Quality of Life Research

, Volume 23, Issue 1, pp 119–127 | Cite as

The association between motor vehicle injuries and health-related quality of life: a longitudinal study of a population-based sample in the United States

  • Suliman Alghnam
  • Mari Palta
  • Patrick L. Remington
  • John Mullahy
  • Maureen S. Durkin



As many as 3 million US residents are injured in traffic-related incidents every year leaving many victims with disabling conditions. To date, limited numbers of studies have examined the effects of traffic-related injuries on self-reported health. This study aims to examine the association between health-related quality of life (HRQOL) and traffic-related injuries longitudinally in a nationally representative sample of US adult population.


This is a longitudinal study of adult participants (age ≥18) from seven panels (2000–2007) of the Medical Expenditure Panel Survey. The dependent variables included the physical and mental components of the SF-12, a measure of self-reported health. The outcome was assessed twice during the follow-up period: round 2 (~4–5 months into the study) and round 4 (~18 months into the study) for 62,298 individuals. Two methods estimate the association between traffic-related injuries and HRQOL: a within person change using paired tests and a between person change using multivariable regression adjusting for age, sex, income and educational level.


Nine hundred and ninety-three participants reported traffic-related injuries during the follow-up period. Compared to their pre-crash HRQOL, these participants lost 2.7 of the physical component score while their mental component did not change. Adjusted results showed significant deficits in the physical component (−2.84, p value = <.001) but not the mental component (−0.07, p value = .83) of HRQOL after controlling for potential confounders.


Traffic injuries were significantly associated with the physical component of HRQOL. These findings highlight the individual and societal burden associated with motor vehicle crash-related disability in the United States.


Motor vehicle crashes SF-12 Health-related quality of life Injuries 


  1. 1.
    Road Safety Status; World Health Organization website. Accessed November 5. http://www.who.int/violence_injury_prevention/road_safety_status/2009/en/index.html.
  2. 2.
    Murray, C. J., Vos, T., & Lozano, R. N. M. (2013). Global burden of disease. (Seatle, 2013) at http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-2010-change-leading-causes-and-risks-between-1990-and-2010?cr=risk&metric=DALY.
  3. 3.
    National Highway Traffic Safety Administration [NHTSA]. (2003). Motor vehicle traffic crash injury and fatality estimates: 2002 early assessment. (Report No. DOT HS 809 586). Washington, DC: U.S. Department of Transportation.Google Scholar
  4. 4.
    Shults, R. A., Jones, B. H., Kresnow, M. J., Langlois, J. A., & Guerrero, J. L. (2004). Disability among adults injured in motor-vehicle crashes in the United States. Journal of Safety Research, 35(4), 447–452.PubMedCrossRefGoogle Scholar
  5. 5.
    Fu, A. Z., Qiu, Y., Radican, L., & Luo, N. (2011). Marginal differences in health-related quality of life of diabetic patients with and without macrovascular comorbid conditions in the United States. Quality of Life Research, 20(6), 825–832.PubMedCrossRefGoogle Scholar
  6. 6.
    Ringdal, M., Plos, K., Lundberg, D., Johansson, L., & Bergbom, I. (2009). Outcome after injury: Memories, health-related quality of life, anxiety, and symptoms of depression after intensive care. Journal of Trauma, 66, 1226–1233.PubMedCrossRefGoogle Scholar
  7. 7.
    Holbrook, T. L., Anderson, J. P., Sieber, W. J., Browner, D., & Hoyt, D. B. (1999). Outcome after major trauma: 12-month and 18-month follow-up results from the Trauma Recovery Project. Journal of Trauma, 46, 765–771.PubMedCrossRefGoogle Scholar
  8. 8.
    Michaels, A. J., Michaels, C. E., Smith, J. S., Moon, C. H., Peterson, C., & Long, W. B. (2000). Outcome from injury: General health, work status, and satisfaction 12 months after trauma. Journal of Trauma, 48, 841–848.PubMedCrossRefGoogle Scholar
  9. 9.
    Holtslag, H. R., Van Beeck, E. F., Lindeman, E., & Leenen, L. P. (2007). Determinants of long-term functional consequences after major trauma. Journal of Trauma, 62, 919–927.PubMedCrossRefGoogle Scholar
  10. 10.
    Aitken, L. M., Davey, T. M., Ambrose, J., Connelly, L. B., Swanson, C., & Bellamy, N. (2007). Health outcomes of adults 3 months after injury. Injury, 38, 19–26.PubMedCrossRefGoogle Scholar
  11. 11.
    Christensen, M. C., Banner, C., Lefering, R., Vallejo-Torres, L., & Morris, S. (2011). Quality of life after severe trauma: Results from the global trauma trial with recombinant factor VII. Journal of Trauma, 70, 1524–1531.PubMedCrossRefGoogle Scholar
  12. 12.
    Black, J. A., Herbison, G. P., Lyons, R. A., Polinder, S., & Derrett, S. (2011). Recovery after injury: An individual patient data meta-analysis of general health status using the EQ-5D. Journal of Trauma, 71, 1003–1010.PubMedCrossRefGoogle Scholar
  13. 13.
    Alonso, J., Ferrer, M., Gandek, B., Ware, J. E., Jr, Aaronson, N. K., Mosconi, P., et al. (2004). Health-related quality of life associated with chronic conditions in eight countries: Results from the International Quality of Life Assessment (IQOLA) project. Quality of Life Research, 13(2), 283–298.PubMedCrossRefGoogle Scholar
  14. 14.
    Haley, W. E., Roth, D. L., Kissela, B., Perkins, M., & Howard, G. (2011). Quality of life after stroke: A prospective longitudinal study. Quality of Life Research, 20(6), 799–806.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Read, K. M., Kufera, J. A., Dischinger, P. C., Kerns, T. J., Ho, S. M., Burgess, A. R., et al. (2004). Life-altering outcomes after lower extremity injury sustained in motor vehicle crashes. Journal of Trauma, 57(4), 815–823.PubMedCrossRefGoogle Scholar
  16. 16.
    Brasel, K. J., Deroon-Cassini, T., & Bradley, C. T. (2010). Injury severity and quality of life: Whose perspective is important? Journal of Trauma, 68(2), 263–268.PubMedCrossRefGoogle Scholar
  17. 17.
    Andersen, D., Ryb, G., Dischinger, P., Kufera, J., & Read, K. (2010). Self-reported health indicators in the year following a motor vehicle crash: A comparison of younger versus older subjects. Annals of Advances in Automotive Medicine, 54, 359–367.PubMedCentralPubMedGoogle Scholar
  18. 18.
    Pons-Villanueva, J., Rodríguez de Armenta, M. J., Martínez-González, M. A., & Seguí-Gómez, M. D. (2011). Longitudinal assessment of quality of life and its change in relation to motor vehicle crashes: The SUN (Seguimiento Universidad de Navarra) Cohort. Journal of Trauma, 70(5), 1072–1077.PubMedCrossRefGoogle Scholar
  19. 19.
    Ameratunga, S. N., Norton, R. N., Connor, J. L., Robinson, E., Civil, I., Coverdale, J., Bennett, D., & Jackson, R. T. (2006). A population-based cohort study of longer-term changes in health of car drivers involved in serious crashes. Annals of Emergency Medicine, 48(6), 729–36. Epub 2006 Sep 25.Google Scholar
  20. 20.
    Nyman, J. A., Barleen, N. A., & Kirdruang, P. (2008). Quality-adjusted life years lost from nonfatal motor vehicle accident injuries. Medical Decision Making, 28(6), 819–828.PubMedCrossRefGoogle Scholar
  21. 21.
    U.S. Department of Health and Human Services. (2012). Healthy People 2020; Accessed May 31, 12: http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx.
  22. 22.
    Agency for Healthcare Research and Quality web site. Medical Expenditure Panel Survey. Available from: http://www.meps.ahrq.gov/mepsweb/. Accessed October 15, 2011.
  23. 23.
    Ware, J., et al. (1996). How to score the SF-12 physical and mental health summary scales, 2nd ed. Lincoln RI: Quality Metric, Inc., and the Health Assessment Lab.Google Scholar
  24. 24.
    Ware, J., Kosinski, M., Turner-Bowker, D., & Gandek, B. (2002). SF12v2: How to score version 2 of the SF-12 health survey. Lincoln, RI: QualiyMetric Incorporated.Google Scholar
  25. 25.
    The EuroQol Group. Available at: http://www.euroqol.org/download/ref.pdf. Accessed November 11, 2011.
  26. 26.
    McDowell, I., & Newell, C. (1996). Measuring health: A guide to Rating Scales and Questionnaires (2nd ed.). New York: Oxford University Press.Google Scholar
  27. 27.
    Thomas, D. R., & Rao, J. N. K. (1987). Small sample comparison of level and power for simple goodness-of-fit statistics under cluster sampling. Journal of American Statistical Association, 82, 630–636.CrossRefGoogle Scholar
  28. 28.
    Holbrook, T. L., Hoyt, D. B., Coimbra, R., Potenza, B., Sise, M. J., Sack, D. I., et al. (2007). Trauma in adolescents causes long-term marked deficits in quality of life: Adolescent children do not recover preinjury quality of life or function up to two years postinjury compared to national norms. Journal of Trauma, 62(3), 577–583.PubMedCrossRefGoogle Scholar
  29. 29.
    Holbrook, T. L., & Hoyt, D. B. (2004). The impact of major trauma: Quality-of-life outcomes are worse in women than in men, independent of mechanism and injury severity. Journal of Trauma, 56(2), 284–290.PubMedCrossRefGoogle Scholar
  30. 30.
    Ellis, J. J., Eagle, K. A., Kline-Rogers, E. M., & Erickson, S. R. (2005). Validation of the EQ-5D in patients with a history of acute coronary syndrome. Current Medical Research and Opinion [0300-7995] Ellis 21(8), 1209–1216.Google Scholar
  31. 31.
    Sullivan, P. W., & Ghushchyan, V. (2006). Preference-based EQ-5D index scores for chronic conditions in the United States. Medical Decision Making, 26(4), 410–420.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Ponsford, J., Hill, B., Karamitsios, M., & Bahar-Fuchs, A. (2008). Factors influencing outcome after orthopedic trauma. Journal of Trauma, 64(4), 1001–1009.PubMedCrossRefGoogle Scholar
  33. 33.
    Yang, Z., Lowe, A. J., de la Harpe, D. E., & Richardson, M. D. (2010). Factors that predict poor outcomes in patients with traumatic vertebral body fractures. Injury, 41(2), 226–230. Epub 2009 Nov 3.Google Scholar
  34. 34.
    Hu, X.-B., Feng, Z., Fan, Y.-C., Xiong, Z.-Y., & Huang, Q.-W. (2012). Health-related quality-of-life after traumatic brain injury: A 2-year follow-up study in Wuhan, China. Brain Injury, 26(2), 183–187.PubMedCrossRefGoogle Scholar
  35. 35.
    Sampalis, S., Liberman, M., Davis, L., Angelopoulos, J., Longo, N., Sampalis, F., et al. (2006). Functional status and quality of life in survivors of injury treated at tertiary trauma centers: What are we neglecting? Journal of Trauma, 60(4), 806–813.PubMedCrossRefGoogle Scholar
  36. 36.
    Jia, H., & Lubetkin, E. I. (2005). The impact of obesity on health-related quality-of-life in the general adult US population. Journal of Public Health (Oxford), 27(2), 156–164. Epub 2005 Apr 8.Google Scholar
  37. 37.
    Heeringa, S., West, B., & Berglund, P. (2010). Applied survey data analysis (pp. 140–144). Boca Raton: Chapman & Hall/CRC, Taylor & Francis Group.Google Scholar
  38. 38.
    Edelman, D., Olsen, M. K., Dudley, T. K., et al. (2002). Impact of diabetes screening on quality of life. Diabetes Care, 25, 1022–1026.PubMedCrossRefGoogle Scholar
  39. 39.
    Cheak-Zamora, N. C., Wyrwich, K. W., & McBride, T. D. (2009). Reliability and validity of the SF-12v2 in the Medical Expenditure Panel Survey. Quality Life Research, 18, 727–735.CrossRefGoogle Scholar
  40. 40.
    Khanna, D., Maranian, P., Palta, M., Kaplan, R. M., Hays, R. D., Cherepanov, D., et al. (2011). Health-related quality of life in adults reporting arthritis: Analysis from the National Health Measurement Study. Quality of Life Research, 20(7), 1131–1140.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    MacKenzie, E. J., McCarthy, M. L., Ditunno, J. F., Forrester-Staz, C., Gruen, G. S., Marion, D. W., et al. (2002). Pennsylvania Study Group on Functional Outcomes Following Trauma. Using the SF-36 for characterizing outcome after multiple trauma involving head injury. Journal of Trauma, 52(3), 527–534.PubMedCrossRefGoogle Scholar
  42. 42.
    Tøien, K., Bredal, I. S., Skogstad, L., Myhren, H., & Ekeberg, O. (2011). Health related quality of life in trauma patients. Data from a one-year follow up study compared with the general population. Scand Journal of Trauma Resuscitation Emergency Medicine, 19, 22.CrossRefGoogle Scholar
  43. 43.
    Kiely, J. M., Brasel, K. J., Guse, C. E., & Weigelt, J. A. (2006). Correlation of SF-12 and SF-36 in a trauma population. Journal of Surgical Research, 132(2), 214–218.PubMedCrossRefGoogle Scholar
  44. 44.
    Langley, J., Derrett, S., Davie, G., Ameratunga, S., & Wyeth, E. (2011). A cohort study of short-term functional outcomes following injury: The role of pre-injury socio-demographic and health characteristics, injury and injury-related healthcare. Health Qual Life Outcomes, 9, 68.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Glymour, M. M., Weuve, J., Berkman, L. F., Kawachi, I., & Robins, J. M. (2005). When is baseline adjustment useful in analyses of change? An example with education and cognitive change. American Journal of Epidemiology, 162(3), 267–278.PubMedCrossRefGoogle Scholar
  46. 46.
    Vittinghoff, E., Glidden, D. V., Shiboski, S. C., & Charles, E. (2005). McCulloch regression methods in biostatistics: Linear, logistic, survival, and repeated measures models (pp. 33, 263–266). New York: Springer Science + Business Media Inc.Google Scholar
  47. 47.
    Holder, Y., Peden, M., Krug, E. G., et al. (2004). Injury surveillance guidelines. Geneva, Switzerland: World Health Organization.Google Scholar
  48. 48.
    Haider, A. H., Chang, D. C., Haut, E. R., Cornwell, E. E., I. I. I., & Efron, D. T. (2009). Mechanism of injury predicts patient mortality and impairment after blunt trauma. Journal of Surgical Research, 153, 138–142.PubMedCrossRefGoogle Scholar
  49. 49.
    Robertson, L. (2007). Injury epidemiology, (3rd ed., p. 14). New York: Oxford University Press.Google Scholar
  50. 50.
    Overgaard, M., Høyer, C. B., & Christensen, E. F. (2011). Long-term survival and health-related quality of life 6 to 9 years after trauma. Journal of Trauma, 71(2), 435–441.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Suliman Alghnam
    • 1
    • 2
  • Mari Palta
    • 1
  • Patrick L. Remington
    • 1
  • John Mullahy
    • 1
  • Maureen S. Durkin
    • 1
  1. 1.University of WisconsinMadisonUSA
  2. 2.King Abdullah International Medical Research CenterKing Saud Bin Abdulaziz University for Health Sciences, KAIMRC, KSAU-HSRiyadhSaudi Arabia

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