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Background with rationale Traumatic spinal injuries (TSI) include column fractures, spinal cord injury, or both. They are among the most severe injuries with potential long-term physical, psychological, and social consequences. Primary causes of TSIs are falls and motor vehicle crashes, however, mental illness and substance use are known to significantly increase all injury risk. Injury is also known to increase risks of mental deterioration and physical complications including self-harm and self-neglect. Main Aim We aimed to identify comorbid mental illness and/or substance use at incident TSI, quantifying associated costs and health service management of these inequities. Methods NSW record-linkage administrative data analyses (2013-2016) will determine accurate prevalence of mental illness and/or substance use disorder among all patients who sustained acute TSI during the study period. Using recurrent event analyses, we will estimate the contributions of mental illness and/or substance use disorder on the impact on hospital acquired complications (HAC), length of stay and costs; assessing records for social work and/or psychologist consultation. Results 13,489 individuals were hospitalised with acute TSI; 21% had either mental health and/or substance use diagnoses; 8.7% had both. These patients were more likely to have experienced falls or intentional self-harm, be male and have multiple comorbidity. Acute care stay and costs were on average twice that of patients with TSI without mental health and/or substance use diagnoses; additionally they were more than twice as likely to experience HACs. Only 56% of TSI patients with these comorbid conditions in the context of TSI, had documented social work or psychologist consultation. Conclusion Patients with mental illness and/or substance use disorder, experience significant health disparities that require concerted health system attention that should begin early in acute care.

BACKGROUNDPopulation aging proceeds with other socioeconomic developments, including educational expansion. Improvements in educational attainment lead to changes in demographic behaviors such as assortative mating, fertility, and the intergenerational transmission of education, which change the health of the elderly and the education of their offspring generation.OBJECTIVEWe examine such a jointly-changing process in South Korea.METHODSWe apply a recursive demographic model (Mare and Maralani 2006) by using the Korean Longitudinal Study of Ageing (KLoSA).RESULTSFirst, improvements in education lead to improvements in health among the elderly. Intermediate demographic factors make positive contributions to this improvement. Second, improvements in education lead to a decline in the ratios of offspring to the elderly because better-educated people have fewer children. However, this decrease is not substantial. Third, improvements in education increase the ratio of college-educated offspring to the unhealthy elderly because of improvements in both offspring's education and elderly health.CONCLUSIONThe results suggest that improvements in education change configurations of the elderly and their offspring's generations, mitigating the negative consequences of population aging, such as increasing burdens of elderly support.(ProQuest: ... denotes formulae omitted.)1. Introduction: Alternative ways to measure population agingPopulation aging is a worldwide phenomenon, with the median age of the world population forecast to rise to 38.1 years in 2050 from 26.7 years in 2000 (Goldstein 2009). Population aging has important socioeconomic consequences because the age structure of a population determines the ratio of net producers to net consumers in a population. Hence, most industrialized countries are concerned about negative consequences of population aging and have attempted to develop pronatal policies that balance the population's age structure (Kalwij 2010; McDonald 2002). Population aging, however, also occurs in tandem with other socioeconomic changes such as educational expansion and improvements in health, which may mitigate the consequences of rising dependency ratios. Skirbekk, Loichinger, and Weber (2012) proposed a new measure of population aging-the cognition-adjusted dependency ratio (CADR)-and showed that the ranking for degree of population aging depends upon the measures: whereas India has fewer elderly people per working-aging individual than the U.S., the U.S. has fewer cognitively-limited elderly people per working-age individual than India. There is also evidence that increasing human capital per capita may offset the loss of total economic product due to fertility decline in a population level (Lee and Mason 2010) and the cost of supporting an elderly population may be reduced as the health of the elderly has continued to improve over decades (Martin, Schoeni, and Andreski 2010). In other words, -population aging is intrinsic to the processes that bring us a highly-educated population and comfortable standards of living" (Lee and Mason 2010: 179). In this study, we examine changing joint configuration of the elderly and their offspring in terms of health and educational attainment by applying a demographic model.Accounting for the changing configurations of the elderly and the offspring generation is important in population aging. This has been largely overlooked, however, in previous research. Earlier studies found that the better-educated enjoy better health and survival chances in later life than do the less educated (e.g., Cutler and Lleras- Muney 2008; Elo and Preston 1996). Based on this positive educational gradient in health and survival chances, recent studies have used educational attainment in projecting the size of the elderly population in the future (Batljan, Lagergren, and Thorslund 2009; Batljan and Thorslund 2009; Joung et al. …

Objectives • To present an efficient privacy-protecting model (PRIDAL) for linking routine and identifiable patient-reported research data. • To describe the application of the PRIDAL model with within a major portfolio trial linking a range of health and demographic datasets pertaining to >230,000 patients, alongside >2,300 questionnaires. • To summarise the lessons learned from the application of the PRIDAL model. Approach The rise in availability, quality and use of routine health data has resulted in well-developed methods for anonymised linkage of data from multiple sources. However methods for combining identifiable data (e.g. patient-reported questionnaires) with routine anonymised data are not yet tried and tested. Linking these data presents opportunities to improve the feasibility and effectiveness of observational and experimental studies, but emerging data linkage processes must address the appropriate balance between data security and usability. The Process for Routine and Identifiable Data Linkage (PRIDAL) was devised to efficiently link routine hospital data and patient-reported quality of life and quality of care questionnaire data as part of the PRISMATIC trial (http://www.trialsjournal.com/content/14/1/301). This is a mixed methods progressive cluster randomised trial of the efficacy of an emergency admission risk prediction tool in primary care, funded by the NIHR HS&DR programme. PRIDAL was conceived by a group of specialists in e-trials, health informatics, information governance and process mapping who reviewed data sources, flows, owners, and security to develop a practical and intuitive process model. Results We will present the PRIDAL process model and describe its application in relation to the PRISMATIC study. We will demonstrate that the model achieves high data matching rates (>99%), and consider the lessons learnt from its application. Conclusions The linking of routine health and patient self-reported data presents a valuable opportunity in health research, but clear, replicable models, are needed to support ethical and practical data linkage. We present the fully tested PRIDAL model as a potential solution.