African-Americans and the poor with work-related back injuries clearly fare worse

African-Americans with work-related back injuries have less money spent on their medical care and receive less compensation for their injuries than Caucasians, according to a Saint Louis University study in the December issue of Pain.

"The implications of these differences are sobering," said Raymond C. Tait, Ph.D., a professor of psychiatry at Saint Louis University School of Medicine, and principal investigator of the study.

"Even though patients have equal access to health care through the Workers' Compensation system, there are substantial differences in the treatment costs that they incur. African-Americans and the poor clearly fare worse."

The research examined 1,472 Workers' Compensation cases in Missouri that involved lower back injuries, which often are a source of chronic pain. The study found that African-Americans had less money spent on their medical care, less excused time from work and smaller financial settlements than Caucasians.

Saint Louis University researchers found that differences in case settlements also varied with socioeconomic status. Those of lower socioeconomic status -– who were less educated and earned smaller incomes –- received less costly medical care and smaller financial settlements for their injuries than those who were more educated and had higher incomes.

However the differences were not so pronounced as those between African-Americans and Caucasians, added John Chibnall, Ph.D., associate professor of psychiatry at Saint Louis University School of Medicine, and a study co-investigator.

"We expected that African-Americans would incur shorter treatment periods, lower treatment costs, lower temporary total disability payments, lower disability ratings and lower settlement awards," Chibnall said. "The extent of it surprised us. It's pretty clear there is disparity in a system that's supposed to provide equal access for everyone."

• Medical care expenditures for African-Americans with work-related back injuries were about one third of those spent for Caucasians.

• Total disability settlements to African Americans were approximately half of those awarded to Caucasians.
• Caucasians were rated nearly two times more disabled than African-Americans.

Tait notes that these statistics reflect the effects of both race and socioeconomic status. Even when socioeconomic status is held constant, disparities remain:

• The typical tab on medical treatment for African-Americans studied is more than $4,000 less than for Caucasians.

• The settlement award is nearly $3,000 lower for African-Americans.

The researchers found that African-Americans also were much less likely than Caucasians to be diagnosed with a disc injury or to undergo surgery.

Patients who had surgery and claims for disc injuries incurred higher treatment costs, had more compensated work absences, longer claim periods and greater disability ratings and larger settlement awards.

There was little or no connection between legal representation and medical expenditures or case settlement, the researchers noted.

Tait speculated that negative stereotypes represent the most likely reason for the differences in treatment and settlements.

"The diagnosis of lower back pain is a bugaboo in medicine today," Tait said. "It is not an exact science. There is no well-recognized paradigm for diagnosing and treating back pain. Consequently treatment decisions often are based on clinical judgment.

"Those judgments may be affected by negative stereotypes about chronic back pain, about compensable in juries, and about minorities. While the patterns that we found are consistent with those described in a 2002 report by the Institute of Medicine that documented racial disparities in health care, the magnitude of the race differences in case management that we found may have been amplified by the combination of negative stereotypes."

Although the results of this study are based on workers injured in Missouri, Tait said that the pattern likely would hold nationally. He cautioned, however, that more research examining medical treatment decisions for different ethnic or racial groups is needed to better understand the disparity.

"The first stage of solving a problem is identifying it. We're at that problem identification stage. Of course we now need more detailed information so that we can move toward solving the problem."