The impact of regulatory workplace safety inspections on workers' compensation claim rates.

BACKGROUND: Studies on the impact of workplace safety inspections on work injuries have found mixed effectiveness. Most studies are from the United States, examining Occupational Health and Safety Administration (OSHA) regulatory inspections in manufacturing firms with more than 10 employees. This study examines whether regulatory inspections in Alberta, Canada, result in reductions in workers' compensation claims rates for inspected firms relative to comparable non-inspected firms. METHODS: Firm and claim-level data from the Workers' Compensation Board of Alberta were linked with regulatory enforcement data from the Government of Alberta for construction, manufacturing, and transportation firms with at least one full-time employee for 37 consecutive months. A matched difference-in-differences study design was used to estimate changes in lost-time claim rates for work-related injuries and musculoskeletal diseases of inspected and comparable non-inspected firms between the year pre-inspection and 2 years, post-inspection, controlling for firm-level characteristics. RESULTS: Inspections were not effective in reducing firm-level claim rates, with the exception of transportation firms with more than one inspection experiencing a 28% decrease in their claim rate in the second year post-inspection, relative to the change in non-inspected firms. In construction, inspected firms experienced a 12% increase in their claim rate in the first year post-inspection. No effect was observed in the manufacturing sector. CONCLUSIONS: Regulatory workplace safety inspections in Alberta generally do not result in greater reductions in firm-level claim rates in the construction, manufacturing, and transportation sectors. Inspections alone may not be sufficient to induce compliance or hazard management changes that lead to reductions in firm-level injuries.

Work Disability Duration Among Mobile Workers: Does Intraprovincial Mobility Matter as Much as Interprovincial Mobility?

OBJECTIVE: The aim of the study is to compare work disability duration of intraprovincially and interprovincially mobile workers with nonmobile workers in British Columbia, Canada. METHODS: Workers' compensation claims were extracted for workers injured between 2010 and 2019. Employer and residential postal codes were converted to economic regions to define nonmobile, intraprovincially, and interprovincially mobile workers. Quantile regression models using matched cohorts were used to estimate differences in work disability days at different percentiles of the distribution. RESULTS: Compared with nonmobile workers, both mobile worker groups had longer work disability durations, particularly interprovincially mobile workers. Differences persisted in injury-stratified models and were partially or fully attenuated in some industry-stratified models. CONCLUSIONS: Workers' compensation systems, employers, and healthcare providers may need to tailor specific interventions for mobile workers who are from out-of-province as well as traveling between regions in the province.

Do regional labor market conditions matter for temporary work disability duration? A multilevel analysis of workers' compensation claims in five Canadian provinces.

BACKGROUND: Research has shown how regionally varying labor market conditions are associated with differences in work disability duration. However, the majority of these studies have not used multilevel models to appropriately account for the hierarchical clustering of individuals nested within contextual units (e.g., regions). Studies that have used multilevel models have focused on privately insured workers or on disability not specifically caused by work-related injury or illness. METHODS: Using claims data from five Canadian provincial workers' compensation systems, linear random-intercept models were used to estimate how much variance in temporary work disability duration ('work disability duration' for brevity) for work-related injuries and musculoskeletal disorders was due to differences between economic regions, what economic region-level labor market characteristics were associated with work disability duration, and what characteristics best explained economic region differences in work disability duration. RESULTS: Economic region characteristics, such as the unemployment rate and proportion of goods-producing employment, were independently associated with individual-level work disability duration. However, economic region variation only accounted for 1.5%-2% of total variation in work disability duration. The majority (71%) of economic region-level variation was explained by the provincial jurisdiction where the worker lived and was injured. Regional variation tended to be greater for female workers than males. CONCLUSIONS: The findings suggest that while regional labor market conditions matter for work disability duration, system-level differences in workers' compensation and health care are more important factors influencing work disability duration. Furthermore, while this study includes both temporary and permanent disability claims, the work disability duration measure only captures temporary disability.

Continuation of telework in the post-pandemic era: Healthcare employees' preference and determinants.

Now in the post-pandemic era, healthcare employers and leaders must navigate decisions around use of telework arrangements made popular during the COVID-19 pandemic. Among healthcare employees who teleworked during the pandemic, this study investigates preference to continue teleworking post-pandemic and the determinants of this preference. An overwhelming majority (99%) preferred to continue teleworking to some degree and the majority (52%) preferred to telework for all work hours. Healthcare employers should consider that most employees who teleworked during the pandemic prefer to continue teleworking for most or all work hours, and that hybrid work arrangements are especially important for clinical telework employees. In addition to space and resource allocation, management considerations include supports to promote productivity, work-life balance, and effective virtual communication while teleworking to promote positive employee health, recruitment, and retention outcomes.

Masking strategy to protect healthcare workers from COVID-19: An umbrella meta-analysis.

BACKGROUND: The burden of severe disease and death due to SARS-CoV-2 (COVID-19) pandemic among healthcare workers (HCWs) worldwide has been substantial. Masking is a critical control measure to effectively protect HCWs from respiratory infectious diseases, yet for COVID-19, masking policies have varied considerably across jurisdictions. As Omicron variants began to be predominant, the value of switching from a permissive approach based on a point of care risk assessment (PCRA) to a rigid masking policy needed to be assessed. METHODS: A literature search was conducted in MEDLINE (Ovid platform), Cochrane Library, Web of Science (Ovid platform), and PubMed to June 2022. An umbrella review of meta-analyses investigating protective effects of N95 or equivalent respirators and medical masks was then conducted. Data extraction, evidence synthesis and appraisal were duplicated. RESULTS: While the results of Forest plots slightly favoured N95 or equivalent respirators over medical masks, eight of the ten meta-analyses included in the umbrella review were appraised as having very low certainty and the other two as having low certainty. CONCLUSION: The literature appraisal, in conjunction with risk assessment of the Omicron variant, side-effects and acceptability to HCWs, along with the precautionary principle, supported maintaining the current policy guided by PCRA rather than adopting a more rigid approach. Well-designed prospective multi-centre trials, with systematic attention to the diversity of healthcare settings, risk levels and equity concerns are needed to support future masking policies.

Heat-Related Illness Among Workers in British Columbia, 2001-2020.

OBJECTIVE: The aim of this study was to describe the incidence of heat-related illness among workers in British Columbia (BC), Canada, 2001-2020. METHODS: Cases of heat-related illness occurring among workers aged 15 years and older were identified from accepted lost-time claims from WorkSafeBC, the provincial workers' compensation board. Incidence rates were calculated using monthly estimates of the working population from Statistics Canada's Labour Force Survey as the denominator. RESULTS: Between 2000 and 2020, there were 528 heat-related illness claims, corresponding to a rate of 1.21 (95% confidence interval, 1.10-1.31) claims per 100,000 workers. Eighty-four percent of claims occurred between June and August. Rates were higher among male workers, younger workers, and among those working in occupations related to primary industry; trades, transport, and equipment operators; and processing, manufacturing, and utilities. CONCLUSIONS: In BC, lost-time claims for heat-related illness occurred disproportionately among certain subgroups of the workforce.

The role of low educational attainment on the pathway from adolescent internalizing and externalizing problems to early adult labour market disconnection in the Dutch TRAILS cohort.

Mental health challenges in adolescence may affect labour market transitions in young adulthood. Policies addressing early labour market disconnection largely focus on early school-leaving and educational attainment; however, the role of low educational attainment on the path from adolescent mental health to labour market disconnection is unclear. Using the TRacking Adolescents' Individual Lives Survey from the Netherlands (n = 1,197), we examined the extent to which achieving a basic educational qualification (by age 22) in the contemporary Dutch education system, mediates the effect of adolescent mental health (age 11-19) on early adult labour market disconnection, defined as 'not in education, employment, or training' (NEET, age 26). We estimated the total effect, the natural direct and indirect effects, and the controlled direct effects of internalizing and externalizing symptoms on NEET by gender. Among young men, clinical levels of adolescent externalizing symptoms were associated with a 0.093 higher probability of NEET compared with no symptoms (95% confidence interval, CI: 0.001, 0.440). The indirect effect through educational attainment accounted for 15.1% of the total effect. No evidence of mediation was observed for the relationship between externalizing symptoms and NEET in young women. No evidence of mediation was observed for the relationship between adolescent internalizing symptoms and NEET in either gender. The findings imply that adolescent externalizing symptoms disrupts the achievement of a basic educational qualification, leading to a higher probability of NEET in young men. This mechanism may play a smaller role in the risk of NEET associated with internalizing symptoms and in young women.

Pre-existing anxiety and depression disorders and return to work after musculoskeletal strain or sprain: a phased-based approach.

PURPOSE: To examine the impact of pre-existing anxiety and depression disorders on return to work (RTW) using a phase-based approach. METHODS: Accepted lost-time workers' compensation claims for upper limb or spine strain or sprain from 2009 to 2013 were extracted for workers in the Canadian province of British Columbia (n = 78,186). Pre-existing anxiety and depression disorders were identified using health claims data. Probability of RTW following a first or second work lost-time episode was analyzed using Prentice, Williams and Peterson models for recurrent events (common hazards ratios (cHR)). Probability of a first lost-time recurrence was analyzed using Cox models (HR). All models included two years of follow up and were stratified by gender. RESULTS: For men, anxiety alone (cHR = 0.90, 95% CI: 0.85 to 0.94) or comorbid with depression (cHR = 0.95, 95% CI: 0.92 to 0.99) was significantly associated with a lower probability of RTW, and comorbid anxiety and depression with a higher probability of recurrence (HR = 1.29, 95% CI: 1.13 to 1.48). In women, comorbid anxiety and depression was significantly associated with a lower probability of RTW (cHR = 0.96, 95% CI: 0.93 to 0.99) and a higher probability of recurrence (HR = 1.15, 95% CI: 1.04 to 1.28); and anxiety alone with a higher probability of recurrence (HR = 1.25, 95% CI: 1.09 to 1.43). There was little evidence that depression alone was associated with RTW or recurrence. CONCLUSIONS: Workers with a pre-existing anxiety disorder may require additional supports both during lost-time and after initial RTW.

Differences in Modified-Return-to-Work by Immigration Characteristics Among a Cohort of Workers in British Columbia, Canada.

Introduction To investigate differences in modified-return-to work (MRTW) within the first 30 days of a work-related, short-term disability injury by immigration characteristics. This question was part of a program of research investigating differences in work and health experiences among immigrant workers and explanations for longer work disability durations. Methods Workers' compensation claims, immigration records and medical registry data were linked to identify a sample of workers in British Columbia, Canada with a short-term disability claim for a work-related back strain, concussion, limb fracture or connective tissue injury occurring between 2009 and 2015. Multivariable logistic regressions, stratified by injury type, investigated the odds of MRTW, defined as at least one day within the first 30 days on claim, associated with immigration characteristics, defined as a Canadian-born worker versus a worker who immigrated via the economic, family member or refugee/other humanitarian classification. Results Immigrant workers who arrived to Canada as a family member or as a refugee/other immigrant had a reduced odds of MRTW within the first 30 days of work disability for a back strain, concussion and limb fracture, compared to Canadian-born workers. Differences in MRTW were not observed for immigrant workers who arrived to Canada via the economic classification, or for connective tissue injuries. Conclusion The persistent and consistent finding of reduced MRTW for the same injury for different immigration classifications highlights contexts (work, health, social, language) that disadvantage some immigrants upon arrival to Canada and that persist over time even after entry into the workforce, including barriers to MRTW.

Exploring Differences in Work Disability Duration by Size of Firm in Canada and Australia.

Purpose To identify whether there were differences in work disability duration between injured workers employed by small, medium, large, and self-insured firms and whether these differences varied between workers' compensation jurisdictions in Canada and Australia. Methods Workers' compensation data were used to identify comparable lost-time, work-related injury and musculoskeletal disorder claims in five Canadian and five Australian jurisdictions between 2011 and 2015. Work disability duration was measured using cumulative disability days paid up to one-year post-injury. Jurisdiction-specific quantile regression models were used to estimate differences in cumulative disability days paid to claims from small (< 20 full-time equivalents (FTEs)) medium (20-199 FTEs), large (200 + FTEs) and self-insured firms at the 25th, 50th, and 70th percentiles in the disability distribution, adjusting for confounders. Results Compared to large firms, workers in small firms generally had longer work disability duration at each percentile, particularly in Saskatchewan and Alberta (Canada), Victoria and Australian Capital Territory (Australia), where an additional 31.1, 18.4, 58.5 and 37.0 days were paid at the 75th percentiles, respectively. The disability duration of workers from self-insured firms was longer than large firms in all Canadian jurisdictions but was shorter or no different in Australian jurisdictions. Smaller differences were observed between claims from large and medium-sized firms. Conclusions Workers in small firms had longer work disability duration than those in large firms in all but one of the study jurisdictions. Claims management processes need to be sensitive to the challenges that small firms face in accommodating and returning injured workers back to work.

Differences in workers' compensation claim rates for within-province and out-of-province workers in British Columbia, Canada, 2010-2017.

BACKGROUND: Little is known about the work-related injury and illness risk of out-of-province workers. This study examines whether there are differences in work-related injury and illness claim rates between within-province and out-of-province workers in British Columbia (BC), Canada. METHODS: Workers' compensation claim data for injuries and illnesses in BC from 2010 to 2017 were linked with denominator data from Statistics Canada. Multivariable negative binomial regression estimated the claim rate ratio (RR) and 95% confidence intervals (CI) for out-of-province workers with all, health care-only (HCO), short-term disability, long-term disability, and fatality (SLF), and serious injury (SI) claims, compared to within-province workers. RESULTS: Compared to within-province workers, out-of-province workers had a lower total claim rate (RR: 0.54, 95% CI: 0.52-0.57), adjusting for sex, age, industry sector, and year. Differences in rates differed by claim type, with the largest differences for HCO claims (RR: 0.49, 95% CI: 0.47-0.52) and smallest differences for SI claims (RR: 0.85, 95% CI: 0.78-0.92). Sex-stratified models showed larger differences for males than females, with older female out-of-province workers having elevated SI claim rates. Industry-specific models showed that, even in sectors with high proportions of out-of-province workers' claims, these workers have lower claim rates than within-province workers. CONCLUSIONS: Out-of-province workers generally have lower claim rates than within-province workers. The overall duration of work exposure, and underreporting or underclaiming, are factors that may explain these lower claim rates. Understanding the determinants and differences of these claim rates may improve the administration and adjudication of claims while also identifying where further prevention measures may be merited.

Evaluating effectiveness of an integrated return-to-work and vocational rehabilitation program on work disability duration in the construction sector.

OBJECTIVE: The aim of this study was to investigate whether an integrated return-to-work (RTW) and vocational rehabilitation (VR) program - the Work Reintegration (WR) program - was associated with reduced work disability duration in the construction sector in Ontario, Canada. METHODS: Workers' compensation data from the Ontario Workplace Safety and Insurance Board were extracted for lost-time construction worker claims following work-related injuries between 2009 and 2015. Claims receiving referrals to RTW and VR specialists (treatments) were matched with claims receiving no referrals (controls) during the periods before and after the WR program introduction. Multivariable difference-in-differences linear and quantile regression models were used to examine differences in cumulative disability days paid during two-years post-injury between treatment and control groups before and after the program change and the difference in these differences, overall, and at different disability distribution percentiles. RESULTS: The WR program introduction was associated with reductions in cumulative disability days paid for all claims but most notably among longer duration claims referred to RTW specialists (reduction of 274 days at the 90th percentile in the disability distribution) and shorter duration claims referred to VR specialists (reductions of 255 and 214 days at the 25th and 50th percentiles in the disability distribution, respectively). CONCLUSIONS: The WR program introduction was effective in reducing cumulative disability days paid for construction worker claims but the effects varied at different percentiles in the disability distribution, as well as by specialist referral. The findings highlight the benefits of better integrated RTW and VR services to injured workers in the construction sector.

Differences in Work Disability Duration for Immigrants and Canadian-Born Workers in British Columbia, Canada.

This study aimed to investigate differences in work disability duration among immigrants (categorized as economic, family member or refugee/other classification upon arrival to Canada) compared to Canadian-born workers with a work-related injury in British Columbia. Immigrants and Canadian-born workers were identified from linked immigration records with workers' compensation claims for work-related back strain, connective tissue, concussion and fracture injuries requiring at least one paid day of work disability benefits between 2009 to 2015. Quantile regression investigated the relationship between immigration classification and predicted work disability days (defined from injury date to end of compensation claim, up to 365 days) and modeled at the 25th, 50th and 75th percentile of the distribution of the disability days. With a few exceptions, immigrants experienced greater predicted disability days compared to Canadian-born workers within the same injury cohort. The largest differences were observed for family and refugee/other immigrant classification workers, and, in particular, for women within these classifications, compared to Canadian-born workers. For example, at the 50th percentile of the distribution of disability days, we observed a difference of 34.1 days longer for refugee/other women in the concussion cohort and a difference of 27.5 days longer for family classification women in the fracture cohort. Economic immigrants had comparable disability days with Canadian-born workers, especially at the 25th and 50th percentiles of the distribution. Immigrant workers' longer disability durations may be a result of more severe injuries or challenges navigating the workers' compensation system with delays in seeking disability benefits and rehabilitation services. Differences by immigrant classification speak to vulnerabilities or inequities upon arrival in Canada that persist after entry to the workforce and warrant further investigation for early mitigation strategies.

An Umbrella Review of the Work and Health Impacts of Working in an Epidemic/Pandemic Environment.

This umbrella review of reviews examined the evidence on the work and health impacts of working in an epidemic/pandemic environment, factors associated with these impacts, and risk mitigation or intervention strategies that address these factors. We examined review articles published in MEDLINE, PsycINFO and Embase between 2000 and 2020. Data extracted from the included reviews were analyzed using a narrative synthesis. The search yielded 1524 unique citations, of which 31 were included. Included studies were focused on health care workers and the risk of infection to COVID-19 or other respiratory illnesses, mental health outcomes, and health care workers' willingness to respond during a public health event. Reviews identified a variety of individual, social, and organizational factors associated with these work and health outcomes as well as risk mitigation strategies that addressed study outcomes. Only a few reviews examined intervention strategies in the workplace such as physical distancing and quarantine, and none included long-term outcomes of exposure or work during an epidemic/pandemic. Findings suggest a number of critical research and evidence gaps, including the need for reviews on occupational groups potentially exposed to or impacted by the negative work and health effects of COVID-19 in addition to health care workers, the long-term consequences of transitioning to the post-COVID-19 economy on work and health, and research with an equity or social determinants of health lens.

Depressive Symptom Trajectories and Early Adult Education and Employment: Comparing Longitudinal Cohorts in Canada and the United States.

Adolescent depressive symptoms are risk factors for lower education and unemployment in early adulthood. This study examines how the course of symptoms from ages 16-25 influences early adult education and employment in Canada and the USA. Using data from the National Longitudinal Survey of Children and Youth (n = 2348) and the National Longitudinal Survey of Youth 79 Child/Young Adult (n = 3961), four trajectories (low-stable; increasing; decreasing; and increasing then decreasing, i.e., mid-peak) were linked to five outcomes (working with a post-secondary degree; a high school degree; no degree; in school; and NEET, i.e., not in employment, education, or training). In both countries, increasing, decreasing, and mid-peak trajectories were associated with higher odds of working with low educational credentials, and/or NEET relative to low-stable trajectories. In Canada, however, all trajectories had a higher predicted probability of either being in school or working with a post-secondary degree than the other outcomes; in the USA, all trajectory groups were most likely to be working with a high school degree. Higher depressive symptom levels at various points between adolescent and adulthood are associated with working with low education and NEET in Canada and the USA, but Canadians are more likely to have better education and employment outcomes.

Impact of anxiety and depression disorders on sustained return to work after work-related musculoskeletal strain or sprain: a gender stratified cohort study.

OBJECTIVE: The aim of this study was to examine the impact of anxiety and depression disorders on sustained return to work (RTW) for men and women with musculoskeletal strain or sprain. METHODS: Accepted lost-time claims for spine and upper-extremity strain or sprain were extracted for workers in the Canadian province of British Columbia from 2009 to 2013 (N=84 925). Pre-existing and new onset anxiety and depression disorders were identified using longitudinal health claims data. Probability of sustained RTW was analyzed using Cox proportional hazards models, stratified by gender and adjusted for potential confounders. RESULTS: For pre-existing disorders, compared to men with no anxiety and no depression, men with anxiety only [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.84-0.93], depression only (HR 0.94, 95% CI 0.89-1.00), and anxiety and depression (HR 0.93, 95% CI 0.90-0.97) had lower probabilities of sustained RTW in adjusted models. The same direction of effect was found for women, but anxiety only had a smaller effect size among women compared to men (HR anxiety only 0.95, 95% CI 0.92-0.99; HR depression only 0.98, 95% CI 0.93-1.03, HR anxiety and depression 0.94, 95% CI 0.91-0.97). Among men and women, new onset disorders were associated with lower probability of sustained RTW and the effect estimates were larger than for pre-existing disorders. CONCLUSIONS: Findings suggest that workers' compensation benefits and programs intended to improve RTW after musculoskeletal injury should take pre-existing and new onset anxiety and depression disorders into consideration and that gender-sensitive work disability strategies may be warranted.

Does gradually returning to work improve time to sustainable work after a work-acquired musculoskeletal disorder in British Columbia, Canada? A matched cohort effectiveness study.

OBJECTIVE: This study investigates if gradual return to work (GRTW) is associated with full sustainable return to work (RTW) for seriously injured workers with a musculoskeletal disorder (MSD), in British Columbia, Canada. METHODS: This is an effectiveness study using a retrospective cohort study design. Accepted workers' compensation lost-time claims were extracted for workers with an MSD who were on full work disability for at least 30 days, between 2010 and 2015 (n=37 356). Coarsened exact matching yielded a final matched cohort of 12 494 workers who experienced GRTW at any point 30 days post-injury and 12 494 workers without any GRTW. The association between GRTW and sustainable RTW through to end of 12 months was estimated with multivariable quantile regression. RESULTS: Workers who were provided with GRTW experienced more time-loss days until sustainable RTW between the 2nd and 5th months after the first time-loss day (<50th quantile of time loss), but less time-loss days until sustainable RTW between the 6th and 12th months of work disability (70th quantile of time loss), with the largest effect for women, workers with soft-tissue injuries and workers in the manufacturing or trades sector (all in the 60th and 70th percentile, after 6-7 months of time loss). CONCLUSIONS: For seriously injured workers with at least 30 days of disability due to a work-acquired MSD, the effect of GRTW becomes apparent at longer disability durations (more than 6 months), with larger beneficial effects for women, workers with soft-tissue injuries and for trade and manufacturing sectors.

Do differences in work disability duration by interjurisdictional claim status vary by industry and jurisdictional context?

OBJECTIVES: To examine whether differences in work disability duration between out-of-province and within-province workers differed by industry and jurisdictional context. METHODS: Workers' compensation data were used to identify comparable lost time, work-related injury and musculoskeletal disorder claims accepted in six Canadian jurisdictions between 2006 and 2015. Out-of-province workers were identified as workers who filed claims in a different provincial jurisdiction to their province of residence. Coarsened exact matching was used to match out-of-province workers with within-province workers based on observable characteristics. Quantile regression models were used to estimate differences in cumulative disability days paid between out-of-province workers and within-province workers at different percentiles in the disability distribution, adjusting for confounders. RESULTS: Compared with within-province workers, out-of-province workers were paid more disability days even after matching and adjusting on observable characteristics. Differences between the two groups of workers were observed for short-duration, medium-duration and long-duration claims (differences of 1.57, 6.39, 21.42, 46.43 days at the 25th, 50th, 75th and 90th percentiles, respectively). Industry-specific models showed that differences were largest in construction, transportation and warehousing, and mining, quarrying and oil and gas extraction. Jurisdiction-specific models showed that differences were largest in the western provinces where out-of-province workers were concentrated in those sectors. CONCLUSIONS: Out-of-province workers are a vulnerable group with respect to risk of longer work disability duration. Workers' compensation systems, employers and healthcare providers may need to tailor specific interventions for these types of workers, particularly those employed in resource economy-dependent regions that are far from their regions of residence.

Prevalence and risk factors for anxiety and depression disorders in workers with work-related musculoskeletal strain or sprain in British Columbia, Canada: a comparison of men and women using administrative health data.

OBJECTIVE: To examine the prevalence and risk factors for medically treated anxiety and depression disorders among men and women with musculoskeletal strain or sprain work injury in British Columbia, Canada. METHODS: A retrospective population-based cohort of accepted workers' compensation lost-time claims from 2000 to 2013 was constructed using linked administrative health data. Anxiety and depression disorders were identified using diagnoses from physician, hospital and pharmaceutical records. The 1-year period prevalence was estimated for the year before and the year after injury. Sociodemographic, clinical and work-related risk factors for prevalent and new onset anxiety and depression disorders were examined using multinomial regression. RESULTS: 13.2% of men and 29.8% of women had medically treated anxiety, depression or both in the year before injury. Only a slight increase (~2%) in the prevalence of these disorders was observed in the year after injury. Somatic and mental comorbidities were both strong risk factors for pre-existing and new onset anxiety and depression for both men and women, but these relationships were stronger for men. CONCLUSION: Anxiety and depression disorders including those from prior to injury are common in workers with musculoskeletal strain or sprain and are associated with a complicated clinical profile. Gender-sensitive and sex-sensitive mental healthcare is an important consideration for work disability management.

Age Differences in Work-Disability Duration Across Canada: Examining Variations by Follow-Up Time and Context.

Purpose This study aimed to understand age differences in wage-replacement duration by focusing on variations in the relationship across different periods of follow-up time. Methods We used administrative claims data provided by six workers' compensation systems in Canada. Included were time-loss claims for workers aged 15-80 years with a work-related injury/illness during the 2011 to 2015 period (N = 751,679 claims). Data were coded for comparability across cohorts. Survival analysis examined age-related differences in the hazard of transitioning off (versus remaining on) disability benefits, allowing for relaxed proportionality constraints on the hazard rates over time. Differences were examined on the absolute (hazard difference) and relative (hazard ratios [HR]) scales. Results Older age groups had a lower likelihood of transitioning off wage-replacement benefits compared to younger age groups in the overall models (e.g., 55-64 vs. 15-24 years: HR 0.62). However, absolute and relative differences in age-specific hazard rates varied as a function of follow-up time. The greatest age-related differences were observed at earlier event times and were attenuated towards a null difference across later follow-up event times. Conclusions Our study provides new insight into the workplace injury/illness claim and recovery processes and suggests that older age is not always strongly associated with worse disability duration outcomes. The use of data from multiple jurisdictions lends external validity to our findings and demonstrates the utility of using cross-jurisdictional data extracts. Future work should examine the social and contextual determinants that operate during various recovery phases, and how these factors interact with age.