Regional socioeconomic disparities in outcomes for workers with low back pain in the United States

Abstract

BackgroundAlthough regional socioeconomic (SE) factors have been associated with worse health outcomes, prior studies have not addressed important confounders or work disability.MethodsA national sample of 59 360 workers’ compensation (WC) cases to evaluate impact of regional SE factors on medical costs and length of disability (LOD) in occupational low back pain (LBP).ResultsLower neighborhood median household incomes (MHI) and higher state unemployment rates were associated with longer LOD. Medical costs were lower in states with more workers receiving Social Security Disability, and in areas with lower MHI, but this varied in magnitude and direction among neighborhoods. Medical costs were higher in more urban, more racially diverse, and lower education neighborhoods.ConclusionsRegional SE disparities in medical costs and LOD occur even when health insurance, health care availability, and indemnity benefits are similar. Results suggest opportunities to improve care and disability outcomes through targeted health care and disability interventions.

Why does the adverse effect of inappropriate MRI for LBP vary by geographic location? An exploratory analysis

“…Additionally, WC administrative data lack information about injury severity and level of functional disability. However, we accounted for low back injury severity (more severe, less severe) using a validated list of ICD-9 codes used in prior studies [8, 9, 47]. In the current study, low back injury severity was a significant predictor of LOD.…”

“…We included “neighborhood” inflation-adjusted median household income (MHI), quantified at census-tract level, which was found to be associated with LOD in cases with occupational LBP [9].…”

“…Prior studies have shown that length of disability (LOD) due to occupational LBP is associated with several factors. These include, individual characteristics (such as age, gender, tenure), physical demand of job and employer/work environment related characteristics [6, 7], regional factors such as state workers’ compensation (WC) policies [8] and residential area socioeconomic characteristics [9], and health care-related factors, primarily reflecting treatments that are inconsistent with accepted clinical guidelines. These include early opioid prescribing (within the first 15 days of seeking medical care), early magnetic resonance imaging (eMRI) scanning not adherent to evidence-based clinical guidelines (within the first 30 days of first registered medical visit for the current low back pain episode), prolonged or passive physical therapy, and other interventions not recommended by evidence-based clinical guidelines [10–13].…”

The Impact of Income Support Systems on Healthcare Quality and Functional Capacity in Workers with Low Back Pain: A Realist Review

“…One offered explanation was that where unemployment is high workers have difficulty finding alternative work that is less physically demanding [28]. Work-focussed healthcare is acknowledged as important for recovery among workers with LBP among workers with LBP, yet some clinicians do not address this.…”

Geographic variation in work disability burden: Identifying hotspots, coldspots, and associated sociodemographic factors

“…Injured workers tend to spend more time off work in socioeconomically disadvantaged areas where more people are off work and there are larger populations of ethnic minorities. 4,5 Rates of work-related injury vary across industry and occupation, 6,7 which are often geographically concentrated. And while the evidence on rurality is mixed, or suggests at the very least a highly complex dynamic, 8 people living in rural areas generally have longer work disability duration.…”