交通伤害后经过治疗的疼痛和心理健康状况：澳大利亚维多利亚州的地理差异和社会经济劣势

介绍

疼痛和心理健康状况在伤害的公共健康负担中占很大比例，并且治疗模式可能因邻域而异。我们旨在（a）在各地政府区域（LGAs）中描述疼痛和心理健康状况治疗的地域差异；（b）研究治疗条件的患病率与LGA社会经济优势和劣势之间的关系。

方法

数据包括在2008年至2013年间通过维多利亚州交通伤害赔偿计划接受了索赔的成年人（18岁以上）（N = 73,796），居住在澳大利亚维多利亚州，受伤后存活了24个月。不包括：受伤后84天内没有索赔，受伤后> 6周的手术和灾难性伤害。使用先前制定的标准，从受资助药物和基于临床医生的治疗的管理记录中确定受伤后3-24个月的治疗状况。使用分层贝叶斯空间逻辑回归模型检查了治疗条件的地理空间格局。

结果

大都市区LGAs（疼痛：7.0％，96.45 / 100,000;精神健康：3.4％，46.82 / 100,000）的治疗状况发生率高于地区LGA（疼痛：3.8％，53.27 / 100,000;心理健康：2.2％，29.63 / 100,000 ）。在大都市区LGAs中，较高的邻里不利性与较高的患病率（r ²  = -0.50，95％CI：-0.72，-0.17）和精神健康（r ²  = -0.63，95％CI：-0.81，- 0.36）。在区域性LGAs中，较高的邻里不利与较低的治疗疼痛发生率相关（r ²  = 0.39，95％CI：0.11,0.62），但与精神健康无关（r ²  = 0.15，95％CI：-0.15,0.44）。

结论

支持对受伤后的疼痛和心理健康进行及时，公正治疗的策略必须考虑治疗使用的社会和地理决定因素的潜在作用，这在地区和大城市之间会有所不同。