Abstract
BackgroundThe role of sex as an important biological determinant of vulnerability to sustaining injury and gender as a social determinate of access to resources, referral for medical care and perceived disability remains conflicted in injured workers. The purpose of this study was to examine sex and gender disparity following a compensable work-related shoulder injury.MethodsThis study involved cross-sectional analyses of data of two independent samples of workers with shoulder injury. Measures of disability and pain were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Numerical Pain Rating Scale (NPRS) for patients seen at an Early Shoulder Physician Assessment (ESPA) program and the American Shoulder and Elbow Surgeons (ASES) assessment form and Visual Analogue Scale (VAS) for the sample who underwent surgery.ResultsThe files of 1000 (443 females, 557 men) consecutive patients seen at an ESPA program and 150 (44 females, and 106 men) consecutive patients who underwent rotator cuff surgery (repair or decompression) were reviewed. Significant gender disparity was observed in the referral pattern of injured workers seen at the ESPA program who were referred for surgical consultation (22 vs. 78 % for females and males respectively, p < 0.0001). The independent rotator cuff surgical group had a similar gender discrepancy (29 % vs. 71 %, p < 0.0001). The timeframe from injury to surgery was longer in women in the surgical group (p = 0.01). As well, women waited longer from the date of consent to date of surgery (p = 0.04). Women had higher incidence of repetitive injuries (p = 0.01) with men reporting higher incidence of falls (p = 0.01). Women seen at the ESPA program were more disabled than men (p = 0.02). Women in both samples had a higher rate of medication consumption than men (p = 0.01 to <0.0001). Men seen at the ESPA program had a higher prevalence of full thickness rotator cuff tears (p < 0.0001) and labral pathology (p = 0.01). However, these pathologies did not explain gender disparity in the subsample of ESPA who were referred for surgical consultation or those who had surgery.ConclusionsSex and gender disparity exists in workers with shoulder injuries and is evident in the mechanism of injury, perceived disability, medication consumption, referral pattern, and wait time for surgery.
Highlights
The role of sex as an important biological determinant of vulnerability to sustaining injury and gender as a social determinate of access to resources, referral for medical care and perceived disability remains conflicted in injured workers
Recent systematic reviews have shown that injured workers with shoulder conditions consistently report poorer outcomes than patients without work-related injuries [6, 7] and compensated shoulder injuries are associated with higher levels of dissatisfaction and disability with longer time frames to return to full activities or gainful employment following surgery [8,9,10,11,12,13,14,15]
Early Shoulder Physician Assessment (ESPA) subgroup Of 1000 patients seen at the ESPA, 169 (17 %) patients were referred for surgical consultation after the first assessment
Summary
The role of sex as an important biological determinant of vulnerability to sustaining injury and gender as a social determinate of access to resources, referral for medical care and perceived disability remains conflicted in injured workers. The purpose of this study was to examine sex and gender disparity following a compensable work-related shoulder injury. Rotator cuff injuries are known to be the most common source of disability of the work related shoulder conditions [1, 2] imposing a burden on health care and workers compensation systems [3,4,5]. Role of “sex” as a biological predictor of sustaining an injury or developing pathology and “gender” as a psychosocial determinant of access to resources, being referred for medical care or perceived disability in the injured workers have not been well examined. Gender-related differences in psychological and economic factors [20, 21] and clinicians’ bias toward prioritizing male referrals for specialized medical consultation [22,23,24] may affect the quality of care provided to women
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