Racial disparity in treating occupational low back pain

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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. '