Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Institute for Work & Health, Toronto, ON, Canada.
J Occup Rehabil. 2021 Jun;31(2):339-349. doi: 10.1007/s10926-020-09922-x.
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.
目的 本研究旨在通过关注不同随访时间段内关系的变化,了解工资替代时长的年龄差异。
方法 我们使用了加拿大六个工人赔偿系统提供的行政索赔数据。研究对象为 2011 年至 2015 年期间因工作相关伤害/疾病而丧失工作能力的 15-80 岁工人的时间损失索赔(N=751679 项索赔)。对数据进行了编码,以确保不同队列之间的可比性。生存分析考察了年龄与残疾福利脱离(与继续领取残疾福利)的风险之间的相关性,允许在时间推移过程中放宽对风险率的比例限制。在绝对(风险差异)和相对(风险比[HR])尺度上均进行了差异检验。
结果 在总体模型中,年龄较大的群体(如 55-64 岁与 15-24 岁)与年龄较小的群体相比,脱离工资替代福利的可能性较低(HR 0.62)。然而,特定年龄的风险率的绝对和相对差异随随访时间的变化而变化。在较早的事件时间点观察到与年龄相关的最大差异,并且在后续随访事件时间点上差异趋于零。
结论 本研究为工作场所伤害/疾病索赔和康复过程提供了新的见解,并表明年龄较大并不总是与较差的残疾持续时间结果密切相关。从多个司法管辖区获取数据增加了我们研究结果的外部有效性,并证明了使用跨司法管辖区数据提取的实用性。未来的研究应该考察在不同康复阶段起作用的社会和背景决定因素,以及这些因素如何与年龄相互作用。