Objective: To propose an incidence definition of back injury for epidemiologic studies using health care contacts.
Methods: Medical services, hospitalizations, and workers' compensation data were linked for a longitudinal database of health care contacts among a cohort of heavy-industry workers for trajectory, group-based analysis.
Results: During follow-up, 25.8% of workers had no health care contacts for back injury. Among workers with at least one contact, four trajectories were identified: one with a high probability of back injury during follow-up and three with episodic trajectories of increasing and decreasing probability of back injury.
Conclusions: Workers with no back injury history could be followed for incidence in cohort studies or as controls in case-control designs. Episodic groups could be followed for new episodes, providing they were free of health care contacts for back injury for at least 3 years.
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