Regions, hospitals and health outcomes over time: A multi-level analysis of repeat prevalence among a cohort of health-care workers.
BACKGROUND
The relative importance of region, workplace, and individual determinants of health burden is debated.


OBJECTIVE
To model the contribution of hospital characteristics to employee mental and musculoskeletal disorders.


METHODS
We linked employment records of nurses and support services' staff with health records, neighbourhood census, and hospital administrative data. We conducted multi-level logistic regression analyses with three levels: year (I), employee characteristics (II), and hospital characteristics (III).


RESULTS
Northern region hospitals experienced lower disorder prevalences (odds ratios (OR) 0.58, 95% confidence intervals (0.40, 0.82) for mental and 0.56 (0.44, 0.73) for musculoskeletal disorders). Hospitals with yearly workloads of the highest versus lowest quintiles of inpatient days/1000 employee hours (>86.0 vs. <42.6) and surgical cases/1000 employee hours (>10.5 vs. <3.9) had greater odds of mental (1.29 (1.05, 1.57); 1.22 (1.05, 1.42)) and musculoskeletal (1.38 (1.21, 1.58); 1.21 (1.09, 1.34)) disorders.


CONCLUSIONS
Opportunities exist for reduction in burden with hospital workload reduction. Further exploration of regional effects is needed.
Cole
Donald C
DC
Institute for Work & Health, 481 University Ave., 8th Floor, Toronto, Ont., Canada M5G 2E9. dcole@iwh.on.ca
Koehoorn
Mieke
M
Ibrahim
Selahadin
S
Hertzman
Clyde
C
Ostry
Aleck
A
Xu
Fan
F
Brown
Patrick
P
D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology* / Q000209:etiology; D009784:Occupational Diseases / Q000453:epidemiology* / Q000209:etiology; D010564:Personnel, Hospital; D015995:Prevalence; D016526:Workload; D017132:Workplace