title: Regions, hospitals and health outcomes over time: A multi-level analysis of repeat prevalence among a cohort of health-care workers.
abstract: 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.
authors.affiliation: Institute for Work & Health, 481 University Ave., 8th Floor, Toronto, Ont., Canada M5G 2E9. dcole@iwh.on.ca
authors.forename: Donald C
authors.initials: DC
authors.lastname: Cole
authors.forename: Mieke
authors.initials: M
authors.lastname: Koehoorn
authors.forename: Selahadin
authors.initials: S
authors.lastname: Ibrahim
authors.forename: Clyde
authors.initials: C
authors.lastname: Hertzman
authors.forename: Aleck
authors.initials: A
authors.lastname: Ostry
authors.forename: Fan
authors.initials: F
authors.lastname: Xu
authors.forename: Patrick
authors.initials: P
authors.lastname: Brown
mesh_terms: 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