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Age Differences in Work-Disability Duration Across Canada: Examining Variations by Follow-Up Time and Context

Abstract

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.

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Acknowledgements

Data access and storage services were provided by Population Data BC (University of British Columbia, Vancouver, Canada). The full data repository was located on a secure server, accessible only via encrypted remote access. Research extracts were provided to the research team in de-identified format. Access to the data for research purposes was made possible through project-specific research agreements with the respective data stewards. Ethical approval for the current study was obtained from the University of Toronto Health Sciences Research Ethics Board (Certificate 36039). The overarching research initiative was approved by the University of British Columbia Behavioural Research Ethics Board (#H13-00896), and was supported by a Canadian Institutes for Health Research Operating Grant ‘Return to work after work injury and illness: An international comparative effectiveness study of Canada, Australia and New Zealand’ (Application Number 326940) and by the Research and Workplace Innovation Program of the Workers Compensation Board of Manitoba. Data were provided by WorkSafeBC, Workers’ Compensation Board of Alberta, Saskatchewan Workers’ Compensation Board, Workers’ Compensation Board of Manitoba, Workplace Safety and Insurance Board (Ontario), and WorkSafeNB. All inferences, opinions, and conclusions drawn in this paper are those of the authors, and do not reflect the opinions or policies of the Data Steward(s).

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Appendix

Appendix

Adjusted hazard rates (Panel A), rate differences (Panel B) and rate ratios (Panel C) for the event of transitioning off benefits, by age groupa. Estimates calculated at various follow-up event times b. WCB claims, 2011–2015. N = 751,679.

Age group 1 week 1 month 2 months 3 months 6 months 9 months 12 months
(A) Hazard Rates Per 100 Workers (99% CI)
 15–24 23.7 (23.2, 24.1) 7.2 (7.0, 7.3) 5.3 (5.2, 5.4) 4.4 (4.3, 4.6) 3.1 (3.1, 3.3) 2.6 (2.5, 2.7) 2.3 (2.2, 2.4)
 25–34 17.5 (17.1, 17.8) 6.0 (5.9, 6.1) 4.4 (4.3, 4.5) 3.7 (3.6, 3.8) 3.1 (3.0, 3.2) 2.7 (2.7, 2.8) 2.5 (2.4, 2.6)
 35–44 14.9 (14.6, 15.2) 5.1 (5.0, 5.2) 3.7 (3.7, 3.8) 3.2 (3.2, 3.3) 2.9 (2.8, 2.9) 2.6 (2.5, 2.7) 2.4 (2.3, 2.5)
 45–54 13.4 (13.1, 13.6) 4.6 (4.5, 4.7) 3.5 (3.4, 3.5) 3.0 (3.0, 3.1) 2.8 (2.7, 2.8) 2.6 (2.5, 2.6) 2.4 (2.3, 2.5)
 55–64 12.2 (12.0, 12.5) 4.6 (4.5, 4.7) 3.4 (3.3, 3.4) 2.9 (2.9, 3.0) 2.7 (2.6, 2.8) 2.5 (2.5, 2.6) 2.4 (2.3, 2.5)
 65+ years 10.6 (10.1, 11.2) 4.3 (4.1, 4.5) 3.2 (3.0, 3.3) 2.8 (2.7, 2.9) 2.7 (2.6, 2.8) 2.6 (2.5, 2.8) 2.5 (2.3, 2.7)
(B) Hazard differences per 100 workers (99% CI)c
 15–24 0.00 (ref.) 0.00 (ref.) 0.00 (ref.) 0.00 (ref.) 0.00 (ref.) 0.00 (ref.) 0.00 (ref.)
 25–34 − 6.2 (− 6.6, − 5.8) − 1.2 (− 1.3, − 1.0) − 0.9 (− 1.0, − 0.8) − 0.7 (− 0.8, − 0.6) − 0.1 (− 0.2, 0.0) 0.1 (0.0, 0.2) 0.2 (0.1, 0.3)
 35–44 − 8.8 (− 9.2, − 8.4) − 2.1 (− 2.3, − 2.0) − 1.6 (− 1.7, − 1.5) − 1.1 (− 1.2, − 1.0) − 0.3 (− 0.4, − 0.2) 0.0 (− 0.1, 0.1) 0.1 (0.0, 0.2)
 45–54 − 10.3 (− 10.6, − 9.9) − 2.6 (− 2.7, − 2.4) − 1.8 (− 1.9, − 1.8) − 1.3 (− 1.4, − 1.2) − 0.4 (− 0.5, − 0.3) 0.0 (− 0.1, 0.1) 0.1 (0.0, 0.2)
 55–64 − 11.4 (− 11.8, − 11.0) − 2.6 (− 2.8, − 2.5) − 1.9 (− 2.0, − 1.8) − 1.4 (− 1.5, − 1.3) − 0.4 (− 0.6, − 0.3) − 0.1 (− 0.2, 0.0) 0.1 (0.0, 0.2)
 65+ years − 13.0 (− 13.7, − 12.4) − 2.9 (− 3.2, − 2.7) − 2.1 (− 2.3, − 2.0) − 1.5 (− 1.7, − 1.4) − 0.4 (− 0.6, − 0.3) 0.0 (− 0.2, 0.2) 0.2 (0.0, 0.4)
Age group 1 week 1 month 2 months 3 months 6 months 9 months 12 months Time-constant
(C) Hazard ratios (99% CI)d
 15–24 1.00 (ref) 1.00 (ref) 1.00 (ref) 1.00 (ref) 1.00 (ref) 1.00 (ref) 1.00 (ref) 1.00 (ref)
 25–34 0.74 (0.72, 0.75) 0.83 (0.81, 0.85) 0.83 (0.81, 0.85) 0.84 (0.82, 0.87) 0.98 (0.94, 1.01) 1.05 (1.00, 1.10) 1.09 (1.03, 1.14) 0.83 (0.82, 0.84)
 35–44 0.63 (0.62, 0.64) 0.71 (0.69, 0.72) 0.71 (0.69, 0.72) 0.74 (0.72, 0.76) 0.91 (0.88, 0.94) 1.00 (0.96, 1.05) 1.06 (1.01, 1.11) 0.71 (0.70, 0.72)
 45–54 0.57 (0.56, 0.58) 0.64 (0.63, 0.66) 0.65 (0.64, 0.67) 0.69 (0.68, 0.71) 0.88 (0.85, 0.91) 0.98 (0.95, 1.02) 1.05 (1.00, 1.10) 0.65 (0.64, 0.66)
 55–64 0.52 (0.51, 0.53) 0.64 (0.62, 0.65) 0.64 (0.62, 0.65) 0.67 (0.65, 0.69) 0.86 (0.83, 0.89) 0.97 (0.93, 1.01) 1.04 (0.99, 1.09) 0.62 (0.61, 0.62)
 65+ years 0.45 (0.43, 0.47) 0.59 (0.56, 0.63) 0.60 (0.57, 0.63) 0.64 (0.61, 0.68) 0.86 (0.82, 0.91) 1.00 (0.93, 1.08) 1.09 (1.00, 1.19) 0.56 (0.55, 0.57)
  1. aModels are adjusted for: age, sex, province, occupation, industry, injury type, and injury year
  2. bEstimated using flexible parametric models to allow for time-varying hazards across the distribution of event times
  3. cDifferences less than ‘0’ correspond to a longer disability duration for a given age group compared to the reference age group
  4. dRatios less than ‘1’ correspond to a decreased likelihood of transitioning off benefits (e.g., longer disability duration) for a given age group compared to the reference age group

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Fan, J.K., Macpherson, R.A., Smith, P.M. et al. Age Differences in Work-Disability Duration Across Canada: Examining Variations by Follow-Up Time and Context. J Occup Rehabil 31, 339–349 (2021). https://doi.org/10.1007/s10926-020-09922-x

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Keywords

  • Age
  • Work injury
  • Return to work
  • Workers’ compensation
  • Survival analysis