Examining the effect of the injury definition on risk factor analysis in circus artists

A secondary data analysis of a prospective cohort study was conducted to explore how different definitions of injury affect the results of risk factor analyses. Modern circus artists (n=1281) were followed for 828,547 performances over a period of 49 months (2004-2008). A univariate risk factor analysis (age, sex, nationality, artist role) estimating incidence rate ratios (IRR) with 95% confidence intervals (95% CI) was conducted using three injury definitions: (1) medical attention injuries, (2) time-loss injuries resulting in ≥1 missed performances (TL-1) and (3) time-loss injuries resulting in >15 missed performances (TL-15). Results of the risk factor analysis were dependent on the injury definition. Sex (females to male; IRR=1.13, 95% CI; 1.02-1.25) and age over 30 (<20 years to >30 years; IRR=1.37, 95% CI; 1.07-1.79) were risk factors for medical attention injuries only. Risk of injury for Europeans compared with North Americans was higher for TL-1 and TL-15 injuries compared with medical attention injuries. Finally, non-sudden load artists (low-impact acts) were less likely than sudden load artists (high-impact acts) to have TL-1 injuries, but the risk of medical attention injuries was similar. The choice of injury definition can have effects on the magnitude and direction of risk factor analyses.