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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


In the manuscript “Health care utilization for musculoskeletal back disorders, Washington State union carpenters, 1989–2003,”1 we reported an increase in health care utilization for back disorders through union-provided insurance among carpenters as workers' compensation claims decreased. In updating this cohort through 2008, I have identified an error in the counting of private health care visits for back disorders, resulting in notably lower rates of utilization than reported between 1995 and 2003. While the rise in private claims is not as great as we originally reported, the pattern remains one of increasing private utilization and decreasing work-related claims. It is also of note that the pattern continues in analyses through 2008 which are included in the amended Figure 1. The conclusion made earlier that the patterns of utilization across private and workers' compensation delivery systems are not independent remains.

In revised analyses there are some changes particularly in smaller cells in our multivariate analyses. Specifically, we had reported residential carpenters had higher utilization rates than the rest of the cohort; corrected findings for this small work group do not reflect this difference. Differences between men and women are diminished somewhat although women still appear to seek care for back disorders at higher rates than men. Updated analyses do not reveal significant differences in utilization across categories of union tenure. There is no apparent trend when looking at patterns of private health care utilization in progressive time windows after a work-related overexertion back injury, but the trend remains after an acute injury. We have provided revisions to Tables 3, 4, and 5 to reflect these changes. There are no differences in the total number of carpenters who sought care for back disorders and the distribution of their diagnoses remain as reported earlier (Tables 1 and 2, 2009).

We are conducting additional analyses on this important occupational cohort that we hope to be able to report soon. However, we appreciate the opportunity to update your readers at this time.

Journal of Occupational and Environmental Medicine. 54(10):1310-1312, October 2012.

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