美国腰痛工人结局的地区社会经济差异。
Regional socioeconomic disparities in outcomes for workers with low back pain in the United States.
作者信息
Shraim Mujahed, Cifuentes Manuel, Willetts Joanna L, Marucci-Wellman Helen R, Pransky Glenn
机构信息
Center for Disability Research and Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts.
Work Environment Department, University of Massachusetts Lowell, Lowell, Massachusetts.
出版信息
Am J Ind Med. 2017 May;60(5):472-483. doi: 10.1002/ajim.22712. Epub 2017 Apr 3.
BACKGROUND
Although regional socioeconomic (SE) factors have been associated with worse health outcomes, prior studies have not addressed important confounders or work disability.
METHODS
A 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).
RESULTS
Lower 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.
CONCLUSIONS
Regional 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.
背景
尽管地区社会经济（SE）因素与较差的健康结果相关，但先前的研究尚未解决重要的混杂因素或工作残疾问题。
方法
对59360例工伤赔偿（WC）案件进行全国抽样，以评估地区SE因素对职业性下背痛（LBP）医疗费用和残疾时长（LOD）的影响。
结果
邻里家庭收入中位数（MHI）较低和州失业率较高与较长的LOD相关。在领取社会保障残疾金的工人较多的州以及MHI较低的地区，医疗费用较低，但邻里之间在幅度和方向上存在差异。在城市化程度更高、种族更多样化和教育程度较低的社区，医疗费用更高。
结论
即使在医疗保险、医疗服务可及性和赔偿福利相似的情况下，医疗费用和LOD也存在地区SE差异。结果表明，通过有针对性的医疗保健和残疾干预措施，有机会改善医疗服务和残疾结果。
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