Purpose
Methods
Literature Search
PECO category | Inclusion criteria | Exclusion criteria |
---|---|---|
Population
| • Study included workers who experienced work disability due to an occupational or non-occupational injury or illness • Study sample based in an OECD labor market country context | • Study included immigrants or linguistic minorities where race or ethnicity was not specified • Study focused exclusively on military or veteran populations |
Exposure
| • Non-White worker • Racial or ethnic minority worker • Exposure to racism or discrimination related to race or ethnicity | • Studies where specific findings from non-White or racial/ethnic groups were not presented or where racism or discrimination related to race or ethnicity was not collected |
Comparison
| • White workers • Racial or ethnic majority workers | • No comparison presented |
Outcome
| • Any outcome measured reflecting the RTW process | • RTW outcomes were not presented • Studies where pre-injury or illness employment were not presented |
Relevance Screen
Quality Appraisal and data Extraction
Evidence Synthesis
Level of evidence | Minimum quality | Minimum quantity | Consistency | Strength of message |
---|---|---|---|---|
Strong | Higha (H) | 3 | 3 H agree; if 3+ studies, ≥3/4 of the M and H agree | Recommendations |
Moderate | Mediumb (M) | 2 H or 2 M and 1 H | 2 H agree or 2 M and 1 H agree; if 3+studies, ≥2/3 of the M and H agree | Consideration |
Limited | 1 H or 2 M or 1 M and 1 H | 2 (M and/or H) agree; if 2 studies, > 1/2 of the M and H agree | Not enough evidence to make recommendations or considerations | |
Mixed | 2 | Findings are contradictory | ||
Insufficient | Medium quality studies that do not meet above criteria |
Results
Study Descriptions
Author, Year | Region | Study objectives | Study design | Sample size and brief description | Length of observation | Racial/ethnic groups (n [%])* | Injury or illness type | Outcome | Quality |
---|---|---|---|---|---|---|---|---|---|
Asher AL, et al., 2017 | United States of America (US) | To create a predictive model of patients’ ability to return to work (RTW) following lumbar spine surgery | Prospective cohort study | • 4,694 • Patients undergoing elective spine surgery for degenerative lumbar disease | Three months post initial surgery | • White (4,246 [91%]) • African American (302 [6.0%]) • Other race (146 [3.0%]) | Non-occupational | • RTW | Medium |
Ben-Shalom Y, Mamun AA., 2015 | US | To study factors associated with achieving RTW milestones | Retrospective cohort study | • 417,238 • A representative proportion of disability insurance beneficiaries from 1996 to 2004 | Five years after receipt of first disability insurance benefit | • White non-Hispanic (294,153 [71%]) • Black non-Hispanic (76,355[18%]) • Hispanic (28,372 [6.8%]) • Other or unknown race (17,941 [4.3%]) | Non-occupational | • Enrollment in employment services • Start of trial work period • Trial work period completion • Suspension or termination of benefits due to RTW | High |
Blinder V, et al., 2013 (a) Blinder V, et al., 2012 (b) | US | To identify early correlates of not returning to work (a) or not being employed (b) for low-income women treated for breast cancer | Prospective cohort study | • 274 (a) / 290 (b) • Women employed at time of a breast cancer diagnosis and were uninsured or underinsured and have a family income ≤200% of federal poverty level | Six, 18-, and 36- and 60-months following breast cancer diagnosis | • Latina (a:145 [53%]) (b:179 [62%]) • Non-Latina white (a:90 [33%] (b:111 [38%]) | Non-occupational | • Not returning to work (a)/ not reporting employment (b) | Medium |
Bradley CJ, Wilk A., 2014 | US | To examine differences between African American and non-Hispanic white women in employment and change in work hours in women newly diagnosed with breast cancer who were initially employed and insured | Prospective cohort study | • 548 • Employed women diagnosed with breast cancer within two months of initiating treatment with intent to cure | Two- and nine-months following baseline interview | • Non-Hispanic white (429 [78%]) • African American (119 [22%]) | Non-occupational | • Employment status • Hours worked/week | Medium |
Busch MA, et al., 2009 | United Kingdom (UK) | To investigate the frequency and determinants of return to paid work after stroke in a multi-ethnic urban population | Prospective cohort study | • 400 • Patients in a stroke registry with first ever stroke between January 1995 and December 2004 and working immediately before stroke | 12 months following stroke | • White (231 [59%]) • Black (128 [33%]) • Other (31 [8.0%]) | Non-occupational | • Employment status | Medium |
Carrougher GJ, et al., 2020 | US | To investigate the effect of patient and injury characteristics on employment for working-aged adult survivors of burn injury | Prospective cohort study | • 967 • Survivors of burn injury, ≥18 years of age or 18 years at follow-up, inpatient hospitalization of ≥ 3 days, known pre-burn employment status | 12 months following burn injury |
Race
• White (654 [78%]) • Black (127 [15%]) • American Indian/Alaska Native (24 [2.9%]) • Asian (15 [1.8%]) • Other (9 [1.0%]) • Multiracial (6 [0.70%]) • Native Hawaiian/Pacific Islander (3 [0.40%])
Ethnicity
• Hispanic/Latino (157 [17%]) • Non-Hispanic/non-Latino (761 [83%]) | Non-occupational | • Employment status | Medium |
Chibnall JT, Tait RC., 2009 | US | To investigate sociodemographic, claim process and short-term adjustment predictors of long-term clinical adjustment among workers’ compensation claimants with low back pain | Prospective cohort study | • 374 • Workers’ compensation claimants with low back pain whose claims were settled in Missouri between January 1, 2001 and June 2, 2002 | Six years post workers’ compensation settlement | • Caucasian (203 [61%]) • African American (171 [52%]) | Occupational | • Employment status • Receipt of social security disability insurance | High |
Chibnall JT, et al., 2005 (a) Tait RC, et al., 2004 (b) | US | To examine relationships among race, socioeconomic status, and post-settlement outcomes (a) and case management (b) of occupational back injuries | Cross-sectional study | • 1,472 • First-incident workers’ compensation claimants with low back injuries whose claims were settled between January 1, 2001 and June 1, 2002 | Not reported | • Caucasian (892 [61%]) • African American (580 [39%]) | Occupational | • Financial struggle (a) • Claim duration (injury to settlement) (b) • Receipt of temporary disability payment (b) | High |
Friedman LS, Ruestow P, Frost L., 2012 | US | To assess ethnic disparities in monetary compensation among construction workers injured on the job | Retrospective cohort study | • 1,039 • Construction workers who filed a workers’ compensation claim in Illinois between 2000 and 2005 | Not reported | • White (724 [70%]) • Hispanic (168 [16%]) • Other (79 [7.6%] • Black (68 [6.5%]) | Occupational | • Total workers’ compensation claim ($USD) • Mean temporary work disability (weeks) | High |
Khan I, et al., 2019 | US | To investigate the factors associated with RTW in patients who achieved otherwise favorable outcomes after lumbar spine surgery | Retrospective cohort study | • 12,435 • Patients undergoing lumbar surgery and were employed prior to surgery and completed 12-month follow-up | 12 months post-surgery | • Caucasian (11,016 [90%]) • African American (886 [7.2%]) • Other race (353 [2.9%]) | Non-occupational | • RTW | High |
MacKenzie EJ, et al., 2006 | US | To understand the factors that influence RTW after major limb trauma | Prospective cohort study | • 432 • Patients admitted to one of eight level 1 trauma centres for treatment of a severe lower extremity injury • English or Spanish speaking and aged 18–69 years | Three, six, 12-, 24- and 84-months post-injury | • White† • Non-white† | Non-occupational | • RTW | Medium |
Marom BS, et al., 2020 (a) Marom BS, et al., 2018 (b) | Israel | To determine the time to RTW and to examine the effect of ethnicity and other prognostic variables on RTW among male manual workers who had experienced a hand injury | Prospective cohort study | • 178 • Male participants, aged 22–65 years who sustained acute hand injury below the elbow, either during or outside of working hours • Manual workers prior to hand injury and were referred by a physician to one of seven occupational therapy clinics • Read or write in Arabic or Hebrew language | 12 months post-injury | • Jewish (88 [50%]) • Arab (90 [51%]) | Non-occupational | • Time to RTW (a) • Employment status (b) | Medium |
Meade MA, et al., 2004 | US | To examine issues of employment and race for persons with spinal cord injury | Retrospective cohort study | • 5,925 • Participants who experienced a spinal cord injury between 1972–2002 and part of a larger database • Classified as African American or white • Ages 18–65 years at time of injury | One-year post-injury (multivariable model) Five, ten, 15-, and 20-years post-injury (descriptive analysis) | • White (4,210 [71%]) • African American (1,715 [29%]) | Non-occupational | • Employment status | High |
Pham TN, et al., 2020 | US | To examine the association of extremity contractures with employment after burn injury | Retrospective cohort study | • 1,203 • Participants aged 18–64 years identified in a burn database (1994–2003) who were working prior to injury | Six-, 12- and 24-month post-injury | • Caucasian† • Non-Caucasian† | Non-occupational | • RTW | Medium |
Sanchez KM, Richardson JL, Mason HRC, 2005 | US | To assess the role of person, disease, and work-related factors on a timely return to the workplace among employed colorectal cancer survivors who sustained employment five years after initial cancer diagnosis | Cross-sectional study | • 142 • Participants who survived a colorectal cancer diagnosis between 1994 and 1995 were randomly selected from two population-based cancer registries • Speak and read English or Spanish • Ages 30–59 years at the survey | • White (104 [73%]) • Black (22 [16%]) • Hispanic (16 [14%]) | Non-occupational | • Delayed RTW (> 2 months following diagnosis) | High | |
Savitsky B, et al., 2020 (a) Savitsky B, et al., 2020 (b) | Israel | To examine socioeconomic and other predictors of RTW (a) and duration to RTW (b) | Retrospective cohort study | • 44,740 (a) / 45,291(a) • Resident to Israel and aged 21–67 years • Injured and hospitalized between January 1, 2008 and December 31st 2013 • Employed 2 months prior to injury as a salaried worker• | One month, one year and 2 years post-injury | • Other Israelis (26,858 [59.3%]) • Israeli Arabs (11,232 [24.8%]) • Immigrants from former Soviet Union (6,341 [14%]) • Ethiopian Immigrants (679 [1.5%]) • Missing (181[0.4%]) | Occupational and non-occupational | • Non-RTW | High |
Skolarus LE, et al., 2016 | US | To compare the proportion of stroke survivors who returned to work within 90 days following their stroke by ethnicity and investigate the role of sociodemographic factors and stroke severity | Prospective cohort study | • 125 • Stroke patients from a larger population-based surveillance study stroke survivors (August 2011-December 2013) who were employed at the time of their stroke | 90 days post-stroke | • Mexican Americans (71 [57%]) • Non-Hispanic white (54 [43%]) | Non-occupational | • RTW | Medium |
Strong LL, Zimmerman FJ, 2005 | US | To examine the relationship between race/ethnicity and the number of workdays missed owing to an injury or illness that caused a participant to miss work according to gender | Prospective cohort study | • 35,710 • Cohort drawn from ten waves of data (years 1988–2000) from a nationally representative population-level dataset | Not reported | • Non-Hispanic white (20,377 [57%]) • Hispanic (5,387 [15%]) • African American (9,946 [28%]) | Non-occupational | • Workdays missed due to injury or illness | High |
Tait RC, Chibnall JT, 2000 | US | To examine medical and psychosocial factors associated with work injury management decisions for patients with low back pain | Retrospective cohort study | • 132 • Workers’ compensation claimants with refractory low back injuries whose impairment was physician assigned | Not reported | • Caucasian (84 [64%]) • African American (47 [36%]) | Occupational | • Temporary total disability costs related to excused time off work | High |
Race, Ethnicity and RTW Outcomes
Author∼, Year | Racial/ethnic groups* | Findings ‡ | Quality |
---|---|---|---|
Asher AL, et al., 2017 | • White • African American • Other race | • African American participants significantly less likely to RTW following lumbar spine surgery compared to white participants (Hazard ratio [HR] = 0.71; 95% confidence interval [95% CI] 0.62–0.82) • Other race groups were significantly less likely to RTW following lumbar spine surgery compared to white participants (HR = 0.82; 95% CI 0.67-1.0) | Medium |
Ben-Shalom Y, Mamun AA, 2015; | • White non-Hispanic • Black non-Hispanic • Hispanic • Other or unknown race | • Black disability insurance beneficiaries more likely to be enrolled in employment services compared to those who were non-Hispanic white (β = 0.014, p < 0.001) • Black disability insurance beneficiaries more likely to start (β = 0.026, p < 0.001) and complete (β = 0.023, p < 0.001) trial work period compared to those who were white • Hispanic disability insurance beneficiaries less likely to be enrolled in employment services when compared to those who were non-Hispanic white (β= -0.0080, p < 0.05) • Other or unknown race disability insurance beneficiaries less likely to be enrolled in employment services when compared to non-Hispanic white participants (β= -0.011, p < 0.001) | High |
Blinder V, et al., 2013 (a) Blinder V, et al., 2012 (b) | • Latina • Non-Latina white | • Latina participants more likely to report not returning to work (a)/not being employed at only six months (Odds ratio [OR] = 0.31, 95% CI 0.12–0.81) and 18 months (OR = 0.73, 95% CI 0.27-2.0) following breast cancer diagnosis when compared to non-Latina white participants (b) • The difference between Latina participants and non-Latina participants was not significantly different at 36 months (53% vs. 59%) (b) | Medium |
Bradley CJ, Wilk A., 2014 | • Non-Hispanic white • African American | • African American participants with breast cancer significantly less likely to be employed at two months following cancer diagnosis (69%) when compared to non-Hispanic white participants (85%) (Odds ratio [OR] = 0.43, 95% CI 0.26–0.71) • African American participants with breast cancer more likely to report fewer work hours at nine months following baseline survey (-4.3%) when compared to non-Hispanic white participants (-2.9%) (β= = -2.1, p < 0.05) | Medium |
Busch et al., 2009 | • White • Black • Other | • Black participants less likely to be employed 12 months following a stroke (30%) when compared to white participants (OR = 0.41; 95% CI 0.19–0.88) | Medium |
Carrougher GJ, et al., 2020 |
Race
• White • Black • American Indian/Alaska Native • Asian • Other • multiracial • Native Hawaiian/Pacific Islander
Ethnicity
• Hispanic/ Latino • Non-Hispanic/ non-Latino | • White race, non-Hispanic ethnicity participants with a burn injury were more likely to be employed at 12 months than those who were non-white race or Hispanic ethnicity (OR = 1.6, 95% CI 1.1–2.3) | Medium |
Chibnall JT, Tait RC, 2009 | • Caucasian • African American | • Caucasian participants with low back pain (67%) were significantly more likely than African American participants to be employed six years post workers’ compensation settlement (57%) when compared to (OR = 1.6 95% CI 1.0- 2.5) • African American participants with low back pain were more likely to receive Social Security Disability Insurance (39%) when compared to Caucasian participants (25%) (OR = 2.0 95% CI 1.3–3.2) | High |
Chibnall JT, et al., 2005 (a) Tait RC, et al., 2004 (b) | • Caucasian • African American | • African American participants with occupational back injuries were significantly more likely to report post-settlement financial struggle compared to Caucasian participants (β = 0.12, p < 0.001) (a) • African American participants with occupational back injuries reported shorter claim periods compared to Caucasian participants (18.2 months vs. 23.2 months) (β = -0.14, p < 0.0001) (b) • African American participants with occupational back injuries were less likely to receive a temporary disability payment (21%) compared to Caucasian participants (42%) (OR = 0.45, 95% CI 0.30–0.60) (b) | High |
Friedman LS, Ruestow P, Frost L., 2012 | • White • Hispanic • Other race • Black | • Black ($47,935.00), Hispanic ($48,519.00) and other race ($43,048.00) participants awarded lower total mean monetary workers’ compensation settlements following an injury compared to white participants ($60,431.00) • Black (21.8 days) Hispanic (26.7 days) participants reported shorter mean temporary work disability days than white participants (29.5 days) | High |
Khan I, et al., 2019 | • Caucasian • African American • Other race | • African American participants (6.2%) were significantly less likely to RTW following lumbar spine surgery when compared to Caucasian participants (91%) (OR = 0.60, 95% CI 0.50–0.80) • Among those with favorable surgical outcomes, there was no significant RTW difference between Caucasian, African American participants, and other racial participants (X2 = 1.1, P = 0.059) | High |
MacKenzie EJ, et al., 2006 | • White • Non-white | • White participants were significantly more likely to RTW at 84 months post major limb trauma when compared to non-white participants (Relative Rate Ratio [RR] = 1.8, 95% CI 1.2–2.7) | Medium |
Marom BS, et al., 2020 (a) Marom BS, et al., 2018 (b) | • Jewish • Arab | • No significant difference between Arab (71%) and Jewish (80%) participants when comparing time to RTW following hand injury (HR = 1.2, 95% CI 0.76-2.0) (b) • Difference between Arab (29%) and Jewish participants (46%) in employment status at three months following hand injury was not significant when adjusting for legal counsel, educational attainment, and disability severity (OR = 1.1, 95% CI 0.46–2.5) (a) | Medium |
Meade MA, et al., 2004 | • White • African America | • African American participants were significantly less likely to be employed at 12 months (5.9%) post-spinal cord injury when compared to white participants (16%) • The racial difference in employment following spinal cord injury persisted across the descriptive follow-up period (β=-1.2, p < 0.001) | High |
Pham TN, et al., 2020 | • Caucasian • Non-Caucasian | • Non-Caucasian ethnicity was significantly associated with a lower likelihood of RTW when compared to Caucasian participants after burn injury (period post-follow-up not reported) (OR = 0.16–0.35 (depending on ethnicity), 95% CI 0.040–0.89) | Medium |
Sanchez KM, Richardson JL, Mason HRC, 2005 | • White • Black • Hispanic | • Black (OR = 1.08, 95% CI 0.41–2.81) and Hispanic (OR = 1.47, 95% CI 0.50–4.27) ethnicity not significantly associated with delayed RTW following colorectal cancer diagnosis when compared to white participants | High |
Savitsky B, et al., 2020 (a) Savitsky B, et al., 2020 (b) | • Other Israelis • Israeli Arabs • Immigrants from former Soviet Union • Ethiopian Immigrants | • Israeli Arabs significantly more likely to report non-RTW at one-month post-injury (53%) when compared to the other Israeli group (33%) (OR = 1.6, 95% CI 1.5–1.7) • There was no significant difference in the likelihood non-RTW at one-month post-injury when comparing Ethiopian Immigrants (43%) and the other Israeli group (33%) (OR = 0.96, 95% CI 0.81–1.14) • Israeli Arabs significantly more likely to report non-RTW at one-year post-injury (20%) when compared to the other Israeli group (8.8%) (OR = 1.9, 95% CI 1.8–2.1) • There was no significant difference in the likelihood non-RTW at one-year post-injury when comparing Ethiopian Immigrants (14%) and the other Israeli group (8.8%) (OR = 1.22, 95% CI 0.97–1.14) • Israeli Arabs significantly more likely to report non-RTW within 2 years post-injury (14%) when compared to the other Israeli group (5.7%) (OR = 2.1, 95% CI 1.9–2.3) • There was no significant difference in the likelihood non-RTW at one-year post-injury when comparing Ethiopian Immigrants (9.6%) and the other Israeli group (5.7%) (OR = 1.25, 95% CI 0.92–1.70) • Israeli Arabs (HR = 1.4, 95%CI 1.3–1.4) and Ethiopian immigrants (HR = 1.2, 95% CI 1.1–1.3) experience a longer duration of stay out of work compared to other groups of Israeli workers | High |
Skolarus LE, et al., 2016 | • Mexican Americans • Non-Hispanic white | • Mexican American participants were significantly less likely to RTW following a stroke (31%) when compared to non-Hispanic white participants (50%) (OR = 0.85, 95% CI 0.32–2.2) • Relationship between being Mexican American being less likely to RTW was non-significant in model which also included educational attainment and level of impairment | Medium |
Strong LL, Zimmerman FJ, 2005 | • Non-Hispanic white • Hispanic • African American | • Hispanic male workers missed more mean workdays (38 days) due to injury or illness than male non-Hispanic white workers (28 days) but the relationship was not significant at the multivariable level (OR = 1.1, 95% CI 0.84–1.5); No significant differences were observed between Hispanic and non-Hispanic white female workers • African American male (30.9 days) missed more mean workdays due to injury or illness than non-Hispanic white male (28.1 days) (OR = 0.83, 95% CI 0.64–1.1) • African American female workers missed more mean workdays (45.2 days) due to injury or illness than non-Hispanic white female workers (24.0 days) but the relationship was not significant at the multivariable level (OR = 1.0, 95% CI = 0.77–1.4) | High |
Tait RC, Chibnall JT, 2000 | • Caucasian • African American | • In the absence of legal representation, African American participants indicated significantly lower temporary total disability costs related to low back pain when compared to Caucasian participants (F (1, 126) = 4.4, p < 0.05). This relationship did not hold in the presence of legal representation. | High |
RTW or Employment Status Following Injury or Illness
Cost and Length of Workers’ Compensation Claim
Length of Disability Absence
Income Support
Work Hours Following RTW
Financial Struggle
Involvement in RTW Services
Evidence Synthesis
Outcome | Levels of evidence | Number of High [H] and Medium [M] quality studies | Message |
---|---|---|---|
Key messages for non-White or racial/ethnic minority groups
‡
| |||
Returning to paid employment following a non-occupational injury or illness* | Strong | 3 H, 7 M | Non-White or ethnic minority workers are less likely to report RTW following a non-occupational injury or illness and will benefit from specific policy and programmatic attention |
Enrollment in RTW programming or employment services | Limited | 1 H | |
Receipt of social security or disability benefits following occupational injury or illness | Mixed | 2 H | Not enough evidence from the scientific literature due to mixed findings comparing non-White or ethnic minority workers and receipt of social security or disability benefits |
Claim duration following occupational injury or illness | Insufficient | 1 H, 1 M | Not enough evidence from the scientific literature |
Total workers’ compensation claim ($) following occupational injury or illness | 1 H | ||
Financial struggle following occupational illness | 1 H | ||
Total missed workdays following non-occupational injury or illness | 1 H | ||
RTW following occupational injury or illness | 1 M | ||
Starting and completing trial work periods following non-occupational injury or illness | 1 M | ||
Total work hours following non-occupational injury or illness | 1 M | ||
Key messages for specific racial and ethnic minority groups
†
| |||
Returning to paid employment following a non-occupational injury or illness* | Moderate | Black workers; 2 H, 3 M | Black workers may face obstacles to returning to work following non-occupational injury or illness and could benefit from policy and programmatic attention |
Returning to paid employment following a non-occupational injury or illness* | Limited | Latinx workers; 1 H, 1 M |