Return to work patterns for those with occupational respiratory disease: Clinical and structural factors

BACKGROUND Workers who have become ill or injured at work typically follow a jagged progression to a “new normal” status. “Return to Work” research has focused primarily on musculoskeletal injuries with very little attention paid to respiratory disorders. Much of this research has emphasized the role of psychological and other personal factors with little attention paid to the broader social context. This study sought to identify both personal and structural factors that impact the ability of workers with work related respiratory disease to return to work. METHODS A retrospective chart review followed patients with work-related respiratory disease at an Occupational Health Center for two years using a sequential mixed methods research design. Multinomial (n=188) and Cox regressions (n=130) assessed predictors of work status outcomes. A subset (n=21) were selected for in-depth interviews. RESULTS Return to work time was improved for union members and for patients who came to the clinic soon after disease onset. Outcomes were worse for individuals with multiple diagnoses. Interviews demonstrated difficulties navigating the complexity of recovery. Disease severity and adversarial employer actions impeded successful return to work. Controlling harmful exposures proved difficult. CONCLUSIONS The study results have implications for all participants in the return to work process. Exposure controls and facilitated access to occupational health services would likely reduce disease severity and improve return to work rates. Improving employers' responses to workplace respiratory illnesses, and recognizing the beneficial role of unions are additional potentially beneficial steps.