This study represents the nation’s first systematic investigation of racial and ethnic differences in medical care for patients with work-related injuries and illnesses. Though previous evidence and anecdotal accounts have suggested that such differences exist, the use of a nationally representative sample from the NAMCS has allowed us to identify and quantify specific variations in care involving procedures and treatments commonly administered in an ambulatory setting. Our analyses have controlled for covari-ables, including age, gender and geographical location, which have not been taken into consideration in previously published investigations of social disparities in occupational health.

The NAMCS data indicate that African-American patients accounted for 11.9% of visits for work-related conditions, slightly higher than the percentage of African Americans in the U.S. civilian workforce (11.3%) during 1997 and 1998. Interestingly, Hispanics accounted for a surprisingly high proportion of medical visits for work-related conditions—18.7%—over twice their share of ambulatory visits for nonwork-related conditions (9.6%) and substantially greater than the percentage of Hispanics (10.9%) in the U.S. civilian labor force. Observed differences among these racial/ethnic groups could reflect the influence of various factors, including relatively more exposure to job hazards among minority workers, inferior access for minorities to on-site medical care at the place of employment, greater care-seeking behavior and medical service utilization among those groups and geographical trends in the proximity of these patients to ambulatory care facilities. levitra plus

The relatively consistent proportion of visits for work-related conditions covered by workers’ compensation among African-American (83.8%), white (81.9%), Hispanic (87.6%) and non-Hispanic patients (81.3%) makes it unlikely that the observed variations in care observed are due solely to differences in insurance coverage for medical care among these groups. The generally broad and comprehensive coverage for work-related conditions afforded to American workers under state and federal workers’ compensation laws is one of the prominent features of occupational medicine. In this important respect, it differs from the general (nonoccupational) medical field, where socially based inequalities in care frequently have been attributed to the significantly lower rates of health insurance coverage among minority groups. This study illustrates that socially based disparities in medical care can arise even under a relatively universal and comprehensive insurance system.

An important finding from this study is that the kind of medical care differences observed between African-American and white patients with work-related conditions are not the same as those existing between Hispanics and non-Hispanics. For example, Hispanics were far more likely than non-Hispanics to receive x-rays, but no such difference was observed for African-American patients compared to whites. Similarly, Hispanic patients were much less likely than non-Hispanics to receive a prescription drugs and more likely to need insurer authorization for care. Neither of these disparities were observed for African-American relative to white patients. Also, African-American patients were considerably more likely than white patients to receive mental health counseling, but no such difference was observed for Hispanics in comparison to non-Hispanics. These findings all suggest that African-American and Hispanics have differing experiences in obtaining care for work-related conditions and underscore the importance of not overly generalizing about the circumstances of minority groups when trying to understand social inequalities in occupational health.
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It might be supposed that the observed differences between racial and ethnic groups reflect underlying variations in the types of disorders suffered among each group. But our data suggest otherwise. The distribution of major diagnostic categories and reported reasons for the visit (e.g., chronic, acute, surgical, follow-up) were generally quite similar among African Americans, whites, Hispanics and non-Hispanics. The different kind of disparities experienced by African Americans and Hispanics (in comparison to the referent groups) might also be conjectured to reflect underlying differences in the severity of the disorders suffered by each group or the extent to which each group receives medical services at work. Unfortunately, the NAMCS did not contain applicable data by which to test those hypotheses, and therefore we cannot rule them out. Other possible explanations are that African-American and Hispanic patients have different care-seeking practices, or that medical care providers treat members of each group differently. Additional study is needed to better understand these dynamics.

An intriguing finding from this study is that Hispanics were considerably (64%) less likely than non-Hispanics to see a physician (MD) for care of a work-related condition, after controlling for age, gender, region and MSA status (the same finding was obtained when the regression analysis was confined to visits for musculoskeletal conditions and acute injuries: OR=0.27, CI:0.12-0.62). Our data indicated that African-American patients were also 58% less likely than white patients to see a physician for treatment of a work-related condition, although that result did not achieve the traditional level of statistical significance (p=0.14), owing to the low number of applicable cases. A possible explanation for this finding, suggested by the data, is that minority patients may be more apt to be seen by technicians (e.g., x-ray technicians for Hispanics), therapists (e.g., physiotherapists) and counselors (e.g., mental health counselors for African-American patients), or by nonphysician clinicians that increasingly comprise a sizable proportion of the clinical staff at many community-based and urgent-care facilities. duloxetine fibromyalgia

In general, our data do not support the view that there is a consistent pattern of discriminatory care for African-American and Hispanic patients being treated for occupational conditions. However, several areas of potential concern have been identified that warrant closer investigation: 1) the lower likelihood for Hispanic patients to see a physician during their visit, 2) canadian prescription drugs being ordered or administered less commonly for Hispanic patients, 3) a greater need for Hispanic patients to obtain insurer authorization for care, and 4) significantly higher levels of mental health counseling for African-American patients compared to whites.

In this regard, the significantly higher rate of x-rays provided to Hispanic patients is also intriguing, especially since it was observed both in the analysis involving visits for all work-related conditions and also for the analysis restricted only to work-related musculoskeletal disorders and acute injuries (OR= 2.26, CI: 1.35-3.78). Interestingly, no similar elevated rate of x-rays among Hispanics (compared to non-Hispanics) has been reported in the research literature. To investigate this issue further, we performed a regression analysis restricting the NAMCS data only to visits for nonwork-related musculoskeletal conditions and found no significant association between Hispanic ethnicity and having an x-ray taken during the visit (OR=0.94, CI: 0.78-1.14). This suggests that the elevated rate of x-rays observed among Hispanics is related specifically to the process of their receiving care for work-related conditions. One possible explanation is that the elevated rate of x-rays among Hispanics is indicative of their suffering more severe injuries at work, possibly because Hispanics work in jobs with more substantial hazards (the NAMCS data did not contain information by which to ascertain relative severity of injuries). Another possibility is suggested by historical evidence indicating that x-rays have sometimes been used as a way of discrediting or repressing the reporting of work-related musculoskeletal disorders among immigrant and minority workers, under the alleged theory that the absence of an objective finding upon x-ray examination invalidates the organic basis and, thus, the legitimacy of a work-related musculoskeletal condition reported by those individuals. quetiapine medication

Limitations

The chief limitation in this study was the unavailability of data in the NAMCS by which to access the potential confounding influence of occupation; job exposures; employment-based medical services; severity of the patient’s condition; and outcomes of care, including vocational function, medical costs, health status, disability and wage loss. In addition, since this study examined office-based ambulatory care only, it was not possible to evaluate the potential influences of other medical services that might have been obtained at the worksite, federal facilities or in hospital settings.
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This study is based on survey responses provided by physicians and clinical staff and, thus, is subject to possible reporting errors or omissions. Racial and ethnic classification of patients was determined by respondents based on observable indicators and information supplied by the patient, an approach that could result in misclassification. Similarly, the determination of whether a visit was paid by workers’ compensation insurance or involved a work-related condition depended entirely on the accuracy of the self-reported survey responses by physicians and clinical staff. There was no way to independently verify this information. The special training that was provided to participating physicians and clinical staff by NCHS investigators on how to complete the patient record forms presumably helped mitigate these potential errors.