Oleinick A, Gluck J V, Guire K
Department of Environmental and Industrial Health, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA.
Am J Ind Med. 1996 Nov;30(5):540-55. doi: 10.1002/(SICI)1097-0274(199611)30:5<540::AID-AJIM3>3.0.CO;2-X.
Occupational back injuries produced $27 billion in direct and indirect costs in 1988. Predictors of prolonged disability have generally been identified in selected clinical populations, but there have been few population-based studies using statewide registries from workers' compensation systems. This study uses a 1986 cohort of 8,628 Michigan workers with compensable back injuries followed to March 1, 1990. Cox proportional hazards analyses with nine categorical covariates identified factors predicting missed worktime for the first disability episode following the injury. The model distinguished factors affecting the acute (< or = 8 weeks) and chronic disability periods (> 8 weeks). The first disability episode following injury contains 69.6% of the missed worktime observed through follow-up. In the acute phase, which contributes 15.2% of first episode missed worktime, gender, age, number of dependents, industry (construction), occupation, and type of accident predict continued work disability. Marital status, weekly wage compensation rate, and establishment size do not. Beyond 8 weeks, age, establishment size and, to a lesser degree, wage compensation rate predict duration of work disability. Graphs show the predicted disability course for injured workers with specific covariate patterns. Future efforts to reduce missed worktime may require modifications in current clinical practice by patient age group and the development of new strategies to encourage small and medium-size employers to find ways to return their injured employees to work sooner. Recent federal statutes covering disabled workers will only partially correct the strong effect of employer establishment size.
1988年，职业性背部损伤造成了270亿美元的直接和间接成本。长期残疾的预测因素通常是在特定的临床人群中确定的，但很少有基于全州工人赔偿系统登记处数据的人群研究。本研究使用了1986年密歇根州8628名有可赔偿背部损伤的工人队列，随访至1990年3月1日。通过对九个分类协变量进行Cox比例风险分析，确定了预测受伤后首次残疾发作缺勤时间的因素。该模型区分了影响急性（≤8周）和慢性残疾期（>8周）的因素。受伤后首次残疾发作包含了随访期间观察到的69.6%的缺勤时间。在占首次发作缺勤时间15.2%的急性期，性别、年龄、受抚养人数、行业（建筑）、职业和事故类型可预测持续的工作残疾。婚姻状况、每周工资补偿率和企业规模则不能。超过8周后，年龄、企业规模以及在较小程度上的工资补偿率可预测工作残疾的持续时间。图表展示了具有特定协变量模式的受伤工人的预测残疾进程。未来减少缺勤时间的努力可能需要根据患者年龄组对当前临床实践进行调整，并制定新策略鼓励中小型雇主找到让受伤员工更快重返工作岗位的方法。最近涉及残疾工人的联邦法规只能部分纠正雇主企业规模的强大影响。
