Clinical and Social Predictors of Application for Social Security Disability Insurance by Workers??? Compensation Claimants With Low Back Pain

Chibnall, John T.; Tait, Raymond C.; Andresen, Elena M.; Hadler, Nortin M.

doi:10.1097/01.jom.0000214357.14677.5a

Cited by 18 publications

(13 citation statements)

References 40 publications

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“…In particular, lower SES was associated with poorer long‐term adjustment even after controlling for baseline adjustment. Race was predictive of baseline adjustment and the WC process factor, a finding consistent with previous studies of this cohort [8,27,53–55], as well as long‐term adjustment as mediated through lower SES and poorer baseline adjustment. Thus, the associations of race were somewhat attenuated 6 years after claim settlement, whereas the significance of the SES association remained, although with a somewhat reduced magnitude over the long term.…”

Section: Discussionsupporting

confidence: 89%

Long-Term Adjustment to Work-Related Low Back Pain: Associations with Socio-demographics, Claim Processes, and Post-Settlement Adjustment

Chibnall

Tait

2009

Pain Med

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Section: Discussionsupporting

confidence: 89%

Long-Term Adjustment to Work-Related Low Back Pain: Associations with Socio-demographics, Claim Processes, and Post-Settlement Adjustment

Chibnall

Tait

2009

Pain Med

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“…One could conclude that Black patients received more consistent care, whereas White patients received variable care and in some instances may have been over treated. Similar results were found by Chibnall et al [9,10] where lumbar surgery rates for White but not Black Workers’ Compensation claimants exceeded normative rates. Barring a clear standard of pain care, it is difficult to adjudicate these two interpretations.…”

Section: Discussionsupporting

confidence: 89%

The Interaction of Patient Race, Provider Bias, and Clinical Ambiguity on Pain Management Decisions

Hirsh

Hollingshead

Ashburn-Nardo

et al. 2015

The Journal of Pain

116

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Although racial disparities in pain care are widely reported, much remains to be known about the role of provider and contextual factors. We used computer-simulated patients to examine the influence of patient race, provider racial bias, and clinical ambiguity on pain decisions. One hundred twenty nine medical residents/fellows made assessment (pain intensity) and treatment (opioid and non-opioid analgesics) decisions for 12 virtual patients with acute pain. Race (Black/White) and clinical ambiguity (high/low) were manipulated across vignettes. Participants completed the Implicit Association Test and feeling thermometers, which assess implicit and explicit racial biases, respectively. Individual- and group-level analyses indicated that race and ambiguity had an interactive effect on providers’ decisions, such that decisions varied as a function of ambiguity for White but not Black patients. Individual differences across providers were observed for the effect of race and ambiguity on decisions; however providers’ implicit and explicit biases did not account for this variability. These data highlight the complexity of racial disparities and suggest that differences in care between White and Black patients are, in part, attributable to the nature (i.e., ambiguity) of the clinical scenario. The current study suggests that interventions to reduce disparities should differentially target patient, provider, and contextual factors.

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“…36 The DOLOR study identified that these socioeconomic factors are associated with worse outcomes among WC patients, such as applying for long-term disability through the Social Security Disability Insurance program. 33 This study confirms that such differences exist and their magnitude is large. Future work should examine the impact of controlling for such differences in studies assessing clinical and disability outcomes over time.…”

Section: Discussionsupporting

confidence: 76%

“…Since SPORT and NSN were not specifically designed to examine disability populations, limited baseline questions were available about psychosocial and work characteristics potentially related to disability compensation status. 33 To create a large, multistate sample of patients WC, we included patients from very different clinical studies, NSN and SPORT. Although we carefully developed eligibility criteria for NSN patients to mirror those in SPORT, it is possible that those found eligible may still be different in important but immeasurable ways.…”

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confidence: 99%

What Is Different About Worker’s Compensation Patients?

Atlas¹,

Tosteson²,

Hanscom³

et al. 2007

Spine

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Study Design-Combined analysis of 2 prospective clinical studies.Objective-To identify socioeconomic characteristics associated with workers' compensation in patients with an intervertebral disc herniation (IDH) or spinal stenosis (SpS).Summary of Background Data-Few studies have compared socioeconomic differences between those receiving or not receiving workers' compensation with the same underlying clinical conditions. Methods-Patients were identified from the Spine Patient Outcomes Research Trial (SPORT)and the National Spine Network (NSN) practice-based outcomes study. Patients with IDH and SpS within NSN were identified satisfying SPORT eligibility criteria. Information on disability and work status at baseline evaluation was used to categorize patients into 3 groups: workers' compensation, other disability compensation, or work-eligible controls. Enrollment rates of patients with disability in a clinical efficacy trial (SPORT) and practice-based network (NSN) were compared. Independent socioeconomic predictors of baseline workers' compensation status were identified in multivariate logistic regression models controlling for clinical condition, study cohort, and initial treatment designation.Results-Among 3759 eligible patients (1480 in SPORT and 2279 in NSN), 564 (15%) were receiving workers' compensation, 317 (8%) were receiving other disability compensation, and 2878 (77%) were controls. Patients receiving workers' compensation were less common in SPORT than NSN (9.2% vs. 18.8%, P < 0.001), but patients receiving other disability compensation were similarly represented (8.9% vs. 7.7%, P = 0.19). In univariate analyses, many socioeconomic characteristics significantly differed according to baseline workers' compensation status. In multiple logistic regression analyses, gender, educational level, work characteristics, legal action, and expectations about ability to work without surgery were independently associated with receiving workers' compensation.Address correspondence and reprint requests to Steven J. Atlas, MD, General Medicine Division, MA General Hospital, 50 Staniford Street, Boston, MA 02114; satlas@partners.org. NIH Public AccessAuthor Manuscript Spine (Phila Pa 1976 Conclusion-Clinical trials involving conditions commonly seen in patients with workers' compensation may need special efforts to ensure adequate representation. Socioeconomic characteristics markedly differed between patients receiving and not receiving workers' compensation. Identifying the independent effects of workers' compensation on outcomes will require controlling for these baseline characteristics and other clinical features associated with disability status. Keywordsworkers' compensation; disability; lumbar disc herniation; sciatica; spinal stenosis; predictorsIn working-age populations, sciatica due to an intervertebral disc herniation (IDH) is a common cause of low back problems resulting in disability. Among older persons in an aging workforce, spinal stenosis (SpS) is the most common cause of low back pain wit...

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Clinical and Social Predictors of Application for Social Security Disability Insurance by Workers??? Compensation Claimants With Low Back Pain

Abstract: Application for SSDI among claimants with occupational low back pain is associated with social factors like race, satisfaction, and socioeconomics as well as clinical factors like diagnosis and surgery.

Cited by 18 publications

References 40 publications

Long-Term Adjustment to Work-Related Low Back Pain: Associations with Socio-demographics, Claim Processes, and Post-Settlement Adjustment

Long-Term Adjustment to Work-Related Low Back Pain: Associations with Socio-demographics, Claim Processes, and Post-Settlement Adjustment

The Interaction of Patient Race, Provider Bias, and Clinical Ambiguity on Pain Management Decisions

What Is Different About Worker’s Compensation Patients?

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