Work-Related Low-Back Injury and Increased Rate of Death

Do certain types of work-related disabilities lead to an increased rate of death? This question has not been well studied. Recently published research, “Increased overall and cause‐specific mortality associated with disability among workers’ compensation claimants with low back injuries,” examined the issue. [1]  The study found that those with a lost-time disabling low-back workers’ compensation claim had a higher rate of mortality when compared to those with claims accepted for the same diagnoses who did not miss time from work.

The study looked at 14, 219 workers in West Virginia with an accepted workers’ compensation claim for a low back injury in 1998 or 1999. A lost-time claim (LT claim) is a claim for a person that had to miss 4 days or more from work. The study found:

• Deaths from accidental poisoning (92% from opioids) were more than 2 times greater among the study population than the general public.
• Low back Injuries that resulted in LT claims were associated with higher overall mortality compared to no-LT claims.
• Deaths from heart disease, cancer, and suicide were all elevated among those with LT claims compared to no-LT claims.
• Both overall mortality and mortality specifically from drug overdoses involving opioids were significantly associated with
  • amount of days away from work,
  • rate of permanent partial disability, and
  • percent permanent disability.
• Heart disease mortality was also significantly associated with the amount of days away from work.

This is the first study that we are aware of to find an association between increased mortality and work-related low back injuries. Two other studies have reported an increase in overall mortality associated with work-related disability. [2,3] More research is needed. If these results are confirmed by additional research, they identify a largely unrecognized and substantial source of mortality from occupational injuries.

Strengths of this study included a large sample size, complete capture of all accepted workers’ compensation claims for the population under study, information on specific causes of death, and an internal control group consisting of workers with claims contemporaneously accepted for the same diagnoses codes for low back pain but without associated work‐related disability.

A challenge with this research is distinguishing between an impact on mortality caused by the status of disability itself as opposed to an effect from the disabling medical condition. [4,5] We encourage further research in this area.

Chris Martin, MD, MSc, is a Professor in the School of Public Health of West Virginia University.

Stephen Bertke, PhD, is a Statistician in the NIOSH Division of Field Studies and Engineering.

References

1. Martin CJ, Jin C, Bertke SJ, Yiin JH, Pinkerton LE. Increased overall and cause-specific mortality associated with disability among workers’ compensation claimants with low back injuries.
   Am J Ind Med. 2020; 63(3):209-217
2. Scott‐Marshall HK, Tompa E, Wang Y, Liao Q. Long‐term mortality risk in individuals with permanent work‐related impairment. Can J Public Health. 2014;105(5):e330‐e335.
3. Boden LI, O’Leary PK, Applebaum KM, Tripodis Y. The impact of non‐fatal workplace injuries and illnesses on mortality. Am J Ind Med. 2016;59(12):1061‐1069
4. Wallman T, Svärdsudd K. Do disability pensioners have a higher mortality rate than non‐pensioners? Adjusting for potential confounding: a commentary on Hult, Stattin, Janlert and Järvholm. Soc Sci Med. 2010;70(10):1487‐1488.
5. Hult C, Stattin M, Janlert U, Järvholm B. Comparing mortality rates and recognizing health selection bias: a response to Wallman and Svärdsudd. Soc Sci Med. 2010;70(10):1489‐1491.