Racial disparity in treating occupational low back pain

治疗职业性腰痛的种族差异

• 批准号: 6976783
• 负责人: RAYMOND Caldwell TAIT
• 金额: $ 24.09万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-30 至 2009-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6976783
• 关键词: African American; age difference; backache; behavioral /social science research tag; caucasian American; clinical research; diagnostic tests; disability insurance; disease /therapy duration; drug administration rate /duration; gender difference; health care service evaluation; health disparity; health economics; health services research tag; human subject; human therapy evaluation; mathematical model; occupational hazard; occupational health /safety; outcomes research; patient care management; psychological adaptation; racial /ethnic difference; socioeconomics; statistics /biometry

DESCRIPTION (Provided by Applicant): An ongoing large-scale study (R01 HS 13087-01; PI: Tait RC) is investigating racial and socioeconomic disparities in long-term outcomes among Missouri workers who sustained work-related low back injuries. Data from that study show highly significant disparities in medical costs, disability payments, disability ratings, and long-term psychosocial and economic adjustment for African American (AA) relative to non-Hispanic white (nHw) claimants and for low SES claimants. A limitation of that study is that it does not address treatment and/or evaluation processes that mediate the relationship between racial/SES factors and outcomes. The proposed study will examine treatment and evaluation variables as a function of racial/SES factors and as predictors of outcome. 500 subjects (250 African American and 250 Caucasian) will be selected from the 1,475 subjects enrolled in the larger study. The two groups will be matched on age and gender. Treatment and evaluation data will be drawn from archives maintained by the Missouri Division of Workers' Compensation. These records contain treatment information from treating physicians, records and depositions from all physicians who provided independent medical examinations, and summary statements from administrative law judges. Evaluation and treatment data will be coded using previously established methods that have yielded reliable and valid ratings. These data then will be integrated into the dataset generated by the ongoing study of outcomes and used to predict those outcomes. Multiple linear regression analyses will be used to evaluate relations among process and outcome variables, including path analysis for continuous variables and logistic regression for dichotomous or categorical variables. This study will address two important aims. The first will evaluate the influence of race and SES on treatment and evaluation processes, such as diagnostic testing/interpretation, treatment decisions, timing of treatment, duration and intensity of treatment, physician ratings of pain, and other factors that reflect medical decision-making: The second will address relations between treatment and evaluation processes, as a function of race and SES, on worker's compensation outcomes, including disability ratings, permanent and temporary disability payments, medical costs, and psychosocial adjustment. Together, these aims will highlight treatment and evaluation processes that mediate the relationship between race/SES and work injury outcomes and provide direction for future intervention studies aimed at addressing those processes.

描述（由申请人提供）：一项正在进行的大规模研究（R 01 HS 13087-01; PI：Tait RC）正在调查密苏里州因工作导致腰部受伤的工人长期结局中的种族和社会经济差异。该研究的数据显示，非裔美国人（AA）相对于非西班牙裔白色（nHw）索赔人和低SES索赔人在医疗费用，残疾支付，残疾评级和长期心理社会和经济调整方面存在非常显著的差异。该研究的一个局限性是，它没有解决调解种族/SES因素和结果之间的关系的治疗和/或评估过程。拟议的研究将检查治疗和评估变量作为种族/SES因素的函数和结果的预测因素。将从入组大型研究的1，475例受试者中选择500例受试者（250例非洲裔美国人和250例高加索人）。这两组将在年龄和性别上相匹配。 治疗和评估数据将来自密苏里州工人赔偿司保存的档案。这些记录包括治疗医生的治疗信息、提供独立医疗检查的所有医生的记录和证词以及行政法法官的简要陈述。 评价和治疗数据将使用先前建立的方法进行编码，这些方法已产生可靠和有效的评级。然后，这些数据将被整合到正在进行的结果研究所生成的数据集中，并用于预测这些结果。将使用多元线性回归分析评价过程和结局变量之间的关系，包括连续变量的路径分析和二分或分类变量的逻辑回归。这项研究将涉及两个重要目标。第一个将评估种族和SES对治疗和评估过程的影响，例如诊断测试/解释，治疗决策，治疗时机，治疗的持续时间和强度，医生对疼痛的评级，以及反映医疗决策的其他因素：第二部分将讨论作为种族和社会经济地位的函数的待遇和评估过程之间的关系，以及工人的补偿结果，包括残疾等级、永久和临时残疾津贴、医疗费用和心理社会调整。总之，这些目标将突出治疗和评估过程，调解种族/SES和工伤结果之间的关系，并为未来的干预研究提供方向，旨在解决这些过程。