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Urban-Rural Differences in Work Disability Following Occupational Injury: Are They Related to Differences in Healthcare Utilization?

Young, Amanda E. PhD; Cifuentes, Manuel MD, ScD; Wasiak, Radoslaw PhD; Webster, Barbara S. BSPT, PA-C

Journal of Occupational and Environmental Medicine: February 2009 - Volume 51 - Issue 2 - p 204-212
doi: 10.1097/JOM.0b013e3181917d8e
Original Articles

Objective: To investigate urban-rural differences in health care utilization following compensable work-related injury and determine whether differences relate to work disability.

Methods: Analysis of worker’s compensation data relating to 4889 people with a bone fracture. Regression analyses were used to test the associations between rurality, work disability, and health care utilization.

Results: Place of residence was found to relate to health care utilization and work-disability duration; however, the direction of this relationship depended on the amount of health care used. At lower levels of utilization, more rural residents had less time off; however, as health care usage increased this trend reversed.

Conclusions: The observed interaction between health care utilization, work-disability, and rurality raises important questions regarding causality and implies that people in both urban and rural areas have the potential to benefit from further investigation into health care practices and associated outcomes.

From the Center for Disability Research (Drs Young, Cifuentes, and Ms Webster), Liberty Mutual Research Institute for Safety, Hopkinton, Mass; United BioSource Corporation (Dr Wasiak), Bethesda, Md; and Department of Environmental Health (Dr Wasiak), Harvard School of Public Health, Boston, Mass.

Part of this work was undertaken when Radoslaw Wasiak was associated With Center for Disability Research, Liberty Mutual Research Institute for Safety.

A.E. Young was responsible for study conception and design, data analysis, and writing and editing of the manuscript. M. Cifuentes, B. Webster, and R. Wasiak assisted with the study design and data analysis and contributed to writing and editing of the manuscript.

Address correspondence to: Amanda E. Young, PhD, Center for Disability Research, Liberty Mutual Research Institute for Safety, 71 Frankland Rd, Hopkinton, MA 07148; E-mail:

©2009The American College of Occupational and Environmental Medicine