Academic journal article Scandinavian Journal of Work, Environment & Health

Notification of Occupational Disease and the Risk of Work Disability: A Two-Year Follow-Up Study

Academic journal article Scandinavian Journal of Work, Environment & Health

Notification of Occupational Disease and the Risk of Work Disability: A Two-Year Follow-Up Study

Article excerpt

Kolstad HA, Christensen MV, Jensen LD, Schlünssen V, Thulstrup AM, Bonde JP. Notification of occupational disease and the risk of work disability: a two-year follow-up study. Scand J Work Environ Health. 2013;39(4):411-419. doi:10.5271/sjweh.3336

Objectives The aim of this study was to analyze if notification of an occupational disease increases the risk of work disability.

Methods We included 2304 patients examined at the Department of Occupational Medicine, Aarhus University Hospital, 1998-2005 and followed them for two years. A total of 564 patients were notified of an occupational disease when they were examined at baseline and 1740 patients were not. We obtained weekly information on sick payment, unemployment payment, disability pension, rehabilitation benefit, and other social benefits during the two years of follow-up from a national register. Using Cox regression models, we analyzed notification and adjusted hazard ratios (HRadj) of work disability (defined as >12 weeks of social benefits during the first or second year of follow-up).

Results Prior to notification, notified patients had higher levels of clinical, occupational, and social characteristics that predict poorer vocational prognosis. Analyses that adjusted for these differences showed an increased risk of work disability following notification for patients who were working when notified at baseline (HRadj 1.46, 95% CI 1.17-1.82). No effect was seen for patients who were not working.

Conclusions Notification of an occupational disease may, as an unintended side effect, increase the risk of work disability. A cautious interpretation is warranted because data analyses may not fully have accounted for the poorer vocational prognosis already present at baseline.

Key terms gainful employment; occupational health service; workers' compensation.

Workers who contract diseases caused by their work or working conditions have the right to compensation for disability, wage loss, and medical expenses according to most jurisdictions (1). Compensation systems vary between states and countries, but qualification for compensation usually requires that physicians make a notification or workers submit a claim to the compensation authorities. Processing of claims is often long-lasting, may require comprehensive documentation from workers, health and safety representatives, general practitioners, hospitals as well as expert testimony, and may have disabling consequences beyond the health condition that prompted the claim (2). Poorer prognosis following workers' compensation claims has been reported for patients with head injury (3), chronic pain (4), low-back pain (5-14), neck pain (15), carpal tunnel syndrome (16), accidents (17), for a general working population (18), and following surgery for shoulder disorders (19-22) and lumbar spine diseases (23), when compared with patients not involved in a compensation claim. Affected outcomes have included patient satisfaction, function, quality of life, mental health, cognition, symptoms, return to work, and days away from work (17).

Studies of the health effects of worker's compensation notifications have to be interpreted with caution because of the inherited methodological weaknesses of observational studies, and a recent meta-review concluded that the evidence that compensation is associated with subsequent poorer health is equivocal (17). In addition to workers experiencing more strenuous working conditions, it is expected that disabled workers are more likely to be involved in a compensation claim than those less disabled or those with less strenuous working conditions, even if they are diagnosed with the same disorder (24, 25). This may confound associations between notification status and subsequent health and employment in line with confounding by indication. Confounding by indication occurs when a symptom or sign of disease is an indication of a given intervention and is therefore associated with both the intervention and a higher probability of the outcome (26). …

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