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Health Care Utilization for Musculoskeletal Back Disorders, Washington State Union Carpenters, 1989–2003

Lipscomb, Hester J. PhD; Dement, John M. PhD; Silverstein, Barbara PhD; Kucera, Kristen L. PhD; Cameron, Wilfrid MS

Journal of Occupational and Environmental Medicine: May 2009 - Volume 51 - Issue 5 - p 604-611
doi: 10.1097/JOM.0b013e31819c561c
Original Articles

Objective: Private health care utilization rates for musculoskeletal back disorders were contrasted to rates of work-related injuries or disorders for a large cohort of union carpenters over a 15-year period.

Methods: Yearly utilization rates were compared with rates of work-related back injuries or disorders. Negative binomial regression with generalized estimating equations was used to assess utilization rates based on age, gender, union tenure, type of work, and previous work-related back injuries.

Results: Private utilization rates were over twice as high in 2003 as in 1989 whereas compensation rates declined substantially. Utilization was higher among carpenters with less union tenure and increased with the number of work-related injuries.

Conclusions: Patterns of utilization across private and workers' compensation delivery systems are not independent; we need to look broadly at sources of health care coverage to better understand the health of working populations.

From the Department of Community and Family Medicine (Dr Lipscomb, Dr Dement, Dr Kucera), Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, NC; Center to Protect Workers' Rights (Mr Cameron), Silver Spring, Md; and Department of Labor and Industries (Dr Silverstein), State of Washington, Safety and Health Assessment and Research Program (SHARP), Olympia, Wash.

Address correspondence to: Hester J. Lipscomb, PhD, Box 3834, Duke University Medical Center, Durham, NC 27710; E-mail:

©2009The American College of Occupational and Environmental Medicine