Sex and gender disparity in pathology, disability, referral pattern, and wait time for surgery in workers with shoulder injury

Abstract

BackgroundThe role of sex as an important biological determinant of vulnerability to sustaining injury and gender as a social determinate of access to resources, referral for medical care and perceived disability remains conflicted in injured workers. The purpose of this study was to examine sex and gender disparity following a compensable work-related shoulder injury.MethodsThis study involved cross-sectional analyses of data of two independent samples of workers with shoulder injury. Measures of disability and pain were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Numerical Pain Rating Scale (NPRS) for patients seen at an Early Shoulder Physician Assessment (ESPA) program and the American Shoulder and Elbow Surgeons (ASES) assessment form and Visual Analogue Scale (VAS) for the sample who underwent surgery.ResultsThe files of 1000 (443 females, 557 men) consecutive patients seen at an ESPA program and 150 (44 females, and 106 men) consecutive patients who underwent rotator cuff surgery (repair or decompression) were reviewed. Significant gender disparity was observed in the referral pattern of injured workers seen at the ESPA program who were referred for surgical consultation (22 vs. 78 % for females and males respectively, p < 0.0001). The independent rotator cuff surgical group had a similar gender discrepancy (29 % vs. 71 %, p < 0.0001). The timeframe from injury to surgery was longer in women in the surgical group (p = 0.01). As well, women waited longer from the date of consent to date of surgery (p = 0.04). Women had higher incidence of repetitive injuries (p = 0.01) with men reporting higher incidence of falls (p = 0.01). Women seen at the ESPA program were more disabled than men (p = 0.02). Women in both samples had a higher rate of medication consumption than men (p = 0.01 to <0.0001). Men seen at the ESPA program had a higher prevalence of full thickness rotator cuff tears (p < 0.0001) and labral pathology (p = 0.01). However, these pathologies did not explain gender disparity in the subsample of ESPA who were referred for surgical consultation or those who had surgery.ConclusionsSex and gender disparity exists in workers with shoulder injuries and is evident in the mechanism of injury, perceived disability, medication consumption, referral pattern, and wait time for surgery.

Specialty Differences in Initial Evaluation of Patients With Non-Acute Musculoskeletal Pain

“…Being less familiar with patients and the course of their medical issues could serve as a reason that may influence the ordering of imaging. The increased relative odds among women conflicts with other studies showing that women's pain complaints are taken less seriously 39,40 but is in line with previous research showing women receive more medical care. 40,41 Orthopedic surgeons had 3 times increased relative odds of ordering any imaging compared with family physicians, which is inconsistent with studies of MRI use.…”

“…The increased relative odds among women conflicts with other studies showing that women's pain complaints are taken less seriously 39,40 but is in line with previous research showing women receive more medical care. 40,41 Orthopedic surgeons had 3 times increased relative odds of ordering any imaging compared with family physicians, which is inconsistent with studies of MRI use. Specifically, orthopedic surgeons and primary care physicians made equivalent use of MRI; however, imaging ordered by orthopedic surgeons led to higher rates of surgical interventions.…”

Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study

“…We detected a higher screening score for women, but higher scores for information provision, referral, and participation in PCRPs for men. Gender disparity in the use of cancer rehabilitation care and other healthcare services has been noted before in the literature [ 83 , 107 – 109 ].…”

Work-Related and Personal Factors in Shoulder Disorders Among Electronics Workers

“…rotator cuff syndrome) than men, possibly re ecting both biological predisposition and exposure to workrelated repetitive biomechanical constraints [25,33]. The biological distinctions between men and women, including anatomy, strength, hormones, neuromuscular control, and musculoskeletal exibility [46], suggest a different vulnerability to these work-related risk factors of shoulder disorder. In the association between force and shoulder symptoms was not found for women.…”