Doctor of Philosophy in Population and Public Health (PhD)
Geographic variation in healthcare spending and utilization and its impact on return to work for injured workers
No abstract available.
Healthcare workers are at-risk for a time-loss injury due to violence and organizational factors such as staffing ratios. There is little understanding how workers return-to-work (RTW) after violence-related injury and how staffing ratios can improve RTW outcomes. The first objective of this thesis explores RTW outcomes of healthcare workers with violence-related injuries (WVI) compared to healthcare workers with nonviolence-related injuries (WNVI). The study then seeks to examine differences in the likelihood of violence and RTW by staffing ratio, and if violence modifies the relationship between staffing ratios and RTW. The first retrospective cohort study used British Columbia (BC) workers’ compensation data from 2009 to 2014. After matching on age, gender, injury type, care setting, and occupation, 5,762 healthcare workers with at least one day off-work were included. Cox regression and piecewise models were stratified for injury types and adjusted for age, sex, wage, occupation, injury types, history of violence, care setting, and shift type. The second retrospective cohort study used BC workers’ compensation data and long-term care (LTC) staffing data in 2014. The cohort included 1,590 injured LTC workers with at least one day off-work. Negative binomial regression models were adjusted for health region, bed count, and public versus private funding. Cox regression models stratified by WVIs and WNVIs were adjusted for health region, bed count, public versus private funding, sex, age, wage, injury types and occupations. In the first study, RTW was more likely within one month, less likely from two to six months, and just as likely after six months post-injury for WVIs compared to WNVIs. WVIs with mental health injuries were less likely to RTW anytime one-year post-injury compared to WNVIs with mental health injuries. In the second study, higher staffing ratios was associated with lower risk of violence-related injuries compared to lower staffing ratios. For both WVIs and WNVIs, RTW was more likely at higher staffing ratios. However, WVIs had a higher likelihood of RTW compared to WNVIs at high staffing ratios. Findings suggest targeting interventions toward WVIs with mental health injuries and increasing staffing ratio to reduce the risk of violence and improve RTW outcomes.
Introduction:Immigrant workers, particularly recent immigrants, who may have lower English proficiency and a lack of familiarity with Canadian social programs, face particular challenges after a work injury. They may not know their employment rights and may have trouble accessing, understanding, and navigating the compensation system. Although work disability can have negative impacts on the physical and mental health of immigrants, no Canadian research has examined immigrant workers’ experiences after a work injury. The purpose of this study was to investigate differences in disability duration by immigration status for injured workers in British Columbia with an accepted workers' compensation claim between 1995 and 2012.MethodsWorkers in British Columbia with an accepted workers’ compensation claim between 1995 and 2012 were linked to Citizenship and Immigration Canada Permanent Residents data. Injured workers were identified as recent immigrants (less than 10 years in Canada), established immigrants (10 years or more in Canada), and Canadian-born workers, at the time of their injury. Disability duration was defined as the number of disability days paid in the first year after injury. Differences in disability duration by immigration status were examined at the 25th, 50th and 75th percentiles of the distribution using quantile regression. Models were adjusted for age, sex, occupation, injury year, injury type, and previous claims and were stratified by age and sex to investigate interaction effects.Results:Results showed that both recent and established immigrants had longer work disability durations than Canadian-born workers, at all points of the distribution, and after adjusting for demographic and occupation characteristics. The relationship between immigration status and disability duration was greater for younger immigrant workers than for older immigrant workers and for immigrant men than for immigrant women.Conclusion:Consistent with the first hypothesis, immigrants had longer disability durations than Canadian-born workers, at all points of the distribution. Contrary to the second hypothesis, established immigrants had longer disability durations than recent immigrants, at all points of the distribution. Overall, results indicate that immigrants may face barriers to returning to work following a work-related injury and that these barriers persist over time and are greatest for younger immigrant workers and immigrant men.
This thesis explores the relationship between youth labour force participation and mental health. Unemployment is generally considered to have a negative association with youth mental health. However, few studies have examined youth mental health in association with being both out of the labour force and out of school (OLFS). I hypothesize that OLFS, a state in which youth are no longer job-searching and are not in school, has a negative association with mental health that is weaker in comparison to that of unemployment, which involves active job-searching. I further hypothesize that socioeconomic status (SES) and recession moderate the relationship between youth labour force participation and mental health, such that both unemployment and OLFS have a stronger negative association with mental health in youth of low SES, and during recession. Two empirical studies are presented to test these hypotheses. The first examines whether SES moderates the relationship between youth labour force participation and mental health, across three constructs of mental health : distress, depression, and life-satisfaction. The results indicate that unemployment is associated with poor mental health across all mental health constructs, and has a stronger association with distress among low-SES youth. OLFS is associated with depression only, with a stronger association among low-SES youth. Among high-SES youth, OLFS is also associated with better life-satisfaction. The second study looks at the relationship between youth labour force participation and mental health in the periods before (2003, 2005), during (2008-2009), and after the most recent global recession (2010-2012). The findings suggest that the recession was related to improvements in the mental health of unemployed youth but was not clearly related to the mental health of OLFS youth. The concluding chapter highlights the contributions of this thesis, addresses its limitations, and discusses implications for policy makers and for future analyses. Policy makers should consider the association between OLFS and mental health, and the effect modification by SES, when designing programs for unemployed youth. Future research can examine the mechanisms between OLFS and mental health across macrosocial contexts, and over the life course.