Prevalence and risk factors for anxiety and depression disorders in workers with work-related musculoskeletal strain or sprain in British Columbia, Canada:a comparison of men and women using administrative health data

OBJECTIVE: To examine the prevalence and risk factors for medically treated anxiety and depression disorders among men and women with musculoskeletal strain or sprain work injury in British Columbia, Canada. METHODS: A retrospective population-based cohort of accepted workers' compensation lost-time claims from 2000 to 2013 was constructed using linked administrative health data. Anxiety and depression disorders were identified using diagnoses from physician, hospital and pharmaceutical records. The 1-year period prevalence was estimated for the year before and the year after injury. Sociodemographic, clinical and work-related risk factors for prevalent and new onset anxiety and depression disorders were examined using multinomial regression. RESULTS: 13.2% of men and 29.8% of women had medically treated anxiety, depression or both in the year before injury. Only a slight increase (~2%) in the prevalence of these disorders was observed in the year after injury. Somatic and mental comorbidities were both strong risk factors for pre-existing and new onset anxiety and depression for both men and women, but these relationships were stronger for men. CONCLUSION: Anxiety and depression disorders including those from prior to injury are common in workers with musculoskeletal strain or sprain and are associated with a complicated clinical profile. Gender-sensitive and sex-sensitive mental healthcare is an important consideration for work disability management

Data linkage to build detailed return-to-work trajectories for work disability research

Introduction Musculoskeletal disorders (MSDs) are the most prevalent chronic condition in Canada, and account for the highest disability costs. Gradual-return-to-work (GRTW) can improve health and labour market outcomes in an aging workforce at risk of MSDs. Linked longitudinal data enables us to generate evidence of GRTW to inform policy needs. Objectives and Approach The objective of this study was to investigate the effectiveness and cost-benefits of GRTW for workers with a work-acquired MSD in British Columbia, Canada. We linked workers’ compensation data, health services data, and prescription data from three governing bodies to 1) identify injured workers with an accepted MSD lost-time injury between 2010 and 2015; 2) identify trajectories of RTW states (injury, sickness absence, GRTW, RTW, and non-RTW) and the probability of transitioning between states; and 3) assess the association between workers characteristics and RTW trajectories, and analyze the cost-benefits of GRTW. Results Final results are expected early 2019. To our knowledge, this will be the first study linking workers’ compensation data (in particular detailed RTW data), health services data and prescription data from three different governing bodies for a comprehensive, population-based investigation of work disability experiences over a longitudinal time period and within the Canadian context. Also, using this data for the purpose of assessing the cost-benefits is new, and will help to prioritize prevention resources and strategies to limit the health and economic impact of work-related MSDs on employers, workers’ compensation boards and society. Conclusion/Implications Evaluating the effects of GRTW on work disability is essential to maximize the health and economic benefits for injured workers. The innovation of this project is that is links three population-based databases to capture multiple indicators of health and work status to build RTW trajectories over time

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.</p

Is Lifelong Knee Joint Force from Work, Home, and Sport Related to Knee Osteoarthritis?

Purpose. To investigate the association of cumulative lifetime knee joint force on the risk of self-reported medically-diagnosed knee osteoarthritis (OA). Methods. Exposure data on lifetime physical activity type (occupational, household, sport/recreation) and dose (frequency, intensity, duration) were collected from 4,269 Canadian men and women as part of the Physical Activity and Joint Heath cohort study. Subjects were ranked in terms of the “cumulative peak force index”, a measure of lifetime mechanical knee force. Multivariable logistic regression was conducted to obtain adjusted effects for mean lifetime knee force on the risk of knee OA. Results. High levels of total lifetime, occupational and household-related force were associated with an increased in risk of OA, with odds ratio’s ranging from approximately 1.3 to 2. Joint injury, high BMI and older age were related to risk of knee OA, consistent with previous studies. Conclusions. A newly developed measure of lifetime mechanical knee force from physical activity was employed to estimate the risk of self-reported, medically-diagnosed knee OA. While there are limitations, this paper suggests that high levels of total lifetime force (all domains combined), and occupational force in men and household force in women were risk factors for knee OA

Descriptive Epidemiology of Serious Work-Related Injuries in British Columbia, Canada

OBJECTIVE: This study examined the rates and distribution of serious work-related injuries by demographic, work and injury characteristics in British Columbia, Canada from 2002-2008, using population-based data. METHODS: Claims for workers with a serious injury were extracted from workers' compensation data. Serious injuries were defined by long duration, high cost, serious medical diagnosis, or fatality. Workforce estimates were used to calculate stratum-specific rates. Rate-ratios (RR) and 95% CIs were calculated using negative binomial regression for the comparison of rates, adjusting for gender, age and occupation. RESULTS: Women had a lower overall serious injury rate compared to men (RR: 0.93, 95% CI: 0.87-0.99). The 35-44 age group had the highest overall rate compared to the youngest age group. The rate for severe strains/sprains was similarly high for men and women in the 35-44 age group, although there was a differential pattern by gender for other injury types: the rate of fracture was similar across age groups for men, but increased with age for women (RR: 2.7, 95% CI: 2.2-3.3); and the rate of severe falls increased with age for men and women, with a larger three-fold increase for older women (men: RR: 1.8, 95% CI: 1.7-2.1; women: RR: 3.2, 95% CI: 2.7-3.7). CONCLUSIONS: The risk of serious injuries is higher among specific age groups with different patterns emerging for men and women. Variations persisted within similar injury types and occupation groups in our adjusted models. These results provide evidence for the burden of serious injuries and a basis for future analytic research. Given projected demographic shifts and increasing workforce participation of older workers, intervention programs should be carefully implemented with consideration to demographic groups at risk for serious injuries in the workplace

Work organization factors and musculoskeletal symptoms and claims among health care workers

This dissertation is a study of health care workers and the relationship between work organization factors and work-related musculoskeletal outcomes. It was hypothesized that rates of upper-body and lower-body musculoskeletal symptoms and compensation claims would increase with exposure to adverse work organization factors defined by low job control, low work support, high job demands or time pressures, and high levels of workload, while controlling for individual and biomechanical risk factors. Theoretically, both models of work-related musculoskeletal morbidity and job stress informed the study. Musculoskeletal morbidity is believed to develop when the conditions of work exceed the capacity of the worker. These conditions may be the result of adverse work organization factors that produce a stress response among workers with a direct effect on the musculoskeletal system, or they may modify other workplace factors that in turn influence musculoskeletal conditions. The study employed a retrospective, longitudinal cohort design and followed 4020 health care workers from an acute-care hospital over a four-year period. Workers were enumerated from hospital personnel records and outcome data were ascertained from the hospital's occupational health and safety database. Biomechanical scores for occupations were assessed by direct observation and scored using checklists. Scores for the work organization measures of control, demands, support and pressure were assigned to cohort members using a job exposure matrix. The matrix was developed from responses to validated scales included in three random sample surveys of employees over the four-year study period. Workload measures were defined by time-varying levels of departmental sicktime, overtime and work units, calculated from financial reports. The risk of musculoskeletal symptoms and claims associated with work organization factors, controlling for individual and biomechanical factors, was assessed using Poisson regression. In the final models, low levels of job control and work support, as well as high levels of workload related to departmental sicktime, were significantly associated with an elevated risk of upper-body musculoskeletal symptoms and claims. The risk of lower-body musculoskeletal symptoms and claims was significantly elevated for workload due to high levels of departmental sicktime, and that for lower-body compensation claims with low job control. Individual and biomechanical factors were also significant predictors of musculoskeletal outcomes, which gives support to the idea that these outcomes have a multi-factorial etiology.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Measuring gender when you don’t have a gender measure: constructing a gender index using survey data

Abstract Background Disentangling the impacts of sex and gender in understanding male and female differences is increasingly recognised as an important aspect for advancing research and addressing knowledge gaps in the field of work-health. However, achieving this goal in secondary data analyses where direct measures of gender have not been collected is challenging. This study outlines the development of a gender index, focused on gender roles and institutionalised gender, using secondary survey data from the Canadian Labour Force survey. Using this index we then examined the distribution of gender index scores among men and women, and changes in gender roles among male and female labour force participants between 1997 and 2014. Methods We created our Labour Force Gender Index (LFGI) using information in four areas: responsibility for caring for children; occupation segregation; hours of work; and level of education. LFGI scores ranged from 0 to 10, with higher scores indicating more feminine gender roles. We examined correlations between each component in our measure and our total LFGI score. Using multivariable linear regression we examined change in LFGI score for male and female labour force participants between 1997 and 2014. Results Although women had higher LFGI scores, indicating greater feminine gender roles, men and women were represented across the range of LFGI scores in both 1997 and 2014. Correlations indicated no redundancy between measures used to calculate LFGI scores. Between 1997 and 2014 LFGI scores increased marginally for men and decreased marginally for women. However, LFGI scores among women were still more than 1.5 points higher on average than for men in 2014. Conclusions We have described and applied a method to create a measure of gender roles using survey data, where no direct measure of gender (masculinity/femininity) was available. This measure showed good variation among both men and women, and was responsive to change over time. The article concludes by outlining an approach to use this measure to examine the relative contribution of gender and sex on differences in health status (or other outcomes) between men and women

Self-reported work patterns and work-related injuries amoung high school students in British Columbia [poster presentation]

The purpose of this study was to conduct a survey of high school students in British Columbia to describe self-reported patterns of work and to calculate work-related injury rates.Health Care and Epidemiology, Department ofMedicine, Faculty ofPopulation and Public Health (SPPH), School ofUnreviewedFacult