Race differences in diagnosis and surgery for occupational low back injuries

Study Design. Population-based telephone survey in Missouri. Objective. To examine the unique contribution of race to diagnosis and surgery rates in workers' compensation claimants. Summary of Background Data. Race differences in diagnostic specificity and rates of surgery may mediate documented differences in workers' compensation case management outcomes ( treatment expenditures, disability ratings, and settlement awards) between African Americans and whites with low back injuries. Participants and Methods. African American (n = 580) and white (n = 892) workers' compensation claimants with single- incident low back injuries were interviewed regarding diagnoses and treatments received for their injury. Participants were, on average, 21 months after settlement. Analyses examined the association of race (controlling for clinical findings, legal representation, age, gender, and socioeconomic status) with diagnosis ( herniated disc vs. regional backache) and surgery. Risk ratios for race were calculated. Results. Whites were 40% more likely than African Americans to receive a herniated disc diagnosis. Of claimants with the latter diagnosis, whites were 110% more likely than African Americans to undergo surgery. Conclusions. Race differences in diagnosis and surgery may help to explain why African Americans, relative to whites, receive lower workers' compensation medical expenditures, disability ratings, and settlement awards.