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Race Differences in Diagnosis and Surgery for Occupational Low Back Injuries

Chibnall, John T., PhD*; Tait, Raymond C., PhD*; Andresen, Elena M., PhD; Hadler, Nortin M., MD

doi: 10.1097/01.brs.0000217584.79528.9b
Health Services Research
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Study Design. Population-based telephone survey in Missouri.

Objective. To examine the unique contribution of race to diagnosis and surgery rates in workers’ compensation claimants.

Summary of Background Data. Race differences in diagnostic specificity and rates of surgery may mediate documented differences in workers’ compensation case management outcomes (treatment expenditures, disability ratings, and settlement awards) between African Americans and whites with low back injuries.

Participants and Methods. African American (n = 580) and white (n = 892) workers’ compensation claimants with single-incident low back injuries were interviewed regarding diagnoses and treatments received for their injury. Participants were, on average, 21 months after settlement. Analyses examined the association of race (controlling for clinical findings, legal representation, age, gender, and socioeconomic status) with diagnosis (herniated disc vs. regional backache) and surgery. Risk ratios for race were calculated.

Results. Whites were 40% more likely than African Americans to receive a herniated disc diagnosis. Of claimants with the latter diagnosis, whites were 110% more likely than African Americans to undergo surgery.

Conclusions. Race differences in diagnosis and surgery may help to explain why African Americans, relative to whites, receive lower workers’ compensation medical expenditures, disability ratings, and settlement awards.

This population-based study of workers’ compensation claimants with low back injuries in Missouri found that African Americans were less likely than whites to receive a herniated disc diagnosis and undergo surgery. Race-based differences in diagnostic specificity and surgery mediate case management outcomes regarding treatment expenditures, disability ratings, and settlement awards.

From the *Department of Psychiatry, Saint Louis University School of Medicine, St. Louis, MO; †North Florida/South Georgia Veterans Health Service and College of Public Health and Health Professions, University of Florida, Gainesville, FL; and ‡Departments of Medicine and Microbiology/Immunology, University of North Carolina School of Medicine, Chapel Hill, NC.

Acknowledgment date: January 10, 2005. First revision date: May 17, 2005. Acceptance date: July 7, 2005.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Federal funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to John T. Chibnall, PhD, Department of Psychiatry, Saint Louis University School of Medicine, 1221 S. Grand Boulevard, St. Louis, MO 63104; E-mail: chibnajt@slu.edu

© 2006 Lippincott Williams & Wilkins, Inc.