Social inequalities in occupational health care.
Dembe-A; Savageau-JA; Erickson-JB; Banks-SM
AHSRHP Annual Meeting, June 23-25, 2002, Washington, DC. Washington, DC: Academy for Health Services Research and Health Policy, 2002 Jun; :19
Research Objective: This study is aimed at determining whether there are disparities in the incidence of occupational injuries and illnesses and in medical care for those disorders, based on workers' race, ethnicity, and socioeconomic status (SES). Few previous studies have investigated social inequalities in occupational health. Based on existing fragmentary evidence, we hypothesize that Blacks, Hispanics, and workers with low SES have a disproportionately high incidence of occupational injuries and illnesses, receive inferior medical care, suffer more severe disability, return to work more slowly, and are less likely to receive compensation benefits than are whites and those with high SES. Study Design: Retrospective cross-sectional analysis of two existing national population-based surveys: the National Ambulatory Medical Care Survey (NAMCS) and National Longitudinal Survey of Youth (NLSY). Pilot studies by us have demonstrated the usefulness of these databases in providing new information about occupational health care. This study will result in descriptive analyses of work related cases from each database, including stratified sub-analyses comparing patient experiences among racial, ethnic, and socioeconomic patient groups, and selected multivariate analyses to assess the interactive effect of patient sociodemographic characteristics with employment experiences, medical services, and vocational outcomes. Population Studied: The NAMCS covers physician-reported data for a nationally representative sample of 46,875 ambulatory medical care visits made in 1997-1998. 1,179 of those visits (2.5%) were for diagnosis and treatment of work-related conditions. Our analysis of the NLSY covers the experiences of 7,508 persons aged 33-41 who were interviewed in 1998, of which 563 (7.5%) self-reported experiencing an occupational injury or illnesses in the 2-year period preceding the interview. Principal Findings: Both analyses suggest that there are significant disparities among the social groups studied. In the NAMCS, Hispanics with work-related conditions required insurer authorization for care 57% more often than non-Hispanics, and Blacks 14% more often than whites. On average, Blacks saw a physician during their visit 6% less often than whites, and Hispanics 5% less often than non-Hispanics. Blacks had blood pressure measured at the visit 32% less often than whites, and Hispanics 11% less often than non- Hispanics. The NLSY analysis indicated that following a work related condition, Blacks were 16% more likely to miss work, had 28% more missed work days, and were 18% more likely to lose wages than non-Blacks. Similar patterns were observed among Hispanics compared to non-Hispanics, and low-SES (as indicated by educational attainment and family income) compared to high-SES workers. Conclusions: Preliminary data from two national health care surveys indicates disparities in occupational health and health care for work related conditions based on patients' race, ethnicity, and SES. These studies have demonstrated the usefulness of national survey databases as a novel source for collecting information about the health and vocational experiences of injured workers. Implications for Policy, Delivery or Practice: This study helps demonstrate the barriers that Black, Hispanic, and low-SES workers face in accessing occupational health care, and their susceptibility to more severe vocational impacts following a work-related injury. These findings will help alert policymakers and public health advocates to the need to devise specific strategies for protecting the health and earning capacity of minority and low-wage workers.
Demographic-characteristics; Racial-factors; Epidemiology; Statistical-analysis; Sociological-factors; Sociology; Injuries; Traumatic-injuries; Accident-rates; Accident-statistics; Accidents; Age-factors
Allard Dembe, Sc.D., Associate Professor, Center for Health Policy and Research, University of Massachusetts Medical School, 222 Maple Avenue, Higgins Building, Shrewsbury, 01545
Conference/Symposia Proceedings; Abstract
Research Tools and Approaches: Health Services Research
Academy for Health Services Research and Health Policy Annual Meeting, June 23-25, 2002, Washington, DC
University of Massachusetts Medical School, Shrewsbury, Massachusetts