Gender differences in personal and work-related determinants of return-to-work following long-term disability due to musculoskeletal disorders: A 5-year cohort study

Objective To assess the differential effect of personal and work-related psychosocial, physical and organizational determinants by gender on time to return-to-work (RTW) following long-term disability. Methods: Data come from a larger study conducted in the province of Quebec, Canada. A cohort of 455 adults on long-term disability due to work-related musculoskeletal disorders at the back/neck/upper limb was followed for five years through structured interviews and administrative databases. Left-truncated Cox regression modeling stratified by gender was used to assess time to a first partial or full RTW of at least three days. Results Survival curves of time to RTW were similar between men and women on long-term disability (log-rank test p-value=0.920) but many personal and occupational factors influencing RTW differed by gender. Women's risk factors included older age (HR=0.734 - in 10 years unit), poor to very poor perceived economic status (HR=0.625), working ≥40 hours/week and having dependents (HR=0.508) and awareness of workplace-based occupational health and safety program (HR=0.598); higher gross annual income (in $10,000s) was a facilitator (HR=1.225). In men, being over 55 years old (HR=0.458), poor perceived economic status (HR=0.653), working ≥40 hours/week and high perceived physical workload (HR=0.720) and higher job insecurity (HR=0.825) negatively influenced time to RTW. For both men and women, probabilities of not returning to work varied widely according to workers' specific profile of personal and occupational factors (high or low risk profile). Conclusion Results confirm the importance of gender-sensitive strategies to investigate RTW determinants from a gender perspective.