Racial disparity in treating occupational low back pain

描述(由申请人提供)：一项正在进行的大规模研究(R01 HS 13087-01；PI：TAIT RC)正在调查密苏里州遭受工伤的工人的种族和社会经济差异。这项研究的数据显示，非洲裔美国人(AA)与非西班牙裔白人(NHW)索赔人和低社会保障索赔人在医疗费用、残疾赔偿金、残疾评级以及长期心理社会和经济调整方面存在非常显著的差异。这项研究的一个局限性是，它没有涉及调解种族/SES因素与结果之间关系的治疗和/或评估过程。这项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，并作为结果的预测因素。500名受试者(250名非裔美国人和250名高加索人)将从这项更大规模的研究中招募的1475名受试者中挑选出来。这两组人将在年龄和性别上匹配。治疗和评估数据将从密苏里州工人补偿部保存的档案中提取。这些记录包括治疗医生的治疗信息，提供独立体检的所有医生的记录和证词，以及行政法法官的简要陈述。评估和治疗数据将使用先前建立的方法进行编码，这些方法产生了可靠和有效的评级。然后，这些数据将被整合到正在进行的结果研究产生的数据集，并用于预测这些结果。多元线性回归分析将用于评估过程和结果变量之间的关系，包括连续变量的通径分析和二分或分类变量的Logistic回归。这项研究将解决两个重要目标。第一个将评估种族和SES对治疗和评估过程的影响，如诊断测试/解释、治疗决定、治疗时间、治疗持续时间和强度、医生对疼痛的评级以及其他反映医疗决策的因素；第二个将讨论作为种族和SES的功能的治疗和评估过程之间的关系，对工人补偿结果的影响，包括残疾评级、永久和临时残疾付款、医疗费用和心理社会调整。总之，这些目标将突出调解种族/社会经济状况和工伤结果之间关系的治疗和评估过程，并为旨在解决这些过程的未来干预研究提供方向。

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.