Racial and Ethnic Inequities in the Return-to-Work of Workers Experiencing Injury or Illness: A Systematic Review

Abstract

Purpose Non-White workers face more frequent, severe, and disabling occupational and non-occupational injuries and illnesses when compared to White workers. It is unclear whether the return-to-work (RTW) process following injury or illness differs according to race or ethnicity. Objective To determine racial and ethnic differences in the RTW process of workers with an occupational or non-occupational injury or illness. Methods A systematic review was conducted. Eight academic databases - Medline, Embase, PsycINFO, CINAHL, Sociological Abstracts, ASSIA, ABI Inform, and Econ lit - were searched. Titles/abstracts and full texts of articles were reviewed for eligibility; relevant articles were appraised for methodological quality. A best evidence synthesis was applied to determine key findings and generate recommendations based on an assessment of the quality, quantity, and consistency of evidence. Results 15,289 articles were identified from which 19 studies met eligibility criteria and were appraised as medium-to-high methodological quality. Fifteen studies focused on workers with a non-occupational injury or illness and only four focused on workers with an occupational injury or illness. There was strong evidence indicating that non-White and racial/ethnic minority workers were less likely to RTW following a non-occupational injury or illness when compared to White or racial/ethnic majority workers. Conclusions Policy and programmatic attention should be directed towards addressing racism and discrimination faced by non-White and racial/ethnic minority workers in the RTW process. Our research also underscores the importance of enhancing the measurement and examination of race and ethnicity in the field of work disability management.

Best Practices in Documenting and Coding High-Value Care in Workers’ Compensation Encounters—ACOEM Guidance Statement

“…24 Less well studied are potential differences in outcomes based on race or ethnicity, with one systematic review finding worse return-towork outcomes for non-White and racial/ethnic minority workers for nonoccupational disabling conditions, but with insufficient research on such disparities in WC conditions. 29 Understanding the reasons for this gap between outcomes in group health and WC will point us to opportunities to apply prevention principles to patients treated for work injuries. Although not all these risk factors are under the control of the treating clinician, there is an opportunity to mitigate many of these risk factors for poor outcomes by assessing and documenting the critical elements particular to WC care.…”