The impact of workplace factors on filing of workers' compensation claims among nursing home workers

Background: Injuries reported to workers' compensation (WC) system are often used to estimate incidence of health outcomes and evaluate interventions in musculoskeletal epidemiology studies. However, WC claims represent a relatively small subset of all musculoskeletal disorders among employed individuals, and perhaps not a representative subset. This study determined the influence of workplace and individual factors on filing of workers' compensation claims by nursing home employees with back pain. Methods: Surveys were conducted in 18 skilled nursing facilities in four U. S. states. Self-administered questionnaires obtained information on demographic characteristics, working environment, and health behaviors/status. Employees who reported low back pain at least once in four questionnaire surveys were included. WC claims from the same facilities were obtained from the employer's workers compensation insurer and matched by employee name. The dichotomous dependent variable was filing of back-related worker's compensation claim. Association with predictors of interest, including pain severity, physical job demand, job strain, social support, schedule control, and safety climate, was assessed using multivariate regression modeling. Individual characteristics were tested as potential confounders. Results: Pain severity level was significantly associated with filing low-back related claims (odds ratio (OR) = 1.49, 95% CI = 1.18 - 1.87). Higher physical demands at work (OR = 1.07, 95% CI = 1.01 - 1.14) also increased the likelihood of claim filing. Higher job strain (OR = 0.83, 95% CI = 0.73 - 0.94), social support at work (OR = 0.90, 95% CI = 0.82 - 0.99), and education (OR = 0.79, 95% CI = 0.71 - 0.89) decreased the likelihood of claim filing. Conclusions: The results suggest that the WC system captured the most severe occupational injuries. Workplace factors had additional influence on workers' decision to file claims, after adjusting for low back pain severity. Education was correlated with worker's socioeconomic status; its influence on claim filing is difficult to interpret because of the possible mixed effects of working conditions, self-efficacy, and content knowledge.