Does gradually returning to work improve time to sustainable work after a work-acquired musculoskeletal disorder in British Columbia, Canada? A matched cohort effectiveness study

Work Disability Duration Among Mobile Workers: Does Intraprovincial Mobility Matter as Much as Interprovincial Mobility?

OBJECTIVE

The aim of the study is to compare work disability duration of intraprovincially and interprovincially mobile workers with nonmobile workers in British Columbia, Canada.

METHODS

Workers' compensation claims were extracted for workers injured between 2010 and 2019. Employer and residential postal codes were converted to economic regions to define nonmobile, intraprovincially, and interprovincially mobile workers. Quantile regression models using matched cohorts were used to estimate differences in work disability days at different percentiles of the distribution.

RESULTS

Compared with nonmobile workers, both mobile worker groups had longer work disability durations, particularly interprovincially mobile workers. Differences persisted in injury-stratified models and were partially or fully attenuated in some industry-stratified models.

CONCLUSIONS

Workers' compensation systems, employers, and healthcare providers may need to tailor specific interventions for mobile workers who are from out-of-province as well as traveling between regions in the province.

Labour market trajectories after part-time sickness absence: a nationwide cohort study from Finland

OBJECTIVES

The use of part-time sickness absence (pSA) enables return to part-time work from full sickness absence. However, subsequent labour market outcomes of pSA users depend on various individual and work-related characteristics. We investigated labour market paths of private and public sector employees after having a pSA spell. Moreover, we examined individual and work-related factors associated with following them.

DESIGN

Longitudinal register-based cohort study.

SETTING

Finnish employed population.

PARTICIPANTS

9896 receivers of partial sickness allowance aged 45-56 in the years 2010-2014.

OUTCOME

We constructed labour market trajectories based on the proportion of time spent in various labour market statuses measured over 3 years after the end of the pSA spell using multiresponse trajectory analysis. We then examined how different individual and work-related factors were associated with assignment to the different trajectory groups using logistic regression analyses.

RESULTS

The majority of the pSA users followed paths where work participation was consistently elevated (Sustained Work group, 40.4%), or only slightly reduced (Slightly Reduced Work group, 31.6%). Moreover, more than 1/10th of the users followed a path where receiving partial work disability benefits became predominant (Partial Work Disability group, 12.5%). The rest followed paths where other non-employment (Other Non-Employed group, 7.8%) or full work disability (Full Work Disability group, 7.7%) became the prevailing status. Lower educational level and income predicted assignment to all other groups than the Sustained Work group. Additional predictors were identified, yet these differed between the trajectory groups.

CONCLUSIONS

The majority of the pSA users maintained a connection to working life, yet weaker working life paths were also identified. The paths were determined by various individual and work-related factors that can help health professionals and employers to better target support measures particularly towards individuals whose connection to working life is at risk to weaken after the use of pSA.

Evaluation of a return to work coordination programme for injured workers in a public hospital in Singapore

Introduction

This study evaluates the effectiveness of a hospital-based return to work (RTW) programme in facilitating injured workers to RTW earlier through personalised case management. Factors associated with programme effectiveness are also examined.

Method

This was a quasi-experimental study comparing 81 participants who underwent conventional treatment before the RTW programme with 108 participants who directly received the RTW intervention. Analyses included time to RTW and the factors associated with dropout. Stratified analysis and multivariate logistic regression were used to mitigate potential selection bias from the additional recruitment process for the intervention group.

Results

Participants in the intervention group returned to work 59.5 days earlier, with 84% able to RTW 6 months post injury compared with the control (63%; P<0.01). Stratified analysis found the intervention to be associated with better RTW outcomes among males, younger workers, non-residents, blue-collared workers, workers from the construction, marine, manufacturing and metalworking industries, and workers having lower Work Ability score (WAS), while light-duty provision was a possible confounder. The better outcomes in the intervention group were also independent of company size and injury severity. After adjusting for the above factors, the intervention group had 2.2 times higher odds of RTW at 6 months (95% confidence interval 0.84–5.90). Lower WAS and longer delay in initial RTW assessment were associated with delayed RTW within the intervention group. Migrant workers experienced higher dropout rates, thus being identified as a vulnerable group.

Conclusion

The RTW coordination model of care is effective in facilitating RTW, with early programme referral being an important facilitator and WAS as a useful screening tool for delayed RTW.

Differences in Modified-Return-to-Work by Immigration Characteristics Among a Cohort of Workers in British Columbia, Canada

Introduction To investigate differences in modified-return-to work (MRTW) within the first 30 days of a work-related, short-term disability injury by immigration characteristics. This question was part of a program of research investigating differences in work and health experiences among immigrant workers and explanations for longer work disability durations. Methods Workers' compensation claims, immigration records and medical registry data were linked to identify a sample of workers in British Columbia, Canada with a short-term disability claim for a work-related back strain, concussion, limb fracture or connective tissue injury occurring between 2009 and 2015. Multivariable logistic regressions, stratified by injury type, investigated the odds of MRTW, defined as at least one day within the first 30 days on claim, associated with immigration characteristics, defined as a Canadian-born worker versus a worker who immigrated via the economic, family member or refugee/other humanitarian classification. Results Immigrant workers who arrived to Canada as a family member or as a refugee/other immigrant had a reduced odds of MRTW within the first 30 days of work disability for a back strain, concussion and limb fracture, compared to Canadian-born workers. Differences in MRTW were not observed for immigrant workers who arrived to Canada via the economic classification, or for connective tissue injuries. Conclusion The persistent and consistent finding of reduced MRTW for the same injury for different immigration classifications highlights contexts (work, health, social, language) that disadvantage some immigrants upon arrival to Canada and that persist over time even after entry into the workforce, including barriers to MRTW.

Working life expectancy and working years lost among users of part- and full-time sickness absence in Finland

OBJECTIVES

The use of part-time sickness absence (pSA) instead of full-time sickness absence (fSA) is known to increase work participation. Yet, its effect on the total length of working lives remains unclear. We carried out a quasi-experiment to assess the impact of using pSA versus fSA on the length of working lives.

METHODS

We used a register-based 70% random sample of the working-age population living in Finland on 31 December 2007 to (i) form propensity-score-matched groups of users of pSA and fSA and (ii) calculate their working life expectancy (WLE) and working years lost (WYL). We applied the Sullivan method based on daily measured time spent at work and other labor market statuses, followed up over a four-year period until the end of year 2017. The study population consisted of private and public sector employees with SA due to mental and musculoskeletal disorders, ie, the diagnostic groups where pSA has been primarily used.

RESULTS

Among both genders, the pSA group had a significantly higher WLE at age 30 than the fSA group, with larger differences seen in mental disorders compared to musculoskeletal diseases and in the private versus public sector. Overall, the pSA group had fewer WYL due to unemployment and disability retirement but more expected years working with partial disability benefits than the fSA group.

CONCLUSIONS

Based on beneficial working career effects, the use of pSA instead of fSA should always be recommended for persons with mental or musculoskeletal disorders where feasible.

Has the share of the working life expectancy that is spent receiving a partial or full disability pension changed in Finland over the period 2005-2018? A longitudinal register-based study

OBJECTIVES

The share of the overall working careers that is spent receiving disability benefits is unclear. We examined trends in full-time equivalent working life expectancy (FTE-WLE) among those with and without receiving a permanent full or partial disability pension in Finland, where certain amounts of work are allowed while receiving these pensions.

DESIGN

Longitudinal register-based study.

SETTING

Finnish population.

PARTICIPANTS

Nationally representative 70% samples of the working-age population.

OUTCOME

Using the Sullivan method, we examined annual FTE-WLE at age 45, truncated at age 63, in 2005-2018 by disability pension status. Full-time equivalent work participation was based on combined information on annual employment days and work income.

RESULTS

Compared with those with no disability pension, disability pensioners had a larger relative (full and partial pensioners of both genders) and absolute (male partial pensioners) increase in the FTE-WLE between 2005 and 2018. In 2018, the FTE-WLE of both male and female full disability pensioners was around 3.5 months, being 6 months at its highest in musculoskeletal diseases. The FTE-WLE of partial disability pensioners was around 6.5 and 8 years among men and women, respectively, being around half of the corresponding expectancies of non-pensioners. The FTE-WLE of partial disability pensioners was considerable in musculoskeletal diseases and mental disorders and even higher in other diseases. Full disability pensioners spent a disproportionately large time in manual work, increasingly in the private sector, and partial pensioners in the public sector with lower non-manual and manual work, increasingly with the former. At the population level, the share of the FTE-WLE that is spent receiving a disability pension remained relatively small.

CONCLUSIONS

Increased work participation while receiving a disability pension is likely to have had important implications for prolonging individual working careers but only minor contribution to the length of working lives at the population level.

Exploring Differences in Work Disability Duration by Size of Firm in Canada and Australia

Purpose To identify whether there were differences in work disability duration between injured workers employed by small, medium, large, and self-insured firms and whether these differences varied between workers' compensation jurisdictions in Canada and Australia. Methods Workers' compensation data were used to identify comparable lost-time, work-related injury and musculoskeletal disorder claims in five Canadian and five Australian jurisdictions between 2011 and 2015. Work disability duration was measured using cumulative disability days paid up to one-year post-injury. Jurisdiction-specific quantile regression models were used to estimate differences in cumulative disability days paid to claims from small (< 20 full-time equivalents (FTEs)) medium (20-199 FTEs), large (200 + FTEs) and self-insured firms at the 25th, 50th, and 70th percentiles in the disability distribution, adjusting for confounders. Results Compared to large firms, workers in small firms generally had longer work disability duration at each percentile, particularly in Saskatchewan and Alberta (Canada), Victoria and Australian Capital Territory (Australia), where an additional 31.1, 18.4, 58.5 and 37.0 days were paid at the 75th percentiles, respectively. The disability duration of workers from self-insured firms was longer than large firms in all Canadian jurisdictions but was shorter or no different in Australian jurisdictions. Smaller differences were observed between claims from large and medium-sized firms. Conclusions Workers in small firms had longer work disability duration than those in large firms in all but one of the study jurisdictions. Claims management processes need to be sensitive to the challenges that small firms face in accommodating and returning injured workers back to work.

Immigrant status, gender and work disability duration: findings from a linked, retrospective cohort of workers' compensation and immigration data from British Columbia, Canada

OBJECTIVES

To compare differences in work disability durations of immigrant men and women injured at work to comparable Canadian-born injured workers in British Columbia, Canada.

METHODS

Data on accepted workers compensation claims and immigration status from 1995 and 2012 were used to compare the number of work disability days paid at the 25%, 50% and 75% for immigrant and Canadian-born injured workers stratified by gender and recency of immigration.

RESULTS

Immigrant workers comprised 8.9% (78 609) of the cohort. In adjusted quantile regression models, recent and established immigrant women received 1.3 (0.8, 1.9) and 4.0 (3.4, 4.6) more paid disability days at the 50% of the disability distribution than Canadian-born counterparts. For recent and established immigrant men, this difference was 2.4 (2.2, 2.6) and 2.7 (2.4, 4.6). At the 75%, this difference increased for recent immigrant men and established immigrant men and women but declined for recent immigrant women.

CONCLUSIONS

Injured immigrants receive more work disability days than their Canadian-born counterparts except for recent immigrant women. Both immigrant status and gender matter in understanding health disparities in work disability after work injury. KEYWORDS WORK DISABILITY: immigrant health; linked administrative data.

Differences in Work Disability Duration for Immigrants and Canadian-Born Workers in British Columbia, Canada

This study aimed to investigate differences in work disability duration among immigrants (categorized as economic, family member or refugee/other classification upon arrival to Canada) compared to Canadian-born workers with a work-related injury in British Columbia. Immigrants and Canadian-born workers were identified from linked immigration records with workers' compensation claims for work-related back strain, connective tissue, concussion and fracture injuries requiring at least one paid day of work disability benefits between 2009 to 2015. Quantile regression investigated the relationship between immigration classification and predicted work disability days (defined from injury date to end of compensation claim, up to 365 days) and modeled at the 25th, 50th and 75th percentile of the distribution of the disability days. With a few exceptions, immigrants experienced greater predicted disability days compared to Canadian-born workers within the same injury cohort. The largest differences were observed for family and refugee/other immigrant classification workers, and, in particular, for women within these classifications, compared to Canadian-born workers. For example, at the 50th percentile of the distribution of disability days, we observed a difference of 34.1 days longer for refugee/other women in the concussion cohort and a difference of 27.5 days longer for family classification women in the fracture cohort. Economic immigrants had comparable disability days with Canadian-born workers, especially at the 25th and 50th percentiles of the distribution. Immigrant workers' longer disability durations may be a result of more severe injuries or challenges navigating the workers' compensation system with delays in seeking disability benefits and rehabilitation services. Differences by immigrant classification speak to vulnerabilities or inequities upon arrival in Canada that persist after entry to the workforce and warrant further investigation for early mitigation strategies.