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Disability determinations for job-related low back pain have questionable validity and reflect racial inequities

Work-related low back injuries are treated through the Workers' Compensation (WC) system. It is not uncommon for such injuries to eventually result in residual disability, and disability determination can be part of case closure. However, this determination is difficult due to the poor association between low back pain, functional compromise, and measurable spinal abnormalities. This makes WC judgments vulnerable to the influence of factors such as race and socioeconomic status (SES). Recent research conducted at the Saint Louis University School of Medicine by Raymond C. Tait, Ph.D., and colleagues suggests that racial/SES inequities operate in disability determination.

Dr. Tait and colleagues surveyed 580 black and 892 white WC claimants with occupational low back pain from 2 Missouri counties approximately 21 months after claim settlement. They examined several medical variables as predictors of disability ratings, including diagnosis (regional backache versus herniated disc), surgery, and medical costs (as a proxy for intensity of medical care).

Diagnosis and surgery were strongly associated with disability ratings at the time of case settlement. In addition, race was associated with disability ratings, both directly and indirectly, through associations with diagnosis and surgery: Blacks were significantly less likely to receive a diagnosis of herniated disc than whites (33 vs 52 percent) and/or undergo surgery (8 vs. 30 percent).

Disability ratings, however, demonstrated little association with measures of pain, distress, and disability (including employment status) 21 months after claim settlement. Indeed, claimants who received higher disability ratings were somewhat less disabled than claimants with lower ratings. The inequitable allocation of disability ratings reflects disparities in the management of occupational back pain and also raises questions as to the validity of associated disability determination processes.

The study was supported by the Agency for Healthcare Research and Quality (HS13087).

See "Disability determination: Validity with occupational low back pain," by Dr. Tait, John T. Chibnall, Ph.D., Elena M. Andresen, Ph.D., and Nortin M. Hadler, M.D., in the December 2006 Journal of Pain 7(12), pp. 951-957.

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