O2C.2 Does region of residence matter for return-to-work after work-related injury? A comparative analysis of six canadian workers' compensation jurisdictions. (April 2019)

• Record Type: Journal Article
• Authors: Macpherson, Robert; Shen, Hui; Koehoorn, Mieke; Amick, Benjamin; Collie, Alex; Smith, Peter; McLeod, Christopher
• Is Part Of: Occupational and environmental medicine. Volume 76(2019)Supplement 1
• Page Start: A16
• Page End: A16
• Publication Date: 2019-04
• Subjects: Medicine, Industrial -- Periodicals; Environmental health -- Periodicals; 616.980305
• DOI: 10.1136/OEM-2019-EPI.42
• Languages: English
• ISSNs: 1351-0711

Abstract

Abstract : Objectives: To investigate regional differences in return-to-work following work-related injury and whether these differences persist after adjusting for individual characteristics. Methods: Workers' compensation claims from six Canadian provinces were used to create comparable cohorts of workers aged 15–80 with a work-related injury resulting in at least one disability day from 2011 to 2015. Workers' residential postal codes were mapped to Census standard geographic units to categorize workers into six regions representing decreasing urban density and metropolitan influence (ranging from large urban areas of 100, 000+people to rural areas of <10 000 people with no metropolitan influence). Cox regression models were used to estimate the effect of urban-rural residence on the likelihood of injured workers transitioning off work disability benefits within one-year post-injury, adjusting for confounders, including provincial compensation jurisdiction. Models were stratified by industry sectors. Results: The cohort included 7 46 029 work disability claims, of which the majority resided in large urban areas (69%). Unadjusted models showed that workers residing in smaller urban and rural areas had a lower likelihood of transitioning off work disability benefits compared to those in large urban areas. Urban-rural differences persisted in adjusted models (e.g. HR=0.91 95% CI 0.89, 0.94 for workers in rural areas with no metropolitan influence). Industry-stratified models showed that greater differences existed between urban and rural places of residence for workers in the transportation and construction sectors, and smaller differences for workers in the health care and manufacturing sectors. Conclusions: The main finding suggests that injured workers in more rural areas face barriers in returning to work and that workers' compensation resources may need to be allocated to address these regional disparities. Future research will incorporate both individual and regional-level variables in a multilevel model framework to identify the characteristics that are the most important in explaining variability in work disability duration.