Race and outcomes in work-related back injuries

在美国，职业性腰背部损伤是一个重大的经济和医疗问题，已被证明难以持续有效地管理。最近的研究表明，腰痛的医疗管理是高度可变的。关于工人赔偿，还发现了与种族有关的评估和待遇方面的明显差异。虽然这项研究表明，对受伤的少数民族腰背受伤的潜在不公平待遇，但结果的代表性及其对安置后结果（即临床调整和就业能力）的影响仍然未知。本历史队列研究旨在确定职业保健中潜在的种族相关差异，确定问题的范围，并评估这种差异对定居后调整的影响。这项研究将调查一组非裔美国人和白人工人，他们在密苏里州腰背部受伤致残，并在2001年解决了残疾索赔。密苏里州工人赔偿部门（MODWC）的记录将用于确定密苏里州三个人口中心（圣路易斯市，圣路易斯县，杰克逊县）的索赔要求，密苏里州的大多数非洲裔美国人居住在那里。MODWC记录将提供与医疗费用、临时总残疾费用、永久残疾费用以及因工作导致错过工作时间的腰背部受伤的所有索赔人的其他与伤害有关的事项有关的数据。计算机辅助电话访谈方法将用于评估结算后的调整。回归模型将用于评估种族和法律代表的关系，单独和相互作用，与工人赔偿结果和和解后调整索赔人。历史队列设计将解决当前知识状态下的三个弱点。首先，它解决了种族、治疗和残疾结果之间的潜在联系，这是一个被忽视的领域。其次，论述了上述构念与索赔人和解后理算的关系。此外，由于样本量和设计，我们将能够分离潜在的混淆变量（例如，工作类型，社会经济地位）的影响，无论是单独的还是与种族的相互作用。最后，通过招募参与者所需的程序，该研究将建立一个受伤工人的队列，不仅可以在本研究期间监测其调整情况，而且可以在该时间框架之后监测其调整情况。如果在以后的时间点对队列进行检查，就有可能跟踪职业保健的真正长期结果。

Occupational low back injury, a significant economic and healthcare problem in the U.S., has proven difficult to manage consistently and cost-effectively. Recent studies have shown medical management of low back pain to be highly variable. With respect to Workers' Compensation, apparent disparities in assessment and treatment associated with race have also been identified. While this research demonstrated potentially inequitable treatment of injured minorities with low back injuries, the representativeness of the results and their implications for post-settlement outcomes (i.e., clinical adjustment and employability) remain unknown. This historical cohort study is designed to identify potential race-related disparities in occupational healthcare, define the scope of the problem, and to assess the impact of such disparities on post-settlement adjustment. The study will examine a cohort of African Americans and White workers who incurred disabling low back injuries in the State of Missouri and whose disability claims were settled during the year 2001. Records of the Missouri Division of Workers' Compensation (MODWC) will be used to identify those claims from three Missouri population centers (St. Louis City, St. Louis County, Jackson County), where the majority of African Americans in Missouri reside. MODWC records will provide data relevant to medical costs, temporary total disability costs, permanent disability costs, and other injury-related matters for all claimants with work-related low back injuries leading to missed work time. Computer Assisted Telephone Interviewing methods will be used to assess post-settlement adjustment. Regression models will be used to assess the relationship of race and legal representation, alone and in interaction, with Workers' Compensation outcomes and post-settlement adjustment of claimants. The historical cohort design will address three weaknesses in the present state of knowledge. First, it addresses potential associations between race, treatment, and disability outcomes, an area that has been neglected. Second, it addresses relations among the above constructs and the post-settlement adjustment of claimants. Moreover, because of the sample size and the design, we will be able to separate the effects of potentially confounding variables (e.g., job type, socioeconomic status), both alone and in interaction with race. Finally, by dint of the procedures needed to recruit participants, the study will establish a cohort of injured workers whose adjustment can be monitored not only at the time of this study, but potentially beyond that time frame. If the cohort is examined at a later point in time, it will be possible to track true long-term outcomes of occupational healthcare.