Race and outcomes in work-related back injuries

职业性腰部损伤是美国一个重要的经济和医疗问题，已证明很难进行一致和具有成本效益的管理。 最近的研究表明，下背痛的医疗管理是高度可变的。 在工人赔偿方面，还发现了与种族有关的评估和待遇方面的明显差异。 虽然这项研究证明了对腰部受伤的少数民族的潜在不公平待遇，但结果的代表性及其对解决后结果的影响（即，临床适应和就业能力）仍然未知。 这项历史性队列研究旨在确定职业医疗保健中潜在的种族相关差异，确定问题的范围，并评估这种差异对定居后调整的影响。 这项研究将检查一组在密苏里州发生致残性腰部损伤的非裔美国人和白色工人，他们的伤残索赔在2001年得到解决。 密苏里州工人赔偿司（MODWC）的记录将用于确定来自三个密苏里州人口中心（圣路易斯市、圣路易斯县、杰克逊县）的索赔，密苏里州的大多数非裔美国人居住在这些中心。 MODWC记录将提供与医疗费用、临时完全残疾费用、永久残疾费用以及所有因工伤导致误工的腰痛索赔人的其他伤害相关事项有关的数据。 将使用计算机辅助电话访谈方法评估定居后的调整。 回归模型将被用来评估种族和法律的代表性的关系，单独和相互作用，与工人的赔偿结果和索赔人的和解后调整。 历史队列设计将解决目前知识状况中的三个弱点。 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，它处理了上述结构与索赔人的结算后调整之间的关系。此外，由于样本量和设计，我们将能够分离潜在混杂变量的影响（例如，工作类型，社会经济地位），无论是单独还是与种族的相互作用。 最后，通过招募参与者所需的程序，本研究将建立一个受伤工人的队列，其调整不仅可以在本研究时进行监测，而且可能超过该时间范围。 如果在稍后的时间点对队列进行检查，则有可能跟踪职业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.