Disparities in occupational low back injuries: Predicting pain-related disability from satisfaction with case management in African Americans and Caucasians

Objective. To predict postsettlement pain-related disability from claimant race and satisfaction with Workers' Compensation case management. Design. Population-based survey with telephone interviewing. Setting. St. Louis City, St. Louis County, and Jackson County, Missouri. Participants. African American and Caucasian Workers' Compensation claimants (1,475) with single incident low back injuries whose claims were settled between January 1, 2001 and June 1, 2002. Measures. Workers' Compensation variables were obtained from the State of Missouri comprising treatment cost, temporary disability payment, disability rating, and settlement award. Satisfaction with Workers' Compensation case management was evaluated across five Likert-type rating scales. Pain-related disability was measured using the Pain Disability Index. Injury variables included diagnosis of disc injury or regional backache. Socioeconomic status included education and income. Demographic variables were race, age, and gender. Results. Path analysis indicated direct negative associations between satisfaction and disability. Race had a direct association with disability but was also mediated through other variables: African Americans received less treatment/compensation across the Workers' Compensation variables (relative to Caucasians), which predicted lower satisfaction. This pattern also held true for lower socioeconomic status claimants and those with regional backache. Conclusions. For African Americans and lower socioeconomic status persons in the Workers' Compensation system, less treatment/compensation was associated with lower satisfaction with the process, which in turn predicted higher levels of postsettlement disability. Given that the function of Workers' Compensation is to reduce disability from work-related injuries, the current results suggest that the system produces inequitable outcomes for these groups.