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Estimates of life expectancy for compensation after injury

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FOSW01 - The nature of questions arising in court that can be addressed via probability and statistical methods

When a compensation case arises from an injury, which might be caused by medical error or an industrial or traffic accident, the financial settlement will often depend on the life expectancy. Compensation might be for expected reduction in life time, or for the cost of additional care during the rest of the injured person's life.  Estimates based on particular injuries or individual factors might be requested.

Estimates of effects of injury and life style on mortality use a variety of data sources, with no common statistics. Many lawyers assume that a larger data set is always better than a smaller data set. Statisticians should address the questions 'What is the quality of data used?' and 'What are the biases?'. Assessments of the intended population, the accuracy of individual items, the completeness of follow-up and the precise inclusion and exclusion criteria have to be made and explained. An article on mortality after spinal cord injury used a database of 49,214 people, initially 50,661 people. Five restrictions, three of which were discussed, left 31,531 (62%) eligible people. The impact of excluding people with missing data on major covariates was not reported. I suggest that the detailed check-lists provide by the equator network are an important resource for evaluation (http://www.equator-network.org/).

For some claims, the effects of smoking, alcohol consumption, illegal substance use and anorexia or obesity have to be considered as well as the main motivation of the claim. Effect sizes might be given as hazard ratios, standardised mortality rates, from univariate or multivariate models. Approaches to estimating life expectancy which allow for these personal factors include using reported relative risks, hazard ratios and excess death rates to modify the death rates from national or regional life tables. I will discuss the challenges I have faced, both in estimation and in communicating results in court, and the solutions I have adopted.

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