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）正在调查密苏里州因工作而遭受腰背部损伤的工人的长期结果的种族和社会经济差异。该研究的数据显示，与非西班牙裔白人（nHw）索赔人和低SES索赔人相比，非裔美国人（AA）在医疗费用、残疾支付、残疾评级和长期社会心理和经济调整方面存在显著差异。该研究的一个局限性是，它没有解决调解种族/社会地位因素与结果之间关系的治疗和/或评估过程。拟议的研究将审查治疗和评价变量作为种族/社会经济地位因素的作用和作为结果的预测因素。500名受试者（250名非裔美国人和250名白种人）将从1475名受试者中选出。这两组将根据年龄和性别进行匹配。治疗和评估数据将从密苏里州工人赔偿司保存的档案中提取。这些记录载有主治医生的治疗资料、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产生可靠和有效评级的方法进行编码。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中，并用于预测这些结果。多元线性回归分析将用于评估过程变量和结果变量之间的关系，包括连续变量的路径分析和二分类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社会经济地位对治疗和评估过程的影响，如诊断测试/解释、治疗决定、治疗时机、治疗持续时间和强度、医生对疼痛的评分，以及反映医疗决策的其他因素；第二部分将讨论治疗和评估过程之间的关系，作为种族和社会经济地位的函数，对工人赔偿结果的影响，包括残疾等级、永久和临时残疾赔偿、医疗费用和心理社会调整。总之，这些目标将强调调解种族/社会地位和工伤结果之间关系的治疗和评估过程，并为未来旨在解决这些过程的干预研究提供方向。

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.