Race and socioeconomic differences in post-settlement outcomes for African American and Caucasian Workers' Compensation claimants with low back injuries

Abstract

The purpose of this study was to predict post-settlement pain intensity, psychological distress, disability, and financial struggle among African American (n=580) and non-Hispanic Caucasian (n=892) Workers' Compensation claimants with single incident low back injury. The study was a population-based telephone survey conducted in three population centers in Missouri. Post-settlement outcomes were predicted from claimant demographics (race, age, gender); socioeconomic status (SES); diagnosis and legal representation; and Workers' Compensation resolution variables (treatment costs, temporary disability status, disability rating, settlement costs). Simultaneous-entry, hierarchical multiple linear regression analyses indicated that African American race and lower SES predicted higher levels of post-settlement pain intensity, psychological distress (general mental health, pain-related catastrophizing), disability (pain-related role interference), and financial struggle, independent of age, gender, diagnosis, legal representation, and Workers' Compensation resolution variables. The results suggest that African American race and lower SES-relative to Caucasian race and higher SES-are risk factors for poor outcomes after occupational low back injury. Mechanisms to explain these associations are discussed, including patient-level, provider-level, legal, and Workers' Compensation system-level factors.

Perceived Injustice and Adverse Recovery Outcomes

“…Similarly, a Missouri study that also controlled for mediating factors showed that dissatisfaction with (provider or employer) treatment was widespread (approximately 65 % of claimants were "not at all" or "only a little" satisfied with treatment). In this study, dissatisfied claimants were significantly more likely to apply for Social Security Disability Insurance benefits following claim closure, almost 2 years after the initial injury (Chibnall, Tait, Andresen, & Hadler, 2006).…”

“…There is research to suggest that attorney involvement is also associated with poorer mental health outcomes following occupational injury (Chibnall et al, 2006). Similarly, the longitudinal study cited in the previous section (Chibnall & Tait, 2010) found that Workers' Compensation claimants who retained attorneys, secondary to dissatisfaction with care, demonstrated long-term decrements in mental health and higher levels of pain catastrophizing, compared with claimants who did not retain an attorney.…”

Quality of Care for Work-Associated Carpal Tunnel Syndrome

“…Similarly, workers may differentially understand how the workers' compensation system works or fear retaliation if they file a claim. [51][52][53] Prior research has extensively documented disparities in quality of care in the U.S., especially for expensive procedures. 54 Our work is consistent with a large national study that found fewer racial or income disparities in the quality of more routine and less intensive care processes once access barriers, like lack of insurance coverage, had been surmounted.…”

What Is Different About Worker’s Compensation Patients?

“…35 We hypothesize that differences in clinical outcomes among patients based on disability compensation are mediated at least in part by important socioeconomic disparities in these populations. 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.…”