Mortality and health-related quality of life following injuries and associated factors: A cohort study in Chandigarh, North India

Introduction Injuries are among the ten leading causes of deaths worldwide. In recent years, the quality and reporting of injury mortality has improved but little or no data is available on the morbidity burden and impact of non-fatal injuries in India. This study evaluates health recovery status post-injury, identifying predictors of recovery in North India. Methods Prospective cohort study recruiting patients from one tertiary and two secondary-level hospitals in North India between April-June 2014 hospitalised due to any injury. Health-related quality of life was assessed at baseline and at 1-, 2-, 4- and 12-months post-injury using the EuroQol five-dimensional (EQ-5D-5L) questionnaire. Multivariable linear regressions with generalized estimating equations were used to examine the relationship between socio-demographic and injury-related factors with the EQ-5D-5L single utility score and the visual analogue scale (VAS) score. Results A total of 2416 eligible patients aged 18 years were enrolled in the study. Of these, 2150 (74%) completed baseline and all four follow-up EQ-5D-5L questionnaires. Almost 7% (n=172) patients died by the first follow-up and the overall mortality at 12-months was 9% (n=176). Both EQ-5D-5L utility and VAS scores dropped significantly at 1-month post-injury but gradually improved at 2-, 4- and 12-months. Severe injuries, defined as those requiring hospital stay of 7 days were associated with lower utility scores at 1-, 2- and 4-months follow-up (p<0.001). Conclusion This is the first study to examine health outcomes following injuries in India. The findings highlight the need to understand the social, psychological and biological factors influencing recovery outcomes. High mortality following discharge emphasises the need to invest in secondary and tertiary injury prevention in India.