This study was designed to provide increased knowledge of the economic costs and the psychosocial impacts associated with farm-related injuries to youth (i.e., individuals less than 20 years old). It was undertaken because comprehensive literature reviews revealed a paucity of research on both the costs of agricultural injury to youth, particularly for the less seriously injured, and virtually no studies of the psychosocial impacts to youth and their families resulting from a farm-related injury. Four aims were identified for the study. Specific aims for the economic component included: (1) comparing direct costs of health care utilization for injured youth and non- youth across the injury severity spectrum, and identifying and estimating other potentially relevant factors for their impact on costs, including agent(s) of injury and body injury site(s), and (2) assessing the feasibility of developing methods for estimating indirect costs associated with farm-related injuries. The specific aims for the psychosocial component included: 1) developing and pilot testing survey instruments and interview processes for identifying mid- and long-term psychosocial effects of serious farm injuries to youth, particularly with respect to competence and behavior, school achievement, and social interactions; and 2) determining the psychosocial effects of farm injury to youth on family functioning, including distancing, cohesion, and family interaction patterns. The study population included individuals who sought care for farm-related injuries at Marshfield Clinic and/or St. Joseph's Hospital in Marshfield, WI between November 1992 and December 1998. A total of 1,066 injury-event-persons were potentially eligible for the study, including 292 youths. The analytic data set included all injured youth (N=236 ambulatory treated and N=56 hospitalized) and 453 adult injured (N=352 ambulatory treated and N= 1 0 1 hospitalized). All hospitalized injured were included in study analyses. In addition, all ambulatory-treated youth and an approximate 50% random sample of the adult ambulatory-treated were included for analyses. The primary source of case identification was the Emergency Room Surveillance System operating at Marshfield Clinic/St. Joseph's Hospital. A secondary source of case identification was Marshfield Clinic's Urgent Care Department. Study data were developed from a variety of sources, including abstractions from medical records, electronic Clinic and Hospital administrative and financial data systems, and personal interviews (psychosocial component). Abstraction data were edited to include only injury-related health services. These data were linked electronically to provider charge data files, and were subsequently aggregated to visit and then injury episode levels. Charges were adjusted to approximate costs using institution-specific cost to charge ratios. All costs were normalized to calendar year 1996, using the appropriate physician and hospital components of the Consumer Price Index. Multivariate analysis of injury costs indicate that, for those less seriously injured, youth costs tend to be lower than adult costs, and much lower than older adult costs (adults age 65 years and older). Older adult costs were $456 per injury episode compared to $239 for youth, or about 90% higher. For the less seriously injured, machinery, animal, and fall-related injuries contributed to systematically higher costs. Only machinery-related injuries contributed to higher costs for the more seriously injured (i.e., hospitalized). Interaction terms between youth and body part injured and agent of injury did not indicate systemic effects in analyses of either the less or more seriously injured. These results indicate that youth, regardless of the severity of their injuries, tend to have lower costs of treatment than adults and that the effects of injury agents are more pronounced among the less seriously injured. Pilot psychosocial data for the study were developed from in-home interviews with 15 injured youth and their parent or the injured's parent alone. During the semi-structured, in-home interviews, which lasted about 45 minutes, a trained medical sociologist administered Achenbach's Child and Young Adult Behavior Checklist, respectively, and the Family Assessment Devise (Epstein, et al.). These instruments, which have established psychometric properties in non-farm injury populations, provided preliminary data on the injured's self-concept, school achievement, social interactions, and career aspirations. It also provided data on family functioning, distancing, cohesion, and family interaction patterns.
Marshfield Center for Health Services Research, Marshfield Medical Research and Education Foundation, 1000 North Oak Avenue, Marshfield, WI 54449