Racial disparity in treating occupational low back pain

一项正在进行的大规模研究（R 01 HS 13087-01; PI：Tait RC）正在调查种族和社会经济 密苏里州工人中长期结果的差异，这些工人遭受了与工作有关的腰部损伤。 该研究的数据显示，在医疗费用、残疾补助、残疾 评级，以及非洲裔美国人（AA）相对于非裔美国人的长期心理和经济调整。 西班牙裔白色（nHw）索赔人和低SES索赔人。这项研究的一个局限性是， 解决调解种族/社会经济地位因素之间关系的治疗和/或评估过程， 结果。拟议的研究将检查治疗和评估变量作为种族/SES的函数 作为结果的预测因素。将有500例受试者（250例非裔美国人和250例高加索人） 从参加大型研究的1,475名受试者中选出。这两组将在年龄上相匹配， 性别.治疗和评价数据将从密苏里州分部保存的档案中提取。 工人赔偿。这些记录包含来自治疗医师的治疗信息、记录和 提供独立体检的所有医生的证词，以及简要陈述 行政法法官。评价和治疗数据将使用先前建立的 方法已经产生了可靠和有效的评级。然后，这些数据将被集成到数据集中 由正在进行的结果研究产生，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，包括路径分析 对于连续变量和二分或分类变量的逻辑回归。本研究将 实现两个重要目标。第一项将评估种族和社会经济地位对治疗的影响， 评估过程，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- 第二部分将处理治疗和评价过程之间的关系，作为一种功能， 种族和社会经济地位，对工人的赔偿结果，包括残疾评级，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 调解种族/社会经济地位和工伤之间关系的治疗和评估过程 并为旨在解决这些问题的未来干预研究提供方向。'

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. '