Race and outcomes in work-related back injuries

职业性腰背损伤在美国是一个严重的经济和医疗问题，事实证明，很难始终如一地进行经济有效的管理。最近的研究表明，下腰痛的医疗管理是高度可变的。关于工人补偿，也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，对患有腰部损伤的受伤少数群体可能存在不公平待遇，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。这项历史队列研究旨在确定职业卫生保健中与种族有关的潜在差距，确定问题的范围，并评估这种差距对定居后调整的影响。这项研究将调查密苏里州遭受致残腰伤的非裔美国人和白人工人的队列，他们的残疾索赔在2001年得到解决。密苏里州工人补偿部(MODWC)的记录将被用来识别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，密苏里州大多数非裔美国人居住在那里。MODWC记录将为所有因工伤导致错过工作时间的索赔人提供有关医疗费用、临时总伤残费用、永久伤残费用和其他与伤害有关的事项的数据。将使用计算机辅助电话面谈方法来评估结算后调整情况。将使用回归模型单独评估种族和法律代表与工人赔偿结果和索赔人结算后调整之间的关系。历史队列设计将解决目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关联，这是一个被忽视的领域。第二，它涉及上述结构之间的关系和索赔人结算后的调整。此外，由于样本量和设计，我们将能够分离潜在混杂变量(例如，工作类型、社会经济地位)的影响，无论是单独的影响还是与种族的相互作用。最后，借助招募参与者所需的程序，这项研究将建立一个受伤工人队列，他们的适应情况不仅可以在本研究期间监测，而且可能在该时间框架之后监测。如果在以后的时间点对队列进行检查，就有可能跟踪职业卫生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.