Socioeconomic Status Influences Recovery
from Occupational Injuries

Medical staff at Brooke Army Medical Center in San Antonio, Texas, lift a patient from one bed to another after surgery to move him to the recovery room. (U.S. Navy photo by Jhi L. Scott/Released)

Low socio-economic status and a perceived imbalance between job effort and reward play a significant role in predicting recovery from work-related musculoskeletal injuries, according to a new study.

Researchers recruited over 650 hospital workers during 2002-04 to examine work-related musculoskeletal disorders (WRMSDs) of the trunk, neck, and upper and lower extremities. They assessed their recovery two years later to determine if the injuries had resolved and whether or not there were lingering impacts to work status or productivity.

"We documented the recovery trajectory and found that most injuries resolved in a two year time period," said lead author Marion Gillen, deputy director of COEH and clinical professor in the UCSF School of Nursing. "We also found that people in the lowest economic strata had worse outcomes as a result of their injuries."

The study was published in the October 2010 issue of Occupational Medicine (Lond) and funded by U.S. National Institutes of Health. COEH member Paul Blanc, professor of Medicine at UCSF, was senior author on the study. John Frank, who holds a Chair at the University of Edinburgh, was one of the co-authors.

Participants were from two hospital sites in San Francisco, California. Researchers recruited a diverse representation of hospital staff including nurses, clinicians, administrators, clerks and technicians. The cross-sectional, longitudinal study, which was facilitated through cooperation with hospital administrators and unionized labor, compared injured workers to a group of similarly employed, uninjured workers from the same sites.

"As occupational health professionals, we have to start looking at whether we need differentiated rehabilitation efforts and targeted return-to-work programs for people in different job classifications who face the double jeopardy following workplace injury."
Marion Gillen

After controlling for age, sex, race-ethnicity, income and education, recovery outcomes were poorest for those within the lowest 25% of socioeconomic status (SES) and for those who perceived a discrepancy between job effort and reward. "Along with poorer health outcomes, these groups also experienced work status changes or reduced work effectiveness," reported Gillen. The research team identified that certain workers may be at risk of a double jeopardy — worse health and work status — following musculoskeletal injury at work.1

"What is interesting is that these people had the highest level of occupation healthcare available following workplace injury," said Gillen. "For example, they had access to occupational health services with direct clinical care and case management. Still, there is something that is not addressed related to SES status that contributes to disparities in recovery."

The results were noteworthy, according to Gillen, because even though there was a difference in SES status among the study participants, they were all earning above minimum wage. The authors suggest WRMSDs may result in a worse long-term prognosis for workers with low SES status than is generally acknowledged.2

The study highlights that creating work environments with appropriate rewards and less strain may contribute to better work effectiveness. Notes Gillen, "As occupational health professionals, we have to start looking at whether we need differentiated rehabilitation efforts and targeted return-to-work programs for people in different job classifications who face the double jeopardy following workplace injury."

1,2 Gillen M, Cisternas, MG, Yen, IH, Swig L, Rugulies R, Frank J, and Blanc PD. Functional recovery following musculoskeletal injury in hospital workers. Occupational Medicine. 2010 Oct;60(7):532-9.

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