title: Regional socioeconomic disparities in outcomes for workers with low back pain in the United States.
abstract: BACKGROUND
  Although regional socioeconomic (SE) factors have been associated with worse health outcomes, prior studies have not addressed important confounders or work disability.
  
  
  METHODS
  A national sample of 59 360 workers' compensation (WC) cases to evaluate impact of regional SE factors on medical costs and length of disability (LOD) in occupational low back pain (LBP).
  
  
  RESULTS
  Lower neighborhood median household incomes (MHI) and higher state unemployment rates were associated with longer LOD. Medical costs were lower in states with more workers receiving Social Security Disability, and in areas with lower MHI, but this varied in magnitude and direction among neighborhoods. Medical costs were higher in more urban, more racially diverse, and lower education neighborhoods.
  
  
  CONCLUSIONS
  Regional SE disparities in medical costs and LOD occur even when health insurance, health care availability, and indemnity benefits are similar. Results suggest opportunities to improve care and disability outcomes through targeted health care and disability interventions.
authors.affiliation: Center for Disability Research and Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts.|Work Environment Department, University of Massachusetts Lowell, Lowell, Massachusetts.|Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
authors.forename: Mujahed
authors.initials: M
authors.lastname: Shraim
authors.affiliation: Regis College, Weston, Massachusetts.
authors.forename: Manuel
authors.initials: M
authors.lastname: Cifuentes
authors.affiliation: Center for Disability Research and Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Willetts
authors.affiliation: Center for Disability Research and Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts.
authors.forename: Helen R
authors.initials: HR
authors.lastname: Marucci-Wellman
authors.affiliation: Center for Disability Research and Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts.
authors.forename: Glenn
authors.initials: G
authors.lastname: Pransky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D006233:Persons with Disabilities; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D017116:Low Back Pain / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000191:economics*; D012044:Regression Analysis; D018582:Sick Leave; D012959:Socioeconomic Factors; D014481:United States; D014942:Workers' Compensation; D055815:Young Adult
keywords: disability duration; medical costs; occupational low back pain; socioeconomic factors; workers’ compensation