title: Sex and gender disparity in pathology, disability, referral pattern, and wait time for surgery in workers with shoulder injury.
abstract: BACKGROUND
  The role of sex as an important biological determinant of vulnerability to sustaining injury and gender as a social determinate of access to resources, referral for medical care and perceived disability remains conflicted in injured workers. The purpose of this study was to examine sex and gender disparity following a compensable work-related shoulder injury.
  
  
  METHODS
  This study involved cross-sectional analyses of data of two independent samples of workers with shoulder injury. Measures of disability and pain were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Numerical Pain Rating Scale (NPRS) for patients seen at an Early Shoulder Physician Assessment (ESPA) program and the American Shoulder and Elbow Surgeons (ASES) assessment form and Visual Analogue Scale (VAS) for the sample who underwent surgery.
  
  
  RESULTS
  The files of 1000 (443 females, 557 men) consecutive patients seen at an ESPA program and 150 (44 females, and 106 men) consecutive patients who underwent rotator cuff surgery (repair or decompression) were reviewed. Significant gender disparity was observed in the referral pattern of injured workers seen at the ESPA program who were referred for surgical consultation (22 vs. 78 % for females and males respectively, p < 0.0001). The independent rotator cuff surgical group had a similar gender discrepancy (29 % vs. 71 %, p < 0.0001). The timeframe from injury to surgery was longer in women in the surgical group (p = 0.01). As well, women waited longer from the date of consent to date of surgery (p = 0.04). Women had higher incidence of repetitive injuries (p = 0.01) with men reporting higher incidence of falls (p = 0.01). Women seen at the ESPA program were more disabled than men (p = 0.02). Women in both samples had a higher rate of medication consumption than men (p = 0.01 to <0.0001). Men seen at the ESPA program had a higher prevalence of full thickness rotator cuff tears (p < 0.0001) and labral pathology (p = 0.01). However, these pathologies did not explain gender disparity in the subsample of ESPA who were referred for surgical consultation or those who had surgery.
  
  
  CONCLUSIONS
  Sex and gender disparity exists in workers with shoulder injuries and is evident in the mechanism of injury, perceived disability, medication consumption, referral pattern, and wait time for surgery.
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada. helen.razmjou@sunnybrook.ca.|Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada. helen.razmjou@sunnybrook.ca.|Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada. helen.razmjou@sunnybrook.ca.
authors.forename: Helen
authors.identifier: http://orcid.org/0000-0002-3162-4241
authors.initials: H
authors.lastname: Razmjou
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.|Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Lincoln
authors.affiliation: Toronto Rehabilitation Institute, Lyndhurst Centre, Brain & Spinal Cord Rehabilitation Program, Toronto, Canada.
authors.forename: Iona
authors.initials: I
authors.lastname: Macritchie
authors.affiliation: Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.|Department of Orthopedic Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Robin R
authors.initials: RR
authors.lastname: Richards
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Medeiros
authors.affiliation: Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.|Department of Orthopedic Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada.|Department of Orthopaedic Surgery, St. Joseph's Health Centre, Toronto, Canada.
authors.forename: Amr
authors.initials: A
authors.lastname: Elmaraghy
keywords: Gender disparity; Injured workers; Sex; Shoulder