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Summary report of the incidence and prevalence of worker injury and subsequent outcomes in British Columbia… Hertzman, Clyde, 1953-; McGrail, Kimberlyn, 1966-; Hirtle, Robert Douglas Mar 31, 1999

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•Centre for Health Servicesand Policy Research~===--:\- \\\\\\\\Summary Report of the Incidence andPrevalence of Worker Injury andSubsequent Outcome in British Columbia:A Record Linkage StudyClyde HertzmanKimberlyn McGrailRobert HirtleHPRU99:7D March, 1999Health Policy Research UnitDiscussion Paper SeriesTHE UNIVERSITY OF BRITISH COLUMBIASummary report of the incidence and prevalenceof worker injury and subsequent outcomein British Columbia:A record linkage studyClyde Hertzman, MD, FRCPCKimberlyn McGrail, MPHRobert Hirtle, MScFor the Royal Commission on Workers' Compensation in British ColumbiaSeptember 1998The Centre for Health Services and Policy Research was established by the Board ofGovernors of the University of British Columbia in December 1990. It was officiallyopened in July 1991. The Centre's primary objective is to co-ordinate, facilitate, andundertake multidisciplinary research in the areas of health policy, health services research,population health, and health human resources. It brings together researchers in a varietyof disciplines who are committed to a multidisciplinary approach to research, and topromoting wide dissemination and discussion of research results, in these areas. TheCentre aims to contribute to the improvement of population health by being responsive tothe research needs of those responsible for health policy. To this end, it provides aresearch resource for graduate students; develops and facilitates access to health andhealth care databases; sponsors seminars, workshops, conferences and policyconsultations; and distributes Discussion Papers, Research Reports and publicationreprints resulting from the research programs of Centre faculty.The Centre 's Health Policy Research Unit Discussion Paper series provides a vehicle forthe circulation of (pre-publication) work of Centre faculty, staff and associates . It isintended to promote discussion and to elicit comments and suggestions that might beincorporated within revised versions of these papers. The analyses and interpretations, andany errors in the papers, are those of the listed authors. The Centre does not review oredit the papers before they are released.A complete list of available Health Policy Research Unit Discussion Papers and Reprints ,along with an address to which requests for copies should be sent, appears at the back ofeach paper.EXECUTlVES~ARYStarting in June, 1997, the Workers' Compensation Board ofBC made availablecomputerized records of all injured workers claims, from 1986 to 1996, to the UBCCentre for Health Services and Policy Research. These files gave information on eachsuccessful claim: short-term disability, long-term disability (pension), fatality, or healthcare only, as well as the fact and date of all unsuccessful or incomplete claims. Using"personal identifier fields" from these files, staff at the Centre managed to "link" 97.2% ofthese claims to the BC Linked Health Database.The BC Linked Health Data set (BCLHD), developed under contract with the BCMinistry of Health, makes 6 key transaction files in the province "linkable" to one anotherfor the purposes of research. These currently include: the birth file, the death file, MedicalServices Plan claims file, hospital discharge file, long-term care client file, and thePharmacare A plan file (i. e. the provincial drug payment plan for those BC residents over65 years of age). All records in each file, going back to fiscal year 1985/86, have beenencrypted with a scrambled Personal Health Number (PHN) which matches the(scrambled) PHN of a unique individual in the Linkage Co-ordinating File of thoseenrolled in the Medical Services Plan of BC.Using 'personal identifier' fields such as PHN, name, birth date, sex and postal code, wewere able to link approximately 75% of 1.6 million Income Assistance records provided tous by the Ministry of Human Resources. These records include individuals and theirdependents who are awarded welfare benefits, as well as those who apply but are deemedineligible. The records cover applicants and recipients between 1990 and 1997. If any ofthese individuals had also made application for welfare between 1980 and 1989, theevents would be retained as well. The (relatively) low linkage rate may imply that the trueprevalence of welfare use among WCB claimants is under-reported here. However, thereis good reason to believe that the linkage rate for those who actually received assistance,as opposed to those who applied for it but were turned down, is much higher than 75%.Once the personal identifier fields from the injured workers file were successfully matchedto an individual in our Linkage Co-ordinating File, the scrambled Personal Health Numberwas added to the record in the WCB identifier file. This process allowed us to merge theWCB files of specific individuals with other files in the BCLHDB in order to producelongitudinal records of health services utilization for individual injured workers. For theRoyal Commission's purposes, a principal linkage file was created as follows:a. we identified all individuals who filed a claim to the WCB in 1991 (herein, the "1991cohort").b. we brought together ("merged") the WCB records of these individuals for the fullperiod available to us (1986 to 1996).c. we linked this file with the Medical Services Plan and hospital discharge records for thesame time period.d. we further linked this file with the income assistance file (herein, "welfare") which wasrecently supplied to the Centre for Health Services and Policy Research by the Ministryof Human Resources.e. using these linked files, we created individual records for the 1991 cohort, organized intime sequence, for all medical care encounters funded by the WCB and the BC Ministryof Health, as well as all injury claims and encounters with the welfare system.f. by matching on age and sex, we created a series of "control samples" of those found onour linkage co-ordinating file who did not file a WCB claim over the period 1986-1996.g. these files, as well as a file of all WCB claims for the whole period, were analyzed withall personal identifier stripped off, to ensure individual confidentiality.An extensive report of the findings of our work is included. Each section addresses anissue identified as important for the work of the Royal Commission. This summary doesnot attempt to address each of these issues. Rather, it identifies what we believe to be thefour most important results of our research, and briefly describes their basis, in order todraw the comrnisioners' attention to them.1. More than 30% of all injuries in the injured workers me occurred within the first5 months of first employment in a given job; and 50% occurred within the first 18months. Among those 15 to 24,50% of all injuries occurred within the first 5 months onthe job. Among those aged 25-34, the 50% mark was passed in the 12th month of ajob.For those over 35, it took 3 years to reach the 50% mark. Although this is significantchange by the age of employment, the basic trend is the same for all age groups. Thelikelihood of injury within the first month on the job also varied widely by industry, from2% in health and social services to 41 % in construction. Yet, more than halfofall workerinjuries occurred within the first two years on the job in all industries except government,education, and health and social services. These findings suggest that seriousconsideration should be given to directing preventive programs at those entering thelabour force; making workplaces safer for new employees; focussing on the hazards ofentry level jobs; and addressing the psychosocial factors in transition to work which maypredispose individuals to injury.2. A large proportion of WCB claims are made by ''frequent'' WCB claimants. Thetotal number of claims made over the study period by the 1991 injury cohort is highlyuneven. Only 20% of individuals reported one injury to the WCB between 1986 and1997. On the other hand, just under 55% of the cohort report two to five injuries, andthe remaining 25% reported between six and fifty injuries over this twelve-year period.More than 30% of the claims awarded to "high users" (defined here as those with 12 ormore claims over the period 1986-1996) were for injuries occurring during the first yearon ajob. In other words, the high users seem to change jobs frequently, and are caught ina "revolving door" of employment, injury, re-employment in a new job, and re-injury,23. Injured workers form a subset of the population who are high users of non-WeBfunded health care servicesMany individuals who report injuries to the WCB also require health care servicesprovided through the rest of the BC medical system. It was expected that use of theseservices , outside what may be compensated by the WCB related to a workplace injury,would not be significantly greater than a population similar in age and sex who did notreport injuries to the WCB. Yet this was not the case . Between 1986 and 1995, membersof the 1991 injured workers' cohort visited General Practitioners and Specialists at least50% more frequently than age and sex matched members of the BC population. Theproportion of the injury cohort that visit physicians increased up to the injury year (1991),peaked during 1991, and then decreased somewhat, though not to former levels. Incomparison, there is a slow but steady (age-related) increase in the proportion of thematched cohort who visit GPs during these years, though the number remains lowerthroughout.The pattern for hospital use is similar to the one seen for use of physician services.Individuals who make WCB claims are approximately twice as likely to have an in-patienthospital visit or day surgery encounter, compared to the non-claimant cohort matched forage and sex. Once again, this is true even before the index injury year of 1991, though thedifference does increase in 1991 and peaks in 1992.What is the reason for this pattern? To some extent, the increases in health servicesutilization during and after the injury year may be work-related, even though they werenot funded by the WCB. However, this is not the predominant explanation for the patternover the whole period, before, during and after injury. Further analyses showed that thepattern could not be explained as a long-term effect of injuries that occurred in 1986 orlater; nor was it based upon increased medical visits for chronic health problems whichturned into claims later on.Our conclusion is that WCB claimants are already predisposed to be high users of healthcare services even before they become engaged in the WCB system. In order tounderstand this further, it will be necessary to learn more about the experiences of injuredworkers during their entire work history (i.e. prior to 1986, and perhaps in otherjurisdictions) as well as their experiences before they enter the labour force. Thisconclusion in no way negates the importance of the dangerousness of workplaceenvironments as a determinant of injury. The huge variation in injury rates by industryattest to that. What it may address is the question of who, within an environment of agiven level of dangerousness, becomes injured and who does not.4. Injured workers are high consumers of welfare, both before and after injury23% of the WCB 1991 injury cohort received welfare benefits in the period 1991-1997,compared to less than 10% of the age- and sex-matched comparison group. Among theWCB applicants, those applying for short-term disability benefits were more likely toapply for and receive welfare than those applying for LTD/pension benefits or medical3care benefits only. In addition, welfare recipients who are not WCB applicants are farmore likely to be single without kids, and far less likely to be married with kids, than arethe WCB applicants of the same age and sex . Thus, at first glance, WCB applicants seemto be at increased risk of becoming welfare recipients, following injury, than other BritishColumbians. Moreover, in the period 1980 to 1989, prior to the 1991 index injury for theWCB cohort, the patterns of family composition are far more similar to the rest of thewelfare applicant in Be.Surprisingly, however, the proportions of WCB applicants and controls that receivebenefits in the 1980 to 1989 period (prior to injury), are not the same. 21% of the WCBapplicants, compared to 11% of the matched cohort received welfare during this period.In other words, the WCB injury group and the matched cohort appear to be different withrespect to their use of welfare services even prior to the index injury year in 1991. Takentogether, these results do strongly suggest that injured workers are a distinct clientpopulation for income assistance, different from the principal client groups of singlemothers and single adult males. However, as in point #3 above, there is evidence here thatindividual selection factors , perhaps beginning before entry to the labour force, may be atwork here, too.4INTRODUCTIONThe work in this report includes results of analyses undertaken at the Centre for HealthServices and Policy Research (CHSPR) during much of 1998. The questions of interestthis report attempts to answer were developed by the Royal Commission on Workers'Compensation in British Columbia in cooperation with the Workers' Compensation Boardof BC and CHSPR. In general terms, the intent of this work was to identify theexperience of workers once they entered the WCB system. How many people madeclaims? What was the nature of those claims, and was there an standard 'trajectory'through which injured workers passed from injury to return to work? What was theexperience of these individuals in terms of their use of other types of health and socialservices? And were these individuals somehow different from their age- and sex-matchedcounterparts who did not make claims to the WCB?The data used are derived from two sources; the WCB of BC and the BC Linked HealthData set (BCLHD). The former provided information on each successful claim: short­term disability, long-term disability (pension), fatality, or health care only, as well as thefact and date of all unsuccessful or incomplete claims. The latter is a collection of datafiles that have been 'linked' by the CHSPR, The data in the BCLHD are owned byvarious stewards in and outside by the Ministry of Health, and are accessible toresearchers under an access protocol that complies with BC's Freedom ofInformationand Protection ofPrivacy Act. Very briefly, the BCLHD contains information for1985/86 forward on births, deaths, payments to physicians and alternative providers,hospital separations, pharmaceutical use for seniors in the community, and continuingcare. (For more information see: Chamberlayne R et al. 'Creating a Population-basedLinked Health Database: A New Resource for Health Services Research' CJPH Jul/Aug1998 89(4):270-273.)Using "personal identifier fields" -- e.g. names, birth dates, and postal codes - andprobabilistic linkage methods, the CHSPR was able to 'link' 97.2% of WCB claimsbetween 1986 and 1996 to the BCLHD. Creation of these links meant that researcherscould identify an individual-specific claims to the WCB in combination with use of healthcare services as outlined above. Once the linkage was complete, all identifiers, including6-digit postal codes , were stripped from the files to ensure confidentiality. The resultingdata were person-specific but were not individually identifying.A similar methodology was used to link approximately 75% of 1.6 million IncomeAssistance records provided to us by the Ministry of Human Resources. These recordsinclude individuals and their dependents who are awarded welfare benefits, as well asthose who apply but are deemed ineligible. The records cover applicants and recipientsbetween 1990 and 1997. If any of these individuals had also made application for welfarebetween 1980 and 1989, the events would be retained as well. The (relatively) lowlinkage rate may imply that the true prevalence of welfare use among WCB claimants is5under-reported here. However, there is good reason to believe that the linkage rate forthose who actually received assistance, as opposed to those who applied for it but wereturned down, is much higher than 75%.There were more than 800,000 individual claimants making more than 2 million claims tothe WCB from 1986 to 1996. To limit the size of the analysis cohort, only individualswho reported an injury that occurred in 1991 were included in most analyses. Theseindividuals were identified by selecting WCB claim numbers starting in '91'. Where datafrom other injury years are used for comparison purposes, they are so noted. The 1991injury cohort includes people who were injured in other years, people who made multipleclaims in 1991, and people who reported injuries to the WCB but were not compensatedfor them. This latter situation can arise when a claim is incomplete - that is, not allpaperwork is filed, or the claimant decides to not follow up - as well as when the claim isadjudicated and turned down by the WCB. There is no way within these data to separatethese two groups.Part I of this report concentrates on the experience of workers who have received short­term disability compensation from the WCB. Some of these people may go on to receivepension as well, indicating a more permanent, though not necessarily complete, disability.This group as a whole represents injured workers who have some form of continuedcontact with the WCB system. This part of the report attempts to describe who theseindividuals were, what the nature and timing of their injuries was, and what theirexperience in the system was.Part II then broadens back out to the whole 1991 injury cohort. The intent was to look attheir use of health and social services, based on the BCLHD and Income Assistance data,and to describe any recurring patterns. Data for an age- and sex- matched cohort ofindividuals who did not make claims to the WCB between 1986 and 1996 were alsoextracted to provide a point of comparison. Unless otherwise noted, the analyses in PartII include the entire 1991 injury cohort, not just those who were awarded claims by theWCB.The analysis of linked data is usually based on the construction of 'trajectories' of care forindividuals. In this case, all fee-for-service payments to physicians and alternativeproviders, hospital separations, and pharmaceutical use for those over age 65 wasassembled for the 1991 injury cohort and the matched cohort. Various measures of healthservices utilization, such as the proportion of each group that visited a OP during a givenyear, were developed from these trajectories. The intent was to remain at a broad baselevel, to try to capture overall trends, and to use these trends to suggest avenues forfurther investigation.In some cases, there were limits put on the 1991 injury cohort. For example, to eliminatethe effects of prior claims (at least as far as possible given data between 1986 and 1996), asub-group of 'first claimants' was identified. These are individuals who reported an injury6to the WeB for the first time in 1991. The text notes whenever such sub-groups werecreated and used.Possible data interpretations are noted in Parts I and II and are brought together in theExecutive Summary.78PART 1Analysis of the WeB short-term disability file910INJURY CLAIMS AND GENDERInjury claims by gender are summarized in the following table.Table 1.1: Injury Claims by GenderGender 1986 1991 1996Claims 1Working 1 % Claims 1Working ! % Claims Working %Female 134001 613060 12.2 190901 610575~3.1 16706 819890 2.0Male 49205~ 822925 16.0 61551 ! 738345(3 47300 953395 5.0Unknown 21715391 8378811801iTotal 628221 1435985!4.4 1348920i6.0 72384 1773285 4.1Gender distribution based solely on claims for which gender is known shows therelative percentage of claims attributed to females increasing from 21.4% in 1986 to23.7% in 1991 and 26.1% in 1996, with claims for males decreasing proportionately.Fi ure LA: Distribution of WCB Claims b GenderDistribution or WCB Claims by Gender80.070.060.0IIIE 50.0'0U_ 40.0o-15 30.0~CDQ. 20.010.00.01986 1991 1996While there was a decrease in the number of working individuals of each genderbetween 1986 and 1991, the numbers of claims for both genders were seen to increase.The number of claims awarded to females increased from 2.2% of population of workingfemales in 1986 to 3.1% in 1991. Among men, the number increased from 6.0% to 8.3%11during the same time period. By 1996, the numbers of working men and women were updramatically, but numbers of claims showed a marked decline . For each gender, thenumber of claims represented a lower percentage of the working population in 1996(2.0% for females and 5.0% for males) than in either of the other two years.Figure 1.B: Claims as a Percentage of Working Men and WomenClaims as a Percentage of the Working Population9.08.07.06.0s: 5.0I! 4.0at3.02.01.00.0Male1991Female1991 Injury Claims, Gender and Health RegionAmongst men, the highest injury rate (19.4%) occurred in the Coast Garibaldiregion. This rate is 1.6 times higher than the second highest regional rate (12.3% in bothEast Kootenay and North Okanagan), and almost 5 times higher than lowest regional rate(4.0% on the North Shore).The highest injury rate among women was also in Coast Garibaldi (7.5%). As withthe men, this value was 1.7 times higher than the second place West Kootenay Region .The lowest rate (1.8%), four times lower that in Coast Garibaldi, was for NorthVancouver.The lowest injury rates for both men and women were associated with B.C.'s twolargest urban areas: Greater Vancouver and Victoria, and with Peace Liard. For men,there was a 14% jump in rate from Peace Liard to the next lowest region. Among women,this distinction was not so clear. For them, a number of the other regions had similarly lowrates.12Table 1.2: The Distribution of 1991 Claims by Genderand Health Reo-ionClaims by Claims byMen as a Women asHealth Region PercentagE PercentagEof Working of WorkingMales Females1 East Kootenay 10.3 3.82 West Kootenay - Boundary 12.3 4.53 North Okanagan 12.3 3.94 South Okanagan - Similkameer 9.8 3.55 Thompson 9.3 3.36 FraserValley 11.7 3.97 South FraserValley 9.6 3.68 Simon Fraser 9.1 3.29 Coast Garibaldi 19.4 7.510 Central Vancouver Island 10.7 4.111 Upper Island/Central Coast 10.6 3.912 Cariboo 9.4 2.713 North West 10.4 3.314 Peace Liard 7.8 2.715 Northern Interior 8.9 3.116 Vancouver 5.3 2.317 Burnaby 7.4 2.718 North Shore 4.0 1.819 Richmond 5.5 2.420 Caoital Health 6.1 3.2Gender specific data were not analyzed by industry. It is worthy of note that therewere more people employed in manufacturing than any other industry for Coast Garibaldiand the West Kootenays, where injury rates were highest. On the North Shore, whereinjury rates were lowest, manufacturing ranked fifth. Another significant difference is theprevalence of business services in North Vancouver, where this industry accounted for12% of jobs. In Coast Garibaldi and the West Kootenays, it accounted for 2% and 3%respectively.1991 Injury Claims, Gender and Age GroupInjury claims were compared to the 1991 working population between ages 15 and64 by 5-year age group. Similar denominator data were not available for 1986 or 1996.For all age groups , 1991 injuries were more common among men than among women. Forboth males and females, the lowest percentage of claims fell into the age groups at the twoends of the working age continuum: 15 to 19 and 60 to 64. Among women, thepercentage of injuries peaked at 2.0% among those between 40 and 44, declining in bothdirections toward new workers (0.8%) and those preparing for retirement (0.6%).For men, injuries were most common (7.2% - 7.3%) among the 25 to 34 year oldsfollowed by those between 20 and 24. Over age 35, the rate of injury continued todecrease for each successive age group to a low of 2.1% among those between 60 and 64.13Injury rates among those 25 - 34 were twice as high as rates among those over 55 orunder 20.It should be kept in mind that denominators reflect the population at large. As aresult, some portion of the differences noted between age groups may be due to variationsin employment rates.IV en er an ere rouoMen as a Women asAge PercentagE Perce ntagEGroup of Working of WorkingMales Females15-19 2.1 0.820-24 6.7 1.725-29 7.2 1.730-34 7.3 1.735-39 6.0 1.840-44 4.8 1.845-49 4.4 2.050-54 4.1 1.955-59 3.6 1.460-64 2.1 0.6Table 1.3: Distribution of 1991 Claimsb G d d A GDistribution of Injury Claims by Gender and Ses 1986 . 1996Combined gender and socio-economic data were available for 92% of 1986 and1991 claims, 77 percent of 1996 claims. Presumably, 1996 is still being updated. Thesedata are presented separately for males and females in the two graphs that follow.14Figure i.C: Percentage of Female Claims Attributable to Socio-Economic Decile1986, 1991. & 1996 (ordered from left to right by SES decile)Distribution of Female Claims by SES and Year14.0 ~---------------------------,12.0 i---=:;-----;~,~ 10.0j 8.0i~ 6.0...o~ 4.02.00.02 3 4 5 6SESDedle7 8 9 10For both genders, across all years, the number of claims peaked within the thirdSES decile and declined as SES decile increased. Across all 3 years, the percentage ofclaims associated with females whose SES fell in the lower 40% was notably higher thanfor those females whose SES fell in the upper 60%. This same phenomenon held true formales in 1991 and 1996, but not in 1986.For males, the percentage of claims falling into each of the 4 lowest decilesincreased continuously across the three study years. Conversely, there was a continuousdownward trend for the three highest deciles. For females, the upward trend was evidentfor the first and fourth deciles, the downward trend for the ninth and tenth. The singlelargest change for both males and females was the decline in awarded claims between1991 and 1996 for the highest SES decile. The rate of claims in this highest decile was lessthan half that of the third decile (where claims are highest).15Figure I.D: Percentage of Male Claims Attributable to Socio-Economic Decile1986, 1991, & 1996 (ordered from left to right by SES decile)Distribution of Male Claims by SES and Yea14.012.010.0'".Sq:I 8.0......UG.I......~ 6.0.....0~ 4.02.00.01 2 3 4 5 6 7 8 9 10SES DecileINJURY CLAIMS AND INDUSTRY 1991 & 1996Industry of employment was available for 93% of 1991 and 1996 claims. Data for1986 are not included because SIC for that year was coded using 1970 codes and crosscorrelation between 1970 and 1980 codes was imprecise. Retail Trade, Manufacturing,Health and Social Services, Accommodation and Food, and Other Service Industriesemployed close to 50% of the work force in 1991. Numbers employed by industry in 1996are not yet available. Manufacturing (E), Construction (F), Transportation and Storage(G), Retail Trade (1), and Health and Social Services (P) accounted for more than 62% ofclaims in both study years. Those working in Fishing and Trapping (B), Finance andInsurance (K), or as Real Estate and Insurance Agents (L) accounted for less than 1%each.16Figure I.E: Distribution ofInjuries by Industry (1991 & 1996)(Refer to the code key in Table 1.12 on page 30.)Claims by Industry and Year (1991 & 1996)25.0.----- ----- - - - - - - - --- - --- - ----.20.0 ;-------f;:Ih--------------------~r10.0~5.0~0.0A B C 0 E F G H J K L M N 0 p Q RIndustry-GI-~ 15.0 ;--------;;!~t_-------------------~­o~GI11....J:INDUSTRY SPECIFIC 1991 INJURY INCIDENCECounts of people employed by industry were not yet available for 1996. While thesedenominators are available for 1986, data from 1986 are not included because cross­correlations between 1970 SIC numerator codes with 1980 denominator codes wereimprecise.When looking at counts of 1991 claims as a percent of those employed by industry,incidence rates in Logging and Forestry (13.3%), Mining (11.6%), Manufacturing(10.8%), Construction (9.2%) and Transportation & Storage (8.8%) were seen to rankhighest. Those employed in Business Services , Finance and Insurance, or work as RealEstate and Insurance Agents ranked lowest (all less than 1%).17Figure l.F: 1991 Industry Specific Injury IncidenceIndustry Specific Injuries14.012.0rr:::t 10.0(IIs 8.0r....Iii 6.0.......If 4.02.00.0 ..., 1II 1i1 I ~- - - "---- -ABCDEF CHI JKLMN O P Q RIndustry Code181991 INJURY ICD CODESleD codes were available for over 99% of all claims. Ninety five percent of theseclaims could be attributed to 50 three digit codes. This 95% was analyzed as follows:Figure 1.0: Distribution of 1991 Injuries by Body PartInjuries by Body Part403530~ 25"20115.l:1050Trunk Upper Limb Lower Limb Head OtherThirty-six percent were the result of injuries to the trunk, followed by injuries tothe upper limb (29%), injuries to the lower limb (20%), and injuries to the head (7%).Eight percent did not fall readily into the preceding categories.The majority of injuries to the trunk (90.8%) were back injuries (32% of claims),the most common of which were sprains and strains.Following back injuries, the most common injury sites were the hands and wrist.These accounted for 16% of injuries. The majority of these (63%) were open wounds,mostly to the fingers. Other upper limb injuries of note were contusions (4.4% of claims)and sprains/strains (4.1% of claims).Injuries to the lower limb were dominated by sprains/strains of the ankle and foot(4.9%) of the knee and leg (3.8%) and by contusions. The contusion category includesother unspecified sites so percentage values would be unreliable.Forty-eight percent of injuries to the head involved the eye. These accounted for3.3% of all injuries.Detailed information can be found in Table 1.4.19f 1991 I ' . b Bod PT bl 1 4 D '1 d D' ib .a e etai e istn unon 0 ruunes lV IV art% 0£ Cum % % of Cum %1C09 Count ToW of Body of Body DESCRIPTIONTola1 P~rt P~rtTRUNK847 13246 17.2 17.2 47.6 47.6 SPRAINSAND SffiAINS OF OUiER Al\'D UNSPECIFIED PARTSOF BACK846 7305 9.7 26.9 27.0 745 SPRAINSAl''D STRAlNSOF SACROIUAC REGION724 4132 5.4 32.2 14.8 89.4 OUiER M'D UNSPECIFIED DISORDERSOF BACK922 1918 25 34.7 6.9 96.3 CONTUSION OF TRUNK550 418 0.5 35.2 15 97.8 INGUINALHERNIA807 315 0.4 35.7 1.1 911.9 FRACTUREOF RIB(S), STER1'JUM, LARYNX AND TRACHEA722 302 0.4 36.0 1.1 100.0 INTERVER1E3RALDISC DISORDERSUPPER LIMB883 6182 8.0 8.0 28.1 28.1 OPEN WOUND OF FINGER/S)842 2083 2.7 10.7 9.5 37.5 SPRAINSAl\'D STRAINSOF WRISTAl'JD HAND882 1483 1.9 12.6 6.7 44.3 OPEN WOUND OF HAND EXCEPTFINGER(S)ALONE816 1128 15 14.1 5.1 49.4 FRACTUREOF ONE OR MORE PHALANGESOF HAND944 838 1.1 15.2 3.8 53.2 BURNOF WRIST/S) A!'<'D HAl'JDISl815 223 0.3 155 1.0 54.2 FRACTUREOF METACARPALBO:-',£(S)814 193 0.2 15.7 0.9 55.1 FRACTURE OF CARPAL BONE(S)923 3395 4.4 20.1 15.4 705 CONTUSIONOF UPPERLIMB840 3196 4.1 24.2 145 85.0 SPRAINSAl'\,'D STRAINSOF SHOULDERAND UPPERARM927 670 0.9 25.1 3.0 88.0 CRUSHINGINJURyOF UPPER LIMB881 644 0.8 25.9 2.9 91.0 OPEN WOUND OF ELBOW. FOREARM Al'JDWRIST841 553 0.7 26.7 2.5 935 SPRAINSAND STRAINSOF ELBOWAND FOREARM813 464 0.6 27.3 2.1 95.6 FRACTUREOF RADIUS AND UL'ZA354 446 0.6 27.8 2.0 97.6 MONONEURITIS OF UPPERillffi AND MONONEURITISIvfULTIPLEX943 294 0.4 28.2 1.3 98.9 BURNOF UPPERLIMB. EXCEPT WRIST Al'JDHAl'JD831 232 0.3 285 l.l 100.0 DISLOCATION OF SHOULDERLOWER LIMB924 5240 6.8 6.8 33.6 33.6 CONTUSION OF LOWERillffi Al'\'DOF OUiER Al'JD UNSPECIFIED SITES845 3801 4.9 11.7 24.4 58.0 SPRAINSAl"'D SffiAINS OF ANKLE A."JD FOOT892 407 0.5 12.2 2.6 60.6 OPEN WOUt\'D OF FOOTEXCEPT TOE/S)ALO/\'£825 394 05 12.7 25 63.1 FRACTURE OFOl'.'E OR MORETARSALAND METATARSAL BONES824 385 0.5 13.2 2.5 65.6 FRACTUREOF A..'\'KLE826 3S3 0.5 13.7 2.3 67.9 FRACTURE OF ONE OR MOREPHALANGESOF FOOT844 2936 3.8 17.5 18.8 86.7 SPRAINSAl'JDSTRAINSOF KNEE A..'<'D LEG891 628 0.8 18.3 4.0 90.7 OPEN WOUl\'D OF KNEE,LEG(EXCEPT THIGH) AND ANKLE836 306 0.4 18.7 2.0 92.7 DISLOCATION OF KNEE843 412 0.5 19.2 2.6 95.3 SPRAINSA1'JD STRAINSOF HIP AND THIGH945 327 0.4 19.7 2.1 97.4 BURNOF LOWERLL\;ffi(S)928 206 0.3 19.9 1.3 98.8 CRUSHINGINJURyOF LOWER LIMB890 193 0.2 20.2 12 100.0 OPEN WOUND OF HIP M'D THIGHHEAD930 1858 2.4 2.4 34.7 34.7 FOREIGNBODYON EXTE&'JAL EYE940 726 0.9 3.3 135 48.2 BURN CONFINED TO EYEAt\'D ADNEXA873 679 0.9 4.2 12.7 60.9 OUiER OPEN WOUl\'D OF HEAD388 638 0.8 5.1 11.9 72.8 OUiER DISORDERSOF EAR850 575 0.7 5.8 10.7 835 CONCUSSION920 443 0.6 6.4 8.3 91.8 CONTUSIONOF FACE.SCALP. AND NECK EXCEPTEYE(S)918 439 0.6 6.9 8.2 100.0 SUPERFICIAL INTURY OF EYEAND ADNEXA01l:lER726 3314 4.3 4.3 48.4 48.4 PERIPHERALEN1l:IESOPATHIESAND ALLIEDSYNDROMESS48 1201 1.6 5.8 17.6 66.0 OTHERAl\'D ILL-DEFINED SPRAINSAND STRAINS727 850 1.1 6.9 12.4 78.4 OTHERDISORDERS OF SYNOVIUM. TENDON A..'JD BURSA839 3S3 0.5 35.7 5.2 102.9 OTHER. MULTIPLE AND ILL-DEFINEDDISLOCATIONS946 274 0.4 36.1 4.0 106.9 BURNSOF MULTIPLE SPECIFIEDSITES692 226 0.3 36.3 3.3 110.2 CONTACTDER.\lATlTlS AND OTHER ECZEMA987 207 0.3 36.6 3.0 113.3 TOXICEFFECT OF OTHERGASES. FUMESOR VAI'OURSTotal 77231 100.020INJURY CLAIMS and MONTHS ON THEJOB 1986 - 1996Figure l.H: The Relationship between Injury Incidence and Months on the JobInjury Rates and Months on the Job16.0 -r-- - - - ----- - --- - - - - - - - - - - - ---,14.012.0Y>41llO.O..........o~ 8.0...] 6.0~ 4.02.0§§lsssi;S§$8$!iJ~~~~Months on the Job--tr- 1986-0-- 1991-0-1996The relationship between injury and length of time on the job, for each of the 3study years, can be seen in Figure l.H. The obvious inverse relationship between durationof employment and injury rate is punctuated by an apparent tendency to round 'durationon the job' to the nearest half year. The following trends were apparent for each of thethree study years: 1) More than 30% of all injuries occurred within the first 5 months ofemployment, 50% within the first 18 months; 2) Ignoring the half year figures, injury ratesdeclined steadily over the first five months. Looking at summary figures for 5-monthblocks, this trend continued for the first three years (1986) or more.Information about the number of months on the job was available for 62% of 1986claims. Of the injuries where this information was recorded, the largest number (14.8%)happened within the first month on the job, followed by the second month with 6.1% thenthe third month with 4.5%. Ignoring the tendency to over report 6 and 12 monthanniversaries, the fourth and fifth months followed in sequence with 3.5% and 2.6%respectively.The number of months on the job was recorded for 63% of 1991 claims. Of theinjuries where this information was recorded, the largest number (15%) happened withinthe first month on the job, followed by the second month with 6.3%. Again, ignoring thetendency to over report 6 and 12 month anniversaries, the third, fourth and fifth monthsfollowed in sequence with 4.7%, 3.3%, and 2.6% respectively Once more , 50% of allinjuries occurred within the first 18 months.Information about the number of months on the job was only available for 44% of1996 claims. Of the injuries where this information was recorded, the largest number(13.5%) happened within the first month on the job, followed by the second (6.8%), third21~15-24-0-25-34--lr-35+(4.4%), fourth (3.6%), fifth (2.8%), and sixth (2.4%) months in sequence. Again, morethan 50% of all injuries occurred within the first 18 months.The relationship between 1991 injuries, months on the job, and age group aregraphed in Figure 1.1. For workers aged 15 to 24,22.8% of compensated injuriesoccurred in the first month on the job. This figure was 16.2% for 25-34 year olds and10.7% for those over 35. Among 15-24 year olds, over 50% of all compensated injuriesoccurred within the first 5 months. Among those aged 25-34, the 50% mark was passed inthe 12th month. For those over 35, it took 3 years to reach the 50% mark.Figure 1.I: The Relationship between Age Specific 1991 Injurv Incidenceand Months on the JobInjury Rates by Age Group and Months on the Job25.....------ ------------- -------,Po 20 +--+-------------------------l:sot3~ 15 -+-o\-l~-------------------__i<C.....o~1O+-=~~:O"- --------------------l~ '---_........,..~ 5 +--4----.,;u..:-......;::E; ::.......:::=~~-------~~------l1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Months on JotThe relationship between months on the job and likelihood of injury shouldbe a concern to employers and to the WeB. The age-bias in the trend is perhapsan even bigger concern, and suggests that the younger age groups - presumablypeople who are entering the work force for the first time - might be well served byprevention programs. The form that these programs take would depend on abetter understanding of the causes and types of injuries, which were not analysedhere. The fact that this group appears to be particularly prone to injury, however,is reason enough to pursue this policy option.22By IndustryThe number of workers represented in each of the industry types is not evenlydistributed (Table 1.5). In order to compare across industry, Table 1.6 was created, whichshows the cumulative percent of reported injuries, within each industry type, by month onthe job. The first column of the table shows the percentage of total reported injuries thatfall within that industry; so, for example, 20.1% of total injuries are in the manufacturingindustry, while only 0.3% are in finance and insurance.The likelihood of injury within the first month on the job varies widely by industry,from 2% in health and social services to 41% in construction. Almost three-quarters ofinjuries in construction, in fact, occur within six months on the job. This trend may relateboth to the nature of the work (i.e. high propensity for injury) and the fact that there is alot of turnover in jobs (i.e. there is a greater proportion of the workforce in their first sixmonths of employment with a particular company). More than half of all worker injuriesoccur within the first two years on the job in all industries except government, education,and health and social services.23Table 1.5: Frequency of injury by industry and month on the lobf----- - f- - --- --1- - -Month on theiob-0 I 2 3 4 5 6 7 8 9 10 11 12 I2 to 18 19 to 24 2-3 vrs 3-4 vrs 4-5 Y.!s~y'rs TotalIndust ryAgriculture 0 90 26 30 6 8 12 4 6 3 5 2 9 16 19 22 8 13 61 340Fishing and Trapping 0 18 12 9 7 5 5 7 0 3 3 4 5 28 7 9 5 3 14 144Logging and Forestry 0 575 167 93 46 36 36 24 17 16 15 12 63 73 128 135 69 56 280 1841Mining 0 122 40 29 17 16 29 13 12 4 8 3 35 38 61 71 32 36 181 747Manufacturing 2 1136 522 381 262 192 297 161 183 124 98 77 503 558 798 796 531 414 2223 9258Construction o 2223 671 456 266 174 199 87 87 53 58 31 135 176 170 213 102 70 258 5429Transportation and Storage I 233 113 104 85 73 77 48 60 30 43 20 155 215 239 364 196 147 1227 3430Communication and Utilities 0 36 26 35 20 18 30 16 18 28 14 8 54 59 63 64 30 28 198 745Wholesale Trade 0 241 146 103 98 73 83 49 60 42 41 36 135 182 231 242 144 85 500 2491Retail Trade 0 320 229 191 145 134 199 126 110 95 122 64 308 410 452 476 288 244 1107 5020Finance and Insurance 0 20 7 4 6 3 4 2 5 I 3 2 11 11 10 17 5 7 34 152Real Estate and Insurance A~ 0 17 9 6 6 0 6 7 1 6 3 4 14 24 27 23 10 II _ 40 214Business Services 0 143 39 30 21 11 17 9 II 12 6 8 22 32 35 30 24 8 42 500Government I 166 72 65 42 52 70 21 28 21 21 14 124 151 217 232 159 13 1 1068 2655Education 0 65 29 29 27 22 26 8 20 11 13 10 46 67 101 105 72 57 370 1078Health and Social Services 0 99 98 96 75 73 91 56 60 62 49 46 155 288 332 471 304 229 1389 3973.-- ----Accomodation and Food 0 309 223 222 160 115 176 91 94 85 62 46 177 292 275 261 130 80 398 3196Other Services 0 181 109 81 82 71 55 33 28 22 35 15 85 93 127 117 64 37 192 1427OTHER 493 819 308 203 121 108 118 72 56 41 41 16 116 140 142 134 80 51 283 3342497 6813 2846 2167 1492 1184 1530 834 856 659 640 418 2152 2853 3434 3782 2253 1707 9865 45982'<t('lTable 1.6: Frequency of injury by industry and month on the .obcumulative percentage ofinjuries within the time period--Month on the joblndustrv 0 1 2 3 4 5 6 7 8 9 10 11 12 12 to 18 19 to 24 2-3 yrs 3-4 yrs 4-5 yrs >5 yrs Total---Agriculture 0% 26% 34% 43% 45% 47% 51% 52% 54% 54% 56% 56% 59% 64% 69% 76% 78% 82% 100% 340Fishing and Trapping 0% 13% 21% 27% 32% 35% 39% 44% 44% 46% 48% 51% 54% 74% 78% 85% 88% 90% 100% 144Logging and Forestry 0% 31% 40% 45% 48% 50% 52% 53% 54% 55% 56% 56% 60% 64% 71% 78% 82% 85% 100% 1841Mining 0% 16% 22% 26% 28% 30% 34% 36% 37% 38% 39% 39% 44% 49% 57% 67% 71% 76% 100% 747Manufacturing 0% 12% 18% 22% 25% 27% 30% 32% 34% 35% 36% 37% 43% 49% 57% 66% 72% 76% 100% 9258Construction 0% 41% 53% 62% 67% 70% 73% 75% 77% 78% 79% 79% 82% 85% 88% 92% 94% 95% 100% 5429Transportation and Storage 0% 7% 10% 13% 16% 18% 20% 21% 23% 24% 25% 26% 30% 37% 44% 54% 60% 64% 100% 3430Communication and Utilities 0% 5% 8% 13% 16% 18% 22% 24% 27% 30% 32% 33% 41% 49% 57% 66% 70% 73% 100% 745Wholesale Trade 0% 10% 16% 20% 24% 27% 30% 32% 34% 36% 38% 39% 44% 52% 61% 71% 77% 80% 100% 2491Retail Trade 0% 6% 11% 15% 18% 20% 24% 27% 29% 31% 33% 35% 41% 49% 58% 67% 73% 78% 100% 5020Finance and Insurance 0% 13% 18% 20% 24% 26% 29% 30% 34% 34% 36% 38% 45% 52% 59% 70% 73% 78% 100% 152Real Estate and Insurance Agents 0% 8% 12% 15% 18% 18% 21% 24% 24% 27% 29% 30% 37% 48% 61% 71% 76% 81% 100% 214Business Services 0% 29% 36% 42% 47% 49% 52% 54% 56% 59% 60% 61% 66% 72% 79% 85% 90% 92% 100% 500Government 0% 6% 9% 11% 13% 15% 18% 18% 19% 20% 21% 22% 26% 32% 40% 49% 55% 60% 100% 2655Education 0% 6% 9% 11% 14% 16% 18% 19% 21% 22% 23% 24% 28% 35% 44% 54% 60% 66% 100% 1078Health and Social Services 0% 2% 5% 7% 9% 11% 13% 15% 16% 18% 19% 20% 24% 31% 40% 52% 59% 65% 100% 3973Accomodation and Food 0% 10% 17% 24% 29% 32% 38% 41% 43% 46% 48%~ 55% 64% 73% 81% 85% 88% 100% 3196Other Services 0% 13% 20% 26% 32% 37% 41% 43% 45% 46% 49% 50% 56% 62% 71% 79% 84% 87% 100% 1427OTHER 15% 39% 48% 55% 58% 61% 65% 67% 69% 70% I 71% 72% 75% 79% 84% 88% 90% 92% 100% 33421% 16% 22% 27% 30% 33% 36% 38% 40% 41% 42% 43% 48% 54% 62% 70% 75% 79% 100% 45982tr)NREPEAT USERSThere were 8,126 individuals who reported injuries in 1991 who filed 12 or moreclaims between 1986 and 1996. These individuals were 5% of the total 1991 injurycohort, and made 124,209 unique claims over the study period. The number ofindividuals and the number of claims entered in the 'Injured Worker' and the 'AwardedClaims' files are graphed below.Figure I.J: Claims Filed. Distribution of Claims and Claimants.Members of the 1991 Cohort With 12 or More Claims Filedbetween 1986 and 1996Repeat Users and Claim Applications16000140001200010000j 80006000400020000• Individua ls. Claims1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996Both the number of individuals filing claims and the number of claims filed arehigher for the three years preceding 1991 than the corresponding years after 1991. Thistrend was reversed after three years. Throughout the entire study period, each individualinitiated an average of 1.9 claims. This value peaked at 2.0 in 1989 and 1990.The number of individuals filing claims was 1.7 times higher than the number towhom claims were awarded. The number of claims filed was 2.3 times higher than thenumber awarded.26Figure I.K: Distribution of Awarded Claims and Claimants.Members of the 1991 Cohort With 12 or More Claims Filedbetween 1986 and 1996Claims Awarded to Repeat Users7000 -,--- - - - - - - - - -----:::=-- - - - - - -------,6000 +--- - - - - - - - - -• Individuals• Claimso5000 +--- - - - - -300010002000J40001986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996Both the number of individuals and the number of claims entered in the 'AwardedClaims' file are higher for the two years preceding 1991 than the corresponding years after1991. The average number of claims per person was 1.4, peaking at 1.6 in 1994.27Repeat Users and Months on the JobThe following job month information was available for claimants who were injuredin their first year on a job in 1991, and who had more than 11 injuries throughout thestudy period.Table 1.7: 'Months on the Job'for Repeat Users -Available DataCiaims In Hrst Year on a JObYear% tor wtuch) ObMonth InfoAvailab le1986 601987 561988 571989 601990 591992 591993 581994 571995 441996 39Figure 1.L: Repeat Users . Injured during Their 12 Months on a Job in 1991.Who Also Made Claims in Other Study YearsIndividuals Who Were Injuredin the First Year on a Job in 199120.--------- ------------- - --- - - - --,16.0 16.414.5416 +----- - - - ---- -,---r--r-,....- -:-:--;:--- - - - - - ---;i 12 +-----~.........___i ;~1 8 +--,-'-""""---1&1986 1987 1988 1989 1990 1992 1993 1994 1995 199628The following trend looks at individuals who filed 12 or more claims between 1986and 1996, including at least one in 1991 during their first year on ajob. Between 1986 and1990, more than 40% of the claims awarded to high users for whom the number of monthson the job was known, were for injuries occurring during the first year on a job. After1991, this number dropped to the 30% mark.Figure 1.M: Repeat Users, Injured during Their First 12 Months on a Job in 1991. WhoWere Also Injured during Their First 12 Months on a Job in Other Years% of Claims in the First Year on the Jobfor 1991 Repeat Users504010o~~ ~ ~; ~ r;:I;,; I ~! '4' IJ ~I"~ '" 11:i ," I'; ,....-'- 1~- ;. f-- :._ "---- ~, ~S .;[ ,~ 1~: f'i r-- , ~.1,-' t. k.:;" '~ ~- -~ -~ i! t :p' ~ ¥, I:,,; .~ ,-,~: ~t: ,1 ~~ '( I :~- - ~ !~ I~~('I ~ .' ~. b1 0" I,j I · I"'J ,~ ~'1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996The likelihood of injury for these 'high users' in the first year on the job implies apropensity for frequent job change among this group. One interpretation of these numbersis that the reported injury effectively ends employment, followed by re-employment at adifferent location, and then another injury. While this is likely not the only pattern thatwould be found with a closer examination of these high users, the fact of repeated claimsand the high proportion of injuries early in the cycle of employment suggests that it doesfit for some proportion of this group . This -is another area that could be targeted forfurther investigation, and potential policy intervention.Repeat users, pensions and Income AssistanceOf the 5056 'high users' who were awarded claims in 1991, 308 (6%) appear inboth income assistance and pension files. One hundred five of them (2%) were on theincome assistance rolls sometime during a year in which they are also collecting a pensionfrom the WeB.29NATURE OF INJURYThe number and percentage of claims falling into each of 43 'Nature of Injury'codes are tabulated below for the three years of interest.C df Id b th WCB NT bl 1 8 1991 I ' . Ga e rnunes rouoe )V e ature 0 nJ urv o eNature of Injury Code 1986 1991 1996Count % Count % Count %000 TRAUMATIC & DISORDERS, UNSPECIFIED 217 0.3 646 0.8 3851 5.3100 AMPUTATION OR ENUCLEATION 300 0.5 144 0.2 160 0.2110 ASPHYXIA, STRANGULATION, DROWNING 17 0.0 8 0.0 3 0.0120 BURN OR SCALD(HEAT) (HOT SUBsrA1\lCES) 1654 2.6 1723 2.1 1316 1.8130 CHEMICAL BURN 429 0.7 516 0.6 417 0.6140 CONCUSSION - BRAIN, CEREBRAL 181 0.3 559 0.7 421 0.6152 TIJBERCULOSIS 4 0.0 1 0.0 2 0.0153 OTH ER CONTAGIOUS/ INFEOlOUS DISEASE, NEC 87 0.1 78 0.1 52 0.1160 CONTUSION, CRUSHING, BRUISE(SOFT TISSUE) 9790 15.6 12402 15.3 10380 14.3170 CUT, LACERATION, PUNCTURE - OPEN WOUND 9184 14.6 10798 13.3 8332 11.5180 DERMATITIS 241 0.4 235 0.3 172 0.2190 DISLOCATION 286 0.5 370 0.5 342 0.5200 ELECTIUC SHOCK OR BUR.NS, ELECTROCUTION 28 0.0 63 0.1 80 0.1210 .FRACTURE 3784 6.0 4100 5.1 3689 5.1220 FREEZING, FROSTBITE, EXPOS. TO LOW TEMPS 33 0.1 38 0.0 57 0.1230 HEARING LOSS OR IMPAIRMENT 377 0.6 676 0.8 425 0.6240 HEAT STROKE, SUNSTROKE, HEAT EXHAUSTION 5 0.0 8 0.0 5 0.0250 HERNIA, RUPTIJRE (INGUIN AL & NONINGUINAL) 340 0.5 437 0.5 363 0.5261 BURSITIS (EPICOND YUTIS, TENNIS ELBOW) 334 0.5 1242 1.5 1010 1.4262 TENOSYNOvms, SYNOvmS, TENDONITIS 809 1.3 2858 3.5 2276 3.1263 INFLAMMATION OF JOINTS, TENDONS NEC 109 0.2 4 0.0 7 0.0264 CARPAL TUNNEL SYNDROME 120 0.2 435 0.5 241 0.3270 POISONING, SYSTEMIC (INSECT STINGS) 3 0.0 146 0.2 109 0.2281 SILICOSIS (MIN ING) 4 0.0 6 0.0 1 0.0283 ASBESTOSIS 17 0.0 29 0.0 13 0.0290 RADIATION EFFECTS Sill\TBURN, WELDING FLASH 225 0.4 333 0.4 235 0.3300 SCRATCHES, ABRASIONS (SUPERFICIAL WO UND) 2487 4.0 2684 3.3 2164 3.0310 SPRAINS, STRAINS 29520 47.0 40008 49.3 35546 49.1400 MULTIPLE INJURIES 2002 3.2 66 0.1 57 0.1405 NON-PERSONAL DAMAGE (ARTIFICIAL LIMBS;) - - 1 0.0 2 0.0605 SfRESS 1 0.0 96 0.1 261 0.4886 ALLERGIC REAOlON - - 27 0.0 36 0.0887 HEART AITACK (H\lCLUDES STROKE) 9 0.0 14 0.0 1 0.0888 CANCER 7 0.0 1 0.0 1 0.0889 RAYNAUD'S PHENOtVrENON 2 0.0 9 0.0 1 0.0991 CONTUNCTIVmS 18 0.0 10 0.0 15 0.0992 INFECTED BLISTERS 10 0.0 5 0.0 6 0.0993 RESPIRATORY INFLAMMATION 112 0.2 - - - -994 OCCUPATIONAL DISEASE, NEC 32 0.1 40 0.0 25 0.0995 OCCUPATIONAL INJURY, NEC 40 0.1 82 0.1 57 0.1996 UPPER RESPIRATORY INFLAMMATION- -41 0.1 18 0.0997 LOWER RESPIRATORY INFLAMMATION 2 0.0 240 0.3 230 0.3999 INJURY OR ILLNESS, NEC 2 0.0 1 0.0 5 0.030ASTHMA TRENDSThere are a number of ICD codes that may represent cases of occupational asthma.All are listed in the table below.Table 1.9: ICD Codes Potentially Linked to AsthmaICDCode Description Count1986 1991 1996472 CHRONIC PHARYNGITIS AND NASOPHARYNGmS 1477 ALLERGIC RHINmS 5 4478 OfHER DISEASES OF UPPER RESPIRATORY TRACT 1 1490 BRONCHmS NOT SPECIFIED AS AClITE OR CHRONIC 2 6491 CHRONIC BRONCHmS 1 1493 ASTHMA 5 24 27495 EXTRINSIC ALLERGIC ALVEOLmS 31 29 7506 RESPIRATORY CONDmONS DUE TO CHEMICAL FUMES AND VAPOURS 2 5518 OTHER DISEASES OF LUNG 1 1 1519 OfHER DISEASES OF RESPIRATORY SYSTEM 1 1987 TOXIC EFFECT OF OTHER GASES FUMES OR VAPOURS 91 207 173The WCB has traditionally used both 493, asthma, and 495, extrinsic allergicalveolitis. Using the combined number of claims attributed to these two codes, asthmaincidence rose from 5.7 per 10,000 claims in 1986, to a peak of 6.5 per 10,000 claims in1991. By 1996, the number had declined to 4.7 per 10,000.The large number of claims coded 987 -- toxic effects of other gases, fumes, orvapours -- are broken down by nature of injury as follows.Table 1.10: WCB Nature of Injury Codes forlCD 987(Toxic Effects of other Gases. Fumes. or VaDOUrS)Nature of Iniurv 1986 1991 1996270 POISONING. SYSTEMIC (INSECT STIN GS) 32 19 3993 RESPIRATORY INFLAMMATIO N 59996 UPPER RESrIRATORY INFLAMMATION 20 7997 LOWER RESPIRAT ORY INFLAMMATlO 166 16331TRENDS FOR REPETITIVE STRAIN INJURIESThe following table shows claims for which nature of injury was coded as 261­bursitis; 262- tenosynovitis, synovitis, tendonitis; 263- inflammation of joints, tendonsNEC, and 264- carpal tunnel syndrome.Table 1.11: Nature of Iniurv and ICD Codes Related to Renetitive Strain IniuriesNa ture ICDCODES Row Total byof 276 350 354 426 711 715 723 726 727 Total NatureInjury 842 847 881 892 923 of lnjury1986 212 18 1 231261 1991 1 1 705 95 1 803 17131996 608 71 6791986 432 223 655262 1991 1 1 1 1454 440 1 1 5 1904 40181996 1206 250 3 14591986 0263 1991 1 1 61996 1 3 1 51986 109 109264 1991 1 434 435 7851996 239 2 241Column Total 1 1 784 1 1 3 1 4621 1097 4 1 1 1 5 6522Three ICD codes cover 99.7% of claims. These are 726- peripheralenthesiopathies and allied syndromes; 727- other disorders of the synovium, tendon, andbursa; and 354- mononeuritis of upper limb and mononeuritis multiplex.Grouping all the above, repetitive strain injuries claim awards are plotted by year inthe following figure.Figure l.N: Awarded Claims for Potential Repetitive Strain Injuries 1986 - 1996Claims Awarded for Repetitive Strain Injuries by Year350030002500UI 200015001000500a:J I: ,"".~L~·." r-·J1?, .'...<~t:~ ::~~:'.. ''to,., ~.;~;~-:1986321991 1996LAGTIMES BETWEEN INJURY ANDPAYMENT DATESThere are 81,180 unique claim numbers associated with awarded claims for 1991(by claim number). Lag times between month/year of injury and month/year of the firstpayment recorded in the 'awarded claims' file were calculated for the 80,082 records thathad sufficient data.The median wait for payment was 1 month . Payment was made for 90% of all claimswithin 4 months . Ninety-seven percent received payment within 10 months. Injury yearsearlier than 1991 were entered for 296 records (0.4%).Figure 1.0: Lag Times between Injury and Payment DatesLag Between Injury and Payment Dates504540..... 35.§ 30o:Il...... 25u..... 200~ 1510500 1 2 3 4 5 6 7 8 9 10Months33DISABILITY DURATIONDisability duration was calculated for 80,312 unique 1991 claim numbers from thedisability duration file. The duration of disability ranged from 1 day to 'ongoing'. Themedian number of weeks off was 1.9. Ninety percent of awarded disabilities lasted 16weeks or less. Ninety four percent had durations less than 6 months. Only 3% haddurations of one year or more.Figure l.P: The Percentage of Individualswith Disablilities Lasting Sixteen Weeks or LessDisability Duration3025"U 20111-~..... 15....Q.....0~ 10501 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17Weeks34PENSIONS1991 Pensions: Age and GenderEighty six percent of 1991 pensions were awarded to males, 14% to females. Thisdisparity between genders is somewhat larger that that for claims in general where femalesaccounted for 24% of all claims in 1991.While the largest number of pensions by age group was awarded to males aged 30­34, the trend among working men showed that those aged 55-60 had greatest likelihoodof receiving a WeB pension (figure Qbelow). For females, the peak count was for thoseaged 40-44. The probability that a working would receive a pension in 1991 had a highplateau between ages 40 and 59.Figure 1.0: Percentage of the 1991Working Population in Pensions FileAge, Gender, and Pension0.50 .,-- - - - - - - - - - - - - - - - - - - - - - - -----,0.45 +--------------------~~ 0.40 +-------------------- ­~S 0.35 +------------------~ 0.30 +--------------- ­~ 0.25 +-- - - - - - -Gl 0.20 +------@ 0.15 +---~ 0.10+-- ­0.05+-- ­0.00 -t-- .....15 20 25 30 35 40 45 50 55 60Lowest Age in 5 Year Age (35The incidence of injury amongst men and women was seen to decline from the thirdSES decile to the tenth. These data (figs I.C & I.D) showed that workers in the lowest40% by income were more likely to be injured than those in the upper 60%, and that injuryrates dropped off more dramatically for the highest income brackets. This trend was notreflected in pension data. For both men and women, those in the second SES decile wereleast likely to receive a WCB pension. For women, those most likely to receive a pensionwere in the fifth and seventh deciles. For men, the greatest likelihood was among those inthe eighth decile. These trends suggest that workers in lower income brackets are lesslikely to receive a pension, following injury, than those in the higher income brackets.Figure l.R: 1991 Pensions as a Percentage of the Working Population for Whom SES isKnownSES Gender & Pension by Population7.0...--------- ----------- - - -----,361991 Pensions: Health Region and GenderGeneral trends for pensions were not dissimilar from injury data. Those regionswith highest pension rates for both men and women were North Okanagan (3), CoastGaribaldi (9), and the Kootenays (1&2). Lowest rates were for major urban areas: theGVRD (8, 16-19) and Capital District (20). See Table 1.15: n.c. Regional Health Boardsat the end of Part 1.Table 1.12: Distribution of 1991 Pensions by Health RegionPensions for Pensions forMen as a Women as aHealth Region Percentage of PercentageWorking of WorkingMales Females1 East Kootenay 0.94 0.152 West Kootenay - Boundary 1.04 0.263 North Okanagan 1.10 0.194 South Okanagan - Similkamee 0.67 0.135 Thompson 0.73 0.126 Fraser Valley 0.66 0.147 South Fraser Valley 0.46 0.098 Simon Fraser 0.40 0.069 Coast Garibaldi 1.02 0.3210 Central VancouverIsland 0.72 0.1111 Upper Island/Central Coast 0.70 0.0812 Cariboo 0.89 0.1213 North West 0.59 0.0614 Peace Liard 0.55 0.0815 Northern Interior 0.71 0.2116 Vancouver 0.19 0.0517 Burnaby 0.36 0.0518 North Shore 0.17 0.0419 Richmond 0.18 0.0720 Capital Health 0.28 0.0937The Relationship Between Injury Dates and Decision DatesOne hundred pensions were awarded for fatalities in 1991. For these, the medianlag between injury and decision dates was 2 months. Twenty five percent had lags of 8months or more. Ten percent experienced lag times 13 months or longer, and the top 5percent took 29 months or more.Decisions relating to living pensioners took considerably longer. These are plottedin the following histogram. The median wait for a pension decision was 25 months.Twenty five percent of claimants waited 37 months or longer. Ten percent waited at least53 months . The highest five percent waited 62 months or longer. The three longest waitswere 80, 82, and 84 months.Figure 1.5: Lag Times between Injury Dates and Pension Decision DatesLag Times to Decisions for Pensions25 -r-- - - - - - - - - - - - - - - - - - - - - - --,20_ 15ev,..~ 1056 12 18 24 30 36 42 48 54 60 66 72 78 84Months (highest in interval)The Relationship Between Decision Dates and Effective DatesGenerally, pensions were assigned retroactively to an effective date. However, 19records indicated effective dates subsequent to the decision date. Fourteen of thesepensions became effective within 1 month. The others became effective 2, 3, 5, 8, and 11months after the decision date.38The Relationship between Injury Dates and Compensation Dates3402 pension records were analyzed to determine the wait time between injuriesand financial awards. Compensation date was taken as the earlier of pension effective dateor award payment date.Sixty-five percent of 1991 pensioners received interim compensation awards priorto their pension being effective. Seventeen percent received compensation awards aroundthe same time as their pension became effective and 18% had pensions become effectivebefore receiving other compensation awards. The median wait for compensation was 4months. Ninety percent of pensioners received compensation within 10 months. Six andone half percent waited a year or more, 1.6 percent 2 years or more, and 0.5 percent morethan 3 years.Figure l.T: Pensioners Wait Times for 'Awarded Claim' Paymentor 'Pension in Effect', Whichever Came First.Time to Payment/Pension Effective1412'"S 10....'"J: 8.....0-6Iii.......t: 420 -'-----'--o 1 2 3 4 5 6 7 8 9 10 11 12 13 14Months39The Relationship Between Industry and PensionsThe industry in which the pensioner was employed was available for 80% of thepensions awarded.Figure l.V: The Relationship between Pension Claims and IndustryPension Claims by Industry35.0 ..,-- - - - - - - - - - - - - - - - - - - - --,5.030.0..... 20.0o~ 15.0....s~ 10.0.f...."'0N 25.01ABC D E F G H I J K L M N 0 P Q RIndustry CodeOf the 3345 pension recipients with known industry of employment, 28% wereworking in manufacturing (E), 18% in construction (F), 8% in transportation/storage (0)and 7% each in logging/forestry (C) and retail trade (1). No other industry accounted formore than 5% of the pensions awarded for 1991 injuries. Those industries least likely tohave pensionable injuries were fishing/trapping (B), finance/insurance (K), and real estate/insurance agents (L), accounting for less than 1% each. (See Table 1.14: Industry Code atthe end of Part 1.)40SELF-EMPLOYED WORKERS 1991Statistics Canada estimated that self-employed individuals accounted for 11.3% of theemployed workforce in 1991. Females were less likely to be self-employed (7.5%) thanmales (14.2-14.5%). WCB coverage for those self-employed is optional. There is no wayto distinguish self-employed from employees in the WCB data.Data were arranged in 20 local health areas (see Table 1.15: B.C. Regional HealthBoards at the end of Part 1). The percentage of self-employed males ranged from a high of21.3% on the North Shore to a low of 9.7% in the Northern Interior. For females, thesevalues ranged from a high of 10.8% in Peace Liard to a low of 5.6% in the NorthernInterior. Of the twenty local health areas (LHA's), the North Shore, North Okanagan, andPeace Liard were in the highest quartile of percent self-employed for both males andfemales. North West, Simon Fraser, Burnaby, and the Northern Interior were in the lowestquartile.h PhhdW kf S If Ea e e Ism unon 0 e - mnrove or ers t rouz: out t e rovinceHe~lth Dist rict ~bles Females Both SexesEm pl oyed Self- "t. seir- Employed Sel f- % Self- Employed Self· % Self-emeloved emelc ved emploved emelove d em plo ved em ploved1 East Koo tena v 11515 1335 11.6 &;30 715 8.5 19945 2050 10.32 West Kootenay 10-U5 1420 13.6 8020 ill 9.2 18435 2155 11.7·3 North Okanagan 13210 2385 18.1 10900 lOSS 9.7 24110 3440 K 34 South Okanagan 28255 5185 18.4 24215 2040 8.4 52470 Till 13.85 ThomPSOlI 20525 2680 13.1 16550 1080 6.5 37075 3760 10.16 Fraser ValJey 35895 5020 14.0 2mO 2185 7.9 63665 7205 1137 South Fraser 111&85 15255 13.6 87085 6265 7.2 198970 21520 10.88 Simon Fraser 68095 7765 11.4 56030 3265 5.8 124125 11030 8.99 Coast Garibald i 7530 1020 13.5 5255 505 9.6 12785 1525 11.910 Central Vancouver Island 33810 4965 14.7 25995 2330 9.0 59805 7295 12.211 Uppe r Island 19075 2855 15.0 13655 1345 9.8 32730 4200 12.812 Cariboo 11510 1715 14.9 &445 875 10.4 19955 2590 13.0131No rth West 14820 1770 11.9 10645 655 6.2 25465 2425 9.514 Peace Liard 11625 1990 17.1 8350 900 10.8 19975 2890 14.515 Northern Interior 21510 2090 9.7 16565 920 5.6 38075 3010 7.916 Vancouver 12mO 19795 15.5 114260 8065 7.1 242030 27860 11.517 Burnaby 43620 5585 12.8 37235 2215 5.9 80855 7800 9.6·18 No rth Sllore 44115 9375 213 39015 3975 10.2 83130 13350 16.119 Richm ond J5380 4970 14.0 30830 1760 5.7 66210 6730 10.220 Capital 67785 10010 14.8 61325 4735 7.7 129110 14745 11.4totals 738345 107185 14.5 610575 45620 7.5 1348920 152805 11.3T bl 1 13 Th D' ib .Statistics Canada data distinguish between self-employed with and without paid help.Because paid help would be covered by the WCB, it may be that those with employeeswould be more likely to include themselves in that coverage. 'Self-employed with paidhelp' accounted for 5.8% of the total employed workforce in 1991. Those without paidhelp accounted for 5.5%. Males were 1.2 times more likely to have paid help than females.4142APPENDEDTABLES43SIC CodeABCoEFGHIJKLMNoPQRTab le 1.14: One Digit SIC CodesIndustryAgr icul tu reFishing and Trappi ngLogging and ForestryMiningManufactu ringConstructionTransporta tion and StorageCommunication and UtilitiesWho lesale TradeRetail TradeFinance and Insuranc eReal Estate and Insura nce Agent:BusinessServicesGovernmentEducationHealth and Socia l ServicesAccomodation and FoodOther Services44Table 1.15: B.C. Rel!:ionalHealth Boards and LHA'sL I H Ith A ( )B CR· I H Ith B d.. ezuma fa oar s oca ea rea s1 East Kootenay 1 Fernie 4 Windermere2 Cranbrook 5 Creston3 Kimberlev 18 Golden2 West Kootenay - Boundary 6 Kootenay Lake 11 Trail7 Nelson 12 Grand Forks9 Castlegar 13 Kettle Valley10 Arrow Lakes3 North Okanagan 19 Revelstoke 22 Vernon20 Salmon Ann 78 Enderby21 Armstronz-Snallurncheen4 South Okanagan Sirnilkameen 14 Southern Okanagan 17 PrincetonIS Penticton 23 Central Okanagan16 Keremeos 77 Summerland5 Thompson 24 Kamloops 30 South Cariboo26 North Thompson 31 Merritt29 Lillooet6 Fraser Valley 32 Hope 75 Mission33 Chilliwack 76 Agassiz - Harrison34 Abbotsford7 South Fraser Valley 35 Langley 37 Delta36 Surrev8 Simon Fraser 40 New Westminster 43 Coquitlam42 Manle Ridze9 Coast Garibaldi 46 Sunshine Coast 48 Howe Sound47 Powell River10 Central Vancouver Island 65 Cowichan 68 Nanaimo66 Lake Cowichan 69 Qualicum67 Ladvsmith 70 Alberni11 Upper Island/Central Coast 71 Courtenay 84 Vancouver Island West72 Campbell River 85 Vancouver Island North12 Cariboo 27 Cariboo - Chilcotin 49 Central Coast28 Ouesnel13 North West 50 Queen Charlotte 87 Stikine52 Prince Rupert 88 Terrace54 Smithers 92 Nishga80 Kitimat 94 Telezranh Creek14 Peace Liard 59 Peace River South 81 Fort Nelson60 Peace River NorthIS Northern Interior 55 Burns LakelEutsuk Lake 57 Prince George56 Nechako 93 Eutsuk16 Vancouver 39 Vancouver17 Burnabv 41 Burnabv18 North Shore 44 North Vancouver 45 West Vancouver19 Richmond 38 Richmond20 Capital 61 Greater Victoria 63 Saanich62 Sooke 64 Gulf Islands4546PART 2Linkage To The Be Linked Health Data set4748IntroductionBetween 1986 and 1996, the WCB recorded 2,236,624 total claims, as identified byunique claim number. Of these, the Centre for Health Services and Policy Research wasable to probabilistically link 2,172,984, or 97.2%. This probabilistic linkage means that weare able to ask questions about the use of other health (and social) services by people whomake claims to the WCB, including physician services not covered by WCB, hospitalseparations, and application to and the receipt of Income Assistance payments. In orderto assess the extent of use of other services, we have traced the cohort of individuals withinjury year of 1991 (i.e. claim number starts with '91') and their health services utilisationover time.The almost 2.2 million claims from these 11 years represents 874,334 uniqueindividuals, which suggests that the average claimant to WCB makes 2.5 claims between1986 and 1997.There were 203,898 unique claims with a 1991 injury year, of which 198,255 werelinked (97.2%), a rate consistent with overall linkage rates. These roughly 200,000 claimscame from 163,338 unique people, for an average of 1.2 claims per person in 1991. Thisimplies both that there are people who make multiple claims within one calendar year, andthat some of these people also have claims in other years. The latter is reinforced if oneconsiders that more than 19% of total claimants over these 11 years make a claim in 1991(163,338 out of 874,334). Figure 2.A shows the proportion of the 1991 injury yearcohort who also reported injuries in other years.Figure 2.A: Proportion of 1991 injury cohort claimants who report injuries86 87 88 89 904992 93 94 95 96Figure 2.8: Distribution of claims made per study ID includedin in the 1991 injury cohort, 1986 to 1997..,n>-Hf-:-- --------------;row-H~---------------IlWO­,<roo~ lbll~~ .. .." . .1 3 5 7 9 11 13 15 17 1921 2325 27 29 31 33 35 37 39 41 43 45CIIlims madtThe total numberof claims made over thestudy period by the 1991injury cohort is highlyskewed (Figures 2.B &2.C). Just over 20% ofindividuals report only oneinjury to the WCBbetween 1986 and 1997,and nearly three-quartersof the cohort report five orfewer. The remaining 25%D4.51116-10.11·16016·20.21-30.31-40041 -50Figure 2.C: % of 1991 cohort by number of claimsreport between six and 50 claims over this twelve-year period .It should beemphasised that thesenumbers represent differentclaim numbers in other years ­i.e. this is not a carryover of1991 injuries to subsequentyears. There are probably asmall proportion of claimnumbers that would be'collapsed' if one were tofollow them individually (i.e.injuries that are assigneddifferent claim numbers, butupon review are determinedbe the same), but that wouldhave little effect on thenumbers here. It should also be kept in mind that not all of these are compensableinjuries; these data represent the total of injuries reported to WCB, whether they receivedsome form of compensation, were not followed through by the claimant, or wereadjudicated and rejected by the WCB.The average age of the 1991 injury cohort is 35.6 years. As Figure 2.D shows, and aswould be expected, the majority of injuries take place in the 20s, 30s and 40s . There is nosignificant difference in average age comparing STD/LTD/pension, medical care only and'other' claimants (calculations not shown).50Figure 2.D: Cumulative frequency of age of 1991 injury cohort100908070;: 600~... 500~ 40~3020100.>-:////////'000AgePhysician Services UtilisationMany individuals who report injuries to the WCB also require health care servicesprovided through the BC medical system. It was expected that use of these services,outside what may be compensated by the WCB related to a workplace injury, would notbe significantly greater than a population similar in age and sex who did not report injuriesto the WCB between 1986 and 1997. In order to test this assumption, we defined acohort of people who were enrolled with MSP in 1991, and were matched by sex and ageto the 1991 injury cohort. Subsequent tables and graphs in this section provide acomparison in use between these two groups . All use of MSP, unless otherwise noted,excludes payments to providers made by the WCB. In other words , the trends seen hereshould represent patterns of care for the injury cohort for medical problems that areunrelated to compensable WCB injuuries.51Figure 2.E: Percentage of 1991 injury cohort and cohortmatched by age and sex that visit a GP at least once between1986 and 1995. b . vear7O'l- -j-- - --lilliiit---DI--III-- __- -{l I-- ...-IIIil-~fllI__~'l-~t___I__--mI---st-_III_- _lU_--Gll--IIJ_-Ii!J--i&1> -j- --- - - ----\II-- -,.",-- =-- =---Figure 2.E shows theproportion of the 1991 injurycohort and the matched cohortthat visit GPs during each yearfrom 1986 through 1995.WCB claimants are far morelikely than non-claimants tomake a GP visit in any givenyear. The minimum differenceis about 50%, but is closer to100% in 1991, the injury year.30%1986 1987 .988 1989 1m '99' 1992 1993 1994 1995 The proportion of the injuryI .WCDc........ .Non-WCBdUnon~ I cohort that visit GPs increasesto the injury year (1991), peaks during 1991, and then decreases somewhat, though not toformer levels. In comparison, there is a slow but steady increase in the proportion of thematched cohort who visit GPs during these years, though the number remains lowerthroughout.A similar pattern is seen for visits to specialists, shown in Figure 2.F.70% t-------- - - - -IIlI--"'I:::T- - ------l1991199.199319921991109<l1939191119t7Figure 2.F: Percentage of 1991 injury cohort and cohortmatched by age and sex that visit a specialist at least oncebetween 1986 and 1995. bv vear1-35%30%JS'k HII:I----illlbl----tllr---ilII---6S'l- t-- - - -----IE-- .l-- .....- -III-_.,t--60% +------liJ}--so';(- t-liiil--iI~--;lll---;It----'IIIIIIlI- ilrl- ..t-The trend in these chartssuggests two conclusions.First, that individuals whomake claims to the WCBare more frequent users ofphysician services than thegeneral population.Second, that a smallproportion of individualsappear to permanentlyincrease their use ofphysician services followingmaking an injury claim toweB cl.\umnu • __WCB cl.wnoll. WCB.One difficulty with the latter conclusion, however, is that we know a fair numberof people in the 1991 injury cohort also made claims to the WCB in previous years. As aresult of these injuries, they may have chronic conditions that now require more constantattention from physicians (though if this were the case, one could argue these costs shouldbe borne by the WCB, and thus not appear in these data). Furthermore, the increase in theyears prior to 1991 and the plateau following may be the result of people moving in theprovince. We know that these individuals were resident in BC for at least part of 1991,since that is the year of injury, but we know nothing about their location in the other years.Refuting the former conclusion is not as easy , especially given the degree ofdifference between the claimants and non-claimants.52Continuously enrolled1995199J199Z19911990198919Sa. WCBd........19S7Figure 2.G: Percentage of 'continuously enroUed' 1991 injurycohort that visit a GP at least once between 1986 and 1995, byyear1986g5.~ +---.__-111--90.l>lb+--- - - ----- -111- .---.....-- -gO.l>lb75.0'/1;70.l>lb60.l>lb65.l>lbTo decrease at leastsome of these interpretivedifficulties, we limitedinclusion in both cohorts tothose individuals whovisited either a GP or aspecialist at least onceevery other year. In otherwords, to be included, aperson had to use eitherGP or specialist services in(1986 or 1987) and (1988or 1989) , and so on. Theresults are shown inFigures 2.G and 2.R. Thisdefinition is used throughout the rest of this report, and is referred to as representingpeople who are 'continuously enrolled' in MSP.Figure 2H: Percmtage of 'rontinOOU'ily mroIIed' 1991 injmy cohx1:that that are visita ~iaIN: at Ie$t once between 1986and 1995,byyear~I+_---------_i__- __- -=-- _==_- -0.75+---0.51995._"01_The results do notentirely disprove the idea that1991 serves as a 'transitionalyear' for the injury cohort,though the build-up andplateau are certainlyattenuated. More striking isthe decreased differencebetween the injury cohortand the matched group.WCB claimants are still morelikely to visit GPs in all years,and particularly in 1991, butthere is little differencebetween the two groups forthe use of specialists, exceptin the injury year.There are, perhaps, some basic differences between these groups that mightaccount for the changes seen comparing the first set of graphs to the second. It is notimmediately obvious, however, what these differences might be. Indeed, it is telling toexamine the effect of using the'continuously enrolled' definition on the number ofindividuals included in each group . Out of an original 163,339 WCB claimants, 113,370,53or 69%, met the criteria, compared to 55,392 out of 163,191, or 34%, of the matchedcohort. In fact, only 1,707 (1%) ofWCB claimants have no contact with physicians overthe whole study period, compared to 27,218 (17%) of the non-claimants. The'continuously enrolled' definition may, in fact, be a fairly blunt instrument for picking updifferences between the groups, since it requires at least minimal contact with the formalhealth care system. It is clearly safe to assume that any differences observed will beconservative in their estimates of the true variance between these groups.First claimants 199190 .0%t--- - - - ---- -!lIl!I-- =-----,;:;::;----;;=;;- -1916 1917 1981 19!9 1990 1991 1992 199) 19H 199)Figure 2.1: Percentage of 'continuously enrolled' individualswho make their first WeB claim in 1991 that visit a GP atleast once between 1986 and 1995, b year. Non.we B ob i"""'"c WeB c1aimoulu80 0%75.0%Another difficultyin interpretation (that theWCB claimants makeinjury claims in years otherthan 1991) is avoided byrestricting the cohort topeople whose 1991 claimsrepresents their firstcontact with WCB (first, atleast, since 1986, which isthe first year for which wehave linked WCB data).This restriction limits thecohort size to 68,924individuals. Furtherrestricting to those whomake their first claim in1991 AND are'continuously enrolled'leaves 47,842 individuals .Figures 2.1 and 2.1show patterns of GP andspecialist contact for theseindividuals, by year. Thepatterns of GP and specialistuse are very similar to thoseseen in Figures 2.G and 2.H.1995a Non· \li,'CB cb;:m.¥Ll,IQUI 1957 I9SS 1910 1900 199 1 199 2 199 ) l~o&650%Figure 2,J: Percentage of 'continuously enrolled' 1991 injurycohort that that are visit a specialist at least once between1986 and 1995, by year75 0% +--- -70Q'l,80.0% i-- ---------iKI- ~----,.-----600%550%CostAverage per capita MSP costs for the total 1991 injury cohort and matched cohort, andfor the continuously enrolled individuals in each group, are shown in Figure 2.K. Similarto the pattern seen in the proportion of individuals who visit physicians, there is a greater54difference in average costs comparing the total groups to those restricted to thecontinuously enrolled.Figure 2.K: Total MSP $$ per person for WCB claimants and non-WCBclaimants, all IDs, and continuously enrolled, 1986 to 19965500 ..,------ - - --------- - - - - - - ------- - - - -$45O +-- - - - -------- - - - - - ------- ..- - --II -- -I.-J$400 +-- - ------ - - - - - - ---_.---1.-;11--.-1$350 +-- ------ - - - - - - --.__.......--1$300 +-- - - -S2505200S150$100ssoso1986 1987 1988 1989 1990 199 1 1992 1993 1994 1995WCB - aJIlDs • WCB - continuouslyenrolled 0 Non·clairmnlS -. aJIlDs 0 Non-clairmnlS - continuously enrolled'Acute' and 'revolving door' injuriesThe use of physician services by the WCB injury cohort exhibits patterns that are differentfrom a group matched for age and sex. To more fully explore the potential reasons for thesedifferences, we created two subsets of the injury cohort; one including people with 'acute' injuries ,and one including those with more chronic, or 'revolving door' injuries. For both groups, a subsetof the matched cohort was defined, again based on age and sex characteristics of each group. Theacute and revolving door groups were then further divided into 'high users' , described below, and'first claimants' , as above.The 'acute injury' group was defined as having a 1991 Nature of Injury code (in the short­term disability file) of 100, 160, 170, or 210 (see the table on page 18). The 'revolving door'group are those whose 1991 ICD code (in the short-term disability file) was 724, 846, or 847 ­codes for back strains and sprains. In both cases, it is only the 1991 injury that was used to makethis determination; that is, the 'acute injury' group may include people who have made 'revolvingdoor' claims in other years, and vice versa.'High users' are people who make 12 or more claims to the WCB, based on unique claimnumber, between 1986 and 1997, including one in 1991. No distinction was made based on anyfollow-up to the claim. In other words, claims that are not completed are treated exactly the sameas those that are adjudicated and awarded STD payments or pensions.55Figures 2.L through 2.0 show the proportion of 1991 injury and matched cohorts whovisit GPs and specialists by year. The patterns on these graphs are very similar to each other, andto the graphs seen at the beginning of Part 2 for the entire cohorts.,.",,...,,.,Di"iol "~,·_~o~• .....-.. · ..'U east once, :JY year, 1 1019 Sl- I-I I IFigure 2.M: Percent of the 'Revolving door' injury group anda cohort matched for age and sa, that visit GPsJ b 986 9--,mOi"'_...... • ....... . 111" l'ftJ;. ...a .t.or.-. · _ t..a...lFigure 2.L: Percent of the 'Acute' iojury group and a cohortmatched for age and sex, that visit GPs at least once, by year,1986 to 1995f- f- l- I- l- I- l-I- l-I Ia...o ...... · ..'''"c~.doia-a. . · .- ........ I,w:,..... ...'O .I.iol_ I . _ t...a..IFigure 2.0: Percent of the 'Revolving door' injury group anda cohort matched for age and sa, that visit Specialisl<lt b 1986 1995at east once vveo r '0l- I- f-o•.......1"' 1 lW lFigure 2.N: Percent of the 'Acute' injury group and a cohortmatched for age and sa, that visit SpecialistsJ b 1986 1995at east once v vear 10l- I- l- t- >- l- I-l- I-OIL'Ol '''--I. '' . ...O.--..., ._corao1at. ...... 1" 1.""....Figure 2.P: Avenge MSP $ per person for 'acute injury'group and age and sex matched cohort, by year, 1985-1996•,I-~'",1<",..,...Figure 2.Q: Average MSP $ per person for 'revolving doorinjury' group and age and sex matched cohort,hv " "or. 19 A<;.I0Q6""" j-- - - - - - - - -------- --.r--dl-....+------------...,~i.n_~ . v.a..... ......·~h__-.n_~• • UJLLW.'JLLULaJ...l.J:.a.JJ.J....u..~.u...~.LJ..'UO...L.L~Lll.uLJ.La Von . .. . ""o ._ .~ e ........"' . ...The average cost comparison, which again issimilar to the pattern seen for thecomparison of the whole cohorts, is shownin Figures 2.P and 2.Q.56Acute injury Revolvingdoor4239 38873558 321810132 74705717 4860199419931992o Firsl claim- enne1991Table 2.1: Number of individuals by injury and analysis groupHigh Userscontinuously enrolledFirst claimants in 1991continuously enrolled199019891931. Hlgh users , revolving door1911L986Figure 2.R: Percent of continuously enrolled who visit a GP, High Usersand First Claimants. by 'acute' and 'revolving door' injuries. 1986 to 1995- !-- l- I-- - --I- - - l- f--f- - I-4- 4- .... ~750%700%. H igh ust:n:· ~ltTable 2.1 shows the total number of individuals that fall into each of the more restricted'acute' and 'revolving door'injury groups. High users arefar more likely to becontinuously enrolled than arefirst claimants in 1991. Thisis likely true both because theoperational defmition of highuse (>11 claims) would implyresidence in BC for somelength of time, and because first claimants may be defmed as such because they are new to theprovince (i.e. this is their first claim to the WCB in BC, but not necessarily their first claim to anyWCB).Figure 2.R shows the proportion of continuously enrolled individuals in each analysis (highusers and first claimants) and injury group who visit a GP in each year from 1985 to 1996. Inboth analysis groups, the individuals with acute injuries are always less likely to visit a GP thanare those with 'revolving door' injuries . The difference diminishes somewhat in the injury year(1991), but then re-establishes itself in the years following 1991. In addition, the high users areless likely to visit a GP than are the first claimants group, for both injury groups.The former trend isperhaps what would beexpected, since the revolvingdoor group implies a chronicinjury , which may requiremore frequent physicianattention. But the latter isopposite what might bepredicted, particularly in theyears prior to 1991. It mustbe kept in mind, however,that these percentages reflectvisits to GPs that are notcompensated by the WCBsystem. It is quite possibleeRrs! claim - revo lving dethat the high user group --perhaps because of the fact that they are 'known to' the WCB system -- have a greater proportionof their physician care paid for through the WCB .However, it does remain a bit puzzling that the revolving door and acute groups wouldshow the differences they do among the first claimants even prior to 1991. These are allcontinuously enrolled individuals, so we can safely assume they were resident in BC between 1986and 1997, and we know that their first claim to the WCB was in 1991. Therefore, there is no(WCB-related) reason to believe that their patterns of physician contact should be different prior totheir first injury. The fact that they are suggests there might be some differences between theseindividuals in their propensity for injury , though an earlier injury either in Be or in anotherjurisdiction can not be ruled out.57r-• High users - Acuter- • High users - Revolving doorD 1st claimants . Acuter- [J Ist claimants - Revolving doort-- t--I-- I--4 c.. 4Figure 2.T: Mean total MSP $$ for high user' and 'first WeB claim in 1991'groups, by 'acute' and 'revolving door' injuries. 1986 to 1995Figure 2.S: Percent of continuously enrolled who visit a Specialist. HighUsers and First Claimants, by 'acute' and 'revolving door' injuries,1986 to 1995f-- f--- f--- f---f-- f-- f----- r- r- r- r-f-- f-- f-----4- 4- 4- 4- '+ 4- 4- '+ 4- YI..,'9001'995CFU"S[ claim- revolvingde,...IWl'90 3'902'09'CFlJ'lil claim- acute190'1990,.'"19~'9"'981.High users - revolving door'9 1111987198619~900'*850%800%550%600%500%.High usera- ac:ule$800$500$400$700saoo$300$100~ 750%:e! 700%II'650%Figure 2.S shows thesame information, except thistime for visits to specialistsrather than to GPs. Muchthe same pattern emergeshere, with the revolving doorinjury groups more likely tovisit a specialist than theiracute injury counterparts, andthe first claimants more likelyto visit a specialist than highusers (within the same injurygroup). The proportion whovisit specialists is, as wouldbe expected, lower than thatfor GPs, but is higher thanmight be expected for the population overall.Finally, figure 2.Tshows the average total dollarsof payments made to GPs andspecialists combined on behalfof these individuals. Again, the$600pattern is the same as seen forthe proportion who make visitsto a physician; the revolvingdoor group has a higheraverage cost than the acutegroup, and the first claimants a(slightly) higher average costthan the high users.Medical AidThe previous discussion of physician payments is, of course, limited to those paymentsmade in addition to any medical care payments made to physicians by the WCB. Table2.2 shows total number, total people and total amount of medical aid payments made bythe WCB on behalf of the 1991 injury cohort, for 1991 injury claims, from 1991 through1996. These numbers include payments to physicians, clinics/hospitals, and alternativeproviders.58Table 2.2: Medical Aid payments for 1991 cohort related to 1991 injuries#of # # #ofMD $$ ofMD #of $$ of other MD MD$$/ Total $$/people rec'ving rec'ving payments pymts Other pymts pymts/ person personMD svcs other pymts personsvcs1991 117,147 108,449 69,963 345,281 16,001,788 138,460 17,117,721 3.2 $147.55 $282.721992 16,813 14,128 10,042 103,929 8,367,321 36,544 7,979,787 7.4 $592.25 $972.291993 4,379 3,142 2,692 26,910 1,670,039 9,863 2,754,580 8.6 $531.52 $1,010.421994 3,032 1,785 2,065 13,679 791,843 6,992 1,658,367 7.7 $443.61 $808.121995 2,281 1,276 1,549 9,650 903,198 5,109 915,931 7.6 $707.84 $797.511996 1,603 928 1042 6,436 652,040 3,071 766,859 6.9 $702.63 $885.15Missing from Table 2.2, however, are the medical claims paid on behalf of thiscohort for WCB claims made in years other than 1991. Figure 2.A indicated that theseclaims are significant; Table 2.3 shows total number of payments, number of people, totalamount of payments, and average payment per person for ALL claims paid by WCB forthe 1991 injury cohort (Table 2.2 is thus a subset of Table 2.3).Table 2.3: Total Medical Aid payments for 1991cohort#of # # #ofMD $$ ofMD #of $$ of other MD MD$$/ Total $$/people rec'ving rec'ving payments pymts Other pymts pymts person personMDsvcs other pymts /svcs person1986 21,306 20,577 6,529 60,951 2,706,956 14,224 1,995,791 3.0 $131.55 $220.721987 25,160 24,123 8,686 75,098 4,134,550 20,132 3,018,757 3.1 $171.39 $284.311988 30,341 28,371 19,821 91,593 4,999,442 40,298 4,490,227 3.2 $176.22 $312.771989 34,719 32,724 20,690 104,682 5,359,890 42,346 4,601,629 3.2 $163.79 $286.921990 39,203 36,811 24,710 119,075 6,146,501 53,959 5,615,905 3.2 $166.97 $300.041991 118,883 110,227 71,561 362,848 17,566,125 146,853 18,395,900 3.3 $159.36 $302.501992 47,991 43,827 27,557 277,324 15,166,749 82,535 13,401,864 6.3 $346.06 $595.291993 36,248 33,763 19,000 214,676 10,272,483 59,104 10,417,808 6.4 $304.25 $570.801994 33,066 30,707 16,931 202,238 8,326,450 55,297 11,826,064 6.6 $271.16 $609.461995 33,307 31,192 14,996 204,588 10,581,183 41,564 9,127,286 6.6 $339.23 $591.721996 30,462 28,903 13,220 196,748 9,947,388 37,702 8,120,001 6.8 $344.16 $593.1159Total cost ofphysician services0000~Figure 2.D: Total expenditures on physician servicesfor individuals in the 1991 WeB injury cohortI. WCB pyml5 _ 1-lEI MSP pymtsl- I- f-l- I- l- f--f- l- I- f-f- 1- - ~ !- - -f- f- f- - c- '-- -!- l- I-- - - - - - ~ :-'--- l- I-- - - - - - - -~ l- I-- I-- I-- - I-- I-- - -'-+- '-+- Y- Y- Y- -+- -l$0S400$500$450$300$250$350$200$150$100$50Figure 2.Dcombines physicianpayments made by MSPand by WCB to create totalphysician payments madeon behalf of the 1991 injurycohort. Expenditures percapita for the generalpopulation (aged 15-64)are included for two yearsfor which data areavailable. Of note is that inthe earlier year, totalexpenditures for the 1991injury cohort fall belowthese population averages, but in the later year, they are above , and well above includingthe WCB payments to physicians. All $$ in this figure are adjusted to a 1988 base year,and so can be compared across the years.Hospital UseFigure 2.v: Percentage of 1991 injury cohort that useshospital services (inpatient or day surgery) in Be, by yearHospital use byyear of admission for the1991 injury cohort isshown in Figure 2.V. Thepattern for overall hospitaluse is similar to the oneseen for use of MSPservices; the differencehere is that the 'peak' inuse of hospital servicesactually occurs in 1992,although the differencebetween 1991 and 1992 issmall.14.0%12,0%10.0%8.0%60%40%20%0.0%86 87 88 89 90 9 1 92 93 94 95The trend in acute care services can probably be explained with reference to thetrend in use of these services in the overall population. Since 1985/86 there has been ageneral decrease in the use of acute care, and among this cohort there is a slight declinebetween 1986 and 1990. The sharp increase in 1991 corresponds to the injury year, andthus is as expected. The decrease after 1991 is more difficult to interpret; it should beexpected that hospital use by this cohort would decline over time. Their use in 1995,however, is approximately equal to the level in 1990, while the acute care use overall60o wc a.MoHo Sc:If,I"'Y1lIO<b<r-L.,19'Jl1994'- ­199)1991--Figure 2.W: Percent distribution of responsibility forpayment for hospital use by the 1991 injury cohort-'-- ~ '-+- - '-- -1916 1987 lOsS 1989 1990 19910')90%1<)'1.100'lcontinued to fall over this period. This implies that acute care use in 1995 among thiscohort is higher, relative to the general population, than it was in 1990Not all of thesehospital services are theresponsibility of the WCB.Figure 2.W, in fact, showsthat the majority of hospitaluse, even in the injury year,is paid for by the BCMinistry of Health. Thereare a very small number ofhospital stays that are paidfor either by the individual('self-pay') or by otheragencies ('Other' - e.g. thefederal government).Hospital use compared to the matched cohortTo"" · weB C T. "" . ""'ellcd • O,y>U'i ' \\'C8 . 0'1""I ' ""'<hod C top"tk nt . we B C !Jlp>tk .. • ""'ell'IS9 49J'I,.9Figure 2.X: Percentage of 1991 injury cohort and matched, non-WCBcohort that use hospital services (inpatient or day surgery) in BC, by year'-- I- -- i- f-- - -I- f-8.0%0.0%6.0%10.0%12.0%14.0%Individuals who make WCB claims are approximately twice as likely to have a hospitalseparation compared to anon-claimant cohortmatched for age and sex(Figure 2.x). This is trueeven before the index injuryyear of 1991, though thedifference does increase in1991. The proportionatedifference between the twogroups is larger for daysurgery than it is forinpatient hospital care. Theuse of day surgery increasesfor both the WCB and non­WCB groups between 1986and 1995, which isconsistent with overalltrends in hospital use.Many of the people in the WCB 1991 injury cohort are known to have made claims inyears prior to 1991, which might explain part of the difference in the use of hospital servicesbetween these groups. Table 2.Y eliminates this by restricting the WCB group to those who maketheir first claim in 1991 (based on claims history from 1986 to 1997). The matched cohort isexactly the same. The exclusion ofpre-1991 claimants does, indeed, reduce the difference in use,61Figure2.Y: Percentage of 1991 first claimants and matched. non-WCBcohort that use hospital services (inpatient or day surgery) in BC. by year14.0% 112.0% +---- -- - - - ---__- ----11---._-......- -=:---10.0'10 +---------=--_8_---11:..--11--.._-....- --11- -8.090 +.----1f---lI---.._-....- --II----::::-iI-=- - ....- --II--but only slightly. The WeBgroup remains far more likelyto be admitted to hospital foreither day surgery or inpatientcare -- and again, thisdifference exists even prior tothe 1991 injury claim.86 81a ToU) · hJcll inunts CTouf . IN~t'h:d 8 0 1Y:PrB . lszcWmals, . OI)'N' g . nulth:d C lnpI · l st cb imnlS IJInp "lN lchPharmacareThe BC linked health data set (BCLHD) currently includes pharmaceutical useinformation only for people aged 65 and over. Tables 2.4 and 2.5 show the number ofindividuals in the 1991 injury cohort who are 65 and over during each year of the study,the number of this group that receive at least one payment for medication through thePharmacare program, and the average number of payments per person, per year. Table 2.4includes the whole 1991 injury cohort, and Table 2.5 restricts the cohort to those whowere 'continuously enrolled', or 'continuous residents of BC' , as defined above.Table 2.4: Pharmacare use by the 1991 injury cohort# with % with at Average# of cohort Pharmacar least one # of Rx /65+ e A use Rx prescriptions person1985 676 492 72.8% 6182 12.61986 781 572 73.2% 7540 13.21987 901 683 75.8% 7801 11.41988 1032 779 75.5% 8531 11.01989 1184 892 75.3% 9621 10.81990 1371 1077 78.6% 12833 11.91991 1720 1361 79.1% 16350 12.01992 2148 1634 76.1% 19282 11.81993 2821 2066 73.2% 24371 11.81994 3678 2672 72.6% 30587 11.41995 4072 3040 74.7% 38796 12.862Table 2.5: Pharmacare use by the 1991 injury cohortrestricted to people who were 'continuously enrolled' with MSP# with % with at Average# of cohort Pharmacar least one # of Rx/65+ e A use Rx prescriptions person1985 563 412 73.2% 5029 12.21986 651 484 74.3% 6165 12.71987 749 583 77.8% 6473 ILl1988 867 671 77.4% 7068 10.51989 994 769 77.4% 8090 10.51990 1146 936 81.7% 10684 11.41991 1453 1177 81.0% 13507 11.51992 1829 1465 80.1% 16716 11.41993 2417 1925 79.6% 22976 11.91994 3184 2554 80.2% 29689 11.61995 3525 2907 82.5% 37635 12.9Income Assistance .We have linked approximately three-quarters of the Income Assistance (IA) file,which includes all applicants to and recipients of IA benefits - applicants and theirdependents - between October of 1990 and March 1998. This amounts to 1,226,466individuals who were over the age of 18 in 1997. Of these, approximately 25% also makea WCB claim at some point between 1986 and 1996. Among the 163,338 individuals inthe 1991 injury cohort, 54,552, or 33%, apply for IA sometime between 1990 and 1998.Figure 2.Z shows the distribution of birth year in the Income Assistance file. Thepurpose for including this information is to emphasise that because of less than completelinkage rates, the numbers we report subsequently about the use of IA by WCB claimantswill be understated. It is difficult to state to what degree this is occurring, because theunlinked records are not evenly distributed across the age groups, but we know that someadditional number of WCB claimants do make application to IA.63Figure 2.Z : Distribution of birth yea r in the Income Assistance file• • G - - Linked file-+-- Whole file (unlinked)- .. - IA applicants who are also WCBclaimants- ...- IA applicatns who are also in theWCB 1991 injury cohort.f!<' ai ' ~J~ .Ii .D Cl•.•• • p . . . . .•• c .C DC C. - - - - 'Ft ' .s ~. . . .. . . . . . . . . . . . . . . . .. -dJ0 q ~ .. . . .. . . . .. . . . . . ... ..diP·'" ..//'~""'\ .. ~/. '~ ....b!l3tJ{i. . ~" ' . . . .#/ \ . . . . . . . . . . \ .. ~ .. ..........-_oo,o"""'~ ...3000045000400005000350001500010000~~~ 25000......ei 20000=ZBirth yearKeeping this in mind, Table 2.6 disaggregates the WCB 1991 injury cohort by' type' of claimant (medical care only , short-term disability, long-term disability/pension,and other) and 'application status ' for IA benefits. Because of the years of data available,the information on this table relates to payments made either just before or after the 1991Injury.About 30% of WCB claimants who make application for IA are not grantedbenefits. Though the differences are relatively small, individuals in the short-termdisability group are least likely to apply for IA (62.9% of the total) , but are most likely toreceive benefits (26.5% of the total group , or 71% of the applicants).Table 2.6: Individuals in the WeB 1991 injury cohort who apply for Income Assistancebenefits between October 1990 and February 1997Application to IA - no Application to IA -No application to IA benefits benefits rec'vd Totalrow % col % row % col % row % col %Medical care only 41075 69.1% 37.8% 5561 9.4% 34.7% 12777 21.5% 33.2% 59413STD 42876 62.9% 39.4% 7265 10.7% 45.3% 18058 26.5% 46.9% 68199LTD/Pension 2841 70.5% 2.6% 358 8.9% 2.2% 833 20.7% 2.2% 4032Other 21994 69.4% 20.2% 2852 9.0% 17.8% 6848 21.6% 17.8% 31694Total 108786 16036 38516 16333864Table 2.8: Income Assistance data for WeBclaimants in the 1991 injury cohort#of pymts/YEAR # ofindivs payments indiv total $$ $$/ indiv91 18117 95450 5.3 54,709,191 $3,02092 20272 111631 5.5 69,751,315 $3,44193 21213 131604 6.2 87,121,308 $4,10794 20387 135626 6.7 93,531,968 $4,58895 19196 138768 7.2 95,997,673 $5,00196 16885 126612 7.5 82,647,390 $4,89597 13764 106722 7.8 65,911,796 $4,789Table 2.7: Year of IA benefit by 'type' ofWCB claimant forindividuals in the 1991 injury cohortYEA); Medical care only L TD/STD/pensions Other Total91 5863 32.4% 9024 49.8% 3230 17.8% 1811792 6682 33.0% 10004 49.3% 3586 17.7% 2027293 6905 32.6% 10552 49.7% 3756 17.7% 2121394 6606 32.4% 10079 49.4% 3702 18.2% 2038795 6282 32.7% 9422 49.1% 3492 18.2% 1919696 5569 33.0% 8276 49.0% 3040 18.0% 1688597 4576 33.2% 6751 49.0% 2437 17.7% 1376498 3018 33.0% 4494 49.1% 1646 18.0% 9158Table 2.7 thendisaggregates theIA recipientsfurther to identifythe year of benefitby the 'type ' ofWCB claimant.The total columnis the number ofindividuals fromthe 1991 injurycohort who receive benefits in any given year; the denominator for this number is 38,516(from Table 2.5). The 'peak ' number actually occurs in 1993, which may be due either toa lag between the work-related injury and the need for benefits, or to the incidence ofadditional injuries in subsequent years. There is no trend in the proportion of beneficiariesby claimant type.Table 2.8 shows the yearly number of individuals, payments, and cost to IncomeAssistance for the 1991 injury cohort (1990 and 1998 are partial years, and so have beenexcluded). The number of payments should roughly equal the (average) number ofmonths of receipt of IAbenefits. This numberincreases after 1991,suggesting that there isat least a small group ofWCB claimants whobecome relativelydependent on IA. Thetotal amount of IAdollars for this group is$577,138,833.Tables 2.9,2.10 and 2.11 repeat the above information, restricting the cohort toindividuals who make their first WCB claim in 1991, and make application for IncomeAssistance. Table 2.12 shows total payments and $$ for all individuals who, over ourstudy period, make claims to both WCB and IA. Restriction to this subset of WCBapplicants has very little effect on the distribution of individuals on these tables.65Table 2.9: Individuals with first reported WCB injury in 1991 who apply for Income Assistancebenefits between October 1990 and February 1997Application to IA - no Application to IA -No application to IA benefits benefits rec'vd Totalrow % col % row % col % row % col %Medical care only 17568 67.9% 38.7% 2362 9.1% 36.4% 5931 22.9% 34.7% 25861STD 15397 60.9% 33.9% 2594 10.3% 40.0% 7277 28.8% 42.6% 25268LTD/Pension 1183 73.3% 2.6% 125 7.7% 1.9% 307 19.0% 1.8% 1615Other 11219 69.3% 24.7% 1401 8.7% 21.6% 3560 22.0% 20.8% 16180Total 45367 6482 17075 68924Table 2.10: Year of IA benefit by 'type' of WCB claimant forindividuals who make their first WCB claim in 1991Year Medical care onlv LTD/STD/pensions Other Total90 1518 33.4% 2077 45.7% 947 20.8% 454291 2763 33.4% 3806 46.0% 1700 20.6% 826992 3123 34.1% 4153 45.4% 1880 20.5% 915693 3202 33.8% 4344 45.8% 1938 20.4% 948494 3097 33.6% 4169 45.3% 1946 21.1% 921295 2973 34.1% 3908 44.8% 1843 21.1% 872496 2595 34.1% 3408 44.8% 1596 21.0% 759997 2138 35.0% 2727 44.6% 1243 20.4% 6108Table 2.11: Income Assistance data for WeBclaimants who report their first injury in 1991#of pymts/YEAR # ofindivs payments indiv total $$ $$/ indiv91 8269 47848 5.8 26,858,190 $3.24892 9156 53913 5.9 32,777,155 $3.58093 9484 62705 6.6 40,625,067 $4.28494 9212 64717 7.0 43,803.804 $4,75595 8724 65873 7.6 44,799,201 $5,13596 7599 58596 7.7 37,561,665 $4,94397 6108 48523 7.9 29,477,108 $4,82666Table 2.13: Income Assistance recipients (1991 and afterby sex, marital status, and presence of childrenSinWe MarriedNo kids Kids No kids KidsMale 15769 1949 2853 8191Female 3271 2463 803 1566TOTAL 19040 4412 3656 9757Single MarriedNo kids Kids No kids KidsMale 42.8% 5.3% 7.7% 22.2%Female 8.9% 6.7% 2.2% 4.2%TOTAL 51.6% 12.0% 9.9% 26.5%Table 2.12: Income Assistance data for WeB claimantsALL YEARS# of pymts/pYEAR # of people payments erson $$ $$/person91 92513 555308 6.0 331,058,296 $3,57992 103892 660688 6.4 420,641,953 $4,04993 110769 737829 6.7 489.765,626 $4,42294 109249 757324 6.9 517,817,966 $4.74095 104854 771389 7.4 528.819.141 $5.04396 91453 694162 7.6 447.068.088 $4.88997 74225 578367 7.8 354,121,961 $4.771Family composition offA applicantsWe were able to identify family composition only for applicants who received benefits. asfamily status is recorded on our IA data only in relation to payments made. The number ofchildren was not calculated. but wasrecorded only as a 'yes' or 'no '.The sex displayed on Tables2.13 and 2.14 reflects the sex of theWeB applicant. For both groups -- allapplicants. and those who were firstclaimants in 1991 -- single malesaccount for more than 40% of the total.Single females are slightly morepredominant in the first claimant groupcompared to the overall group (12.4%vs. 8.9%, respectively) and marriedpeople (male or female) with kids areslightly less predominant (23.5% vs.26.5%).In comparison, Table 2.15 describes the family composition of the WeB cohortwho receive IA benefits in 1989 and prior'. This table outlines the marital status andpresence or absence of kids at the latest date for which payments from IA were made. Atotal of 54,552 individuals in the 1991 injury cohort receive IA benefits at some pointbetween 1980 and 1996. Of these, 38,516 receive benefits in October 1990 or after, and32,346 receive benefits between January 1980 and December 1989. Beneficiaries aremore likely to be single and to have kids in the prior period compared to the post-1990period (Tables 2.8 and 2.10) .I The data available to us included benefits paid to people between 1980 and 1989 whowere applicants between October 1990 and March 1998. In other words, this is not acomplete picture of IA recipients in 1980 to 1989. and thus the two time periodsshould be compared with caution.67Table 2.16: Income Assistance recipients (1991 and afteby sex, marital status, and presence of childrenSingle MarriedNo kids Kids No kids KidsMale 11179 68 1199 1Female 2755 32 917 0TOTAL 13934 100 2116 1Single MarriedNo kids Kids No kids KidsMale 69.2% 0.4% 7.4% 0.0%Female 17.1% 0.2% 5.7% 0.0%TOTAL 86.3% 0.6% 13.1% 0.0%Table 2.14: Income Assistance recipients (1991 and afterby sex, marital status, and presence of childrenFirst time WeB applicants in 1991Single MarriedNo kids Kids No kids KidsMale 6521 651 1079 2697Female 1995 1499 526 1083TOTAL 8516 2150 1605 3780Sine)e MarriedNo kids Kids No kids KidsMale 40.6% 4.1% 6.7% 16.8%Female 12.4% 9.3% 3.3% 6.7%TOTAL 53.1% 13.4% 10.0% 23.5%Table 2.15: Income Assistance recipients (1980 - 1989)by sex. marital status, and presence of childrenNo kids KidsSin2le 20625 5550Married 1743 5699TOTAL 22368 11249No kids KidsSinzle 61.4% 16.5%Married 5.2% 17.0%TOTAL 66.5% 33.5%Family composition ofthe 'matched' cohort that receive IA benefitsJust under 10% of the age- and sex-matched cohort receive IA benefits in theperiod 1991-1997, compared to 23% of the WCB 1991 injury cohort (Table 2.13). Thefamily composition of this group ofbeneficiaries is outlined in Table2.16. When compared to Table2.13, this suggests the matched IArecipients are far more likely to besingle without kids, and far lesslikely to be married with kids, thanare the WCB applicants.A similar comparison can bemade for recipients of IncomeAssistance in the years 1980 to1989 comparing Tables 2.15 and2.17. In this earlier period, which68Table 2.17: Income Assistance recipients (1989 and prkby sex, marital status, and presence of childrenNo kids KidsSingle 11538 2640Married 988 2552TOTAL 12526 5192INo kids KidsSingle 65.1% 14.9%Married 5.6% 14.4%TOTAL 70.7% 29.3%year in 1991.69represents the time prior to the 1991index injury for the WCB cohort, thepatterns of family composition are farmore similar. The proportions ofeach cohort that receive benefits,however, remain quite different; 21%of the WCB applicants, compared to11% of the matched cohort. Thusthe WCB injury group and thematched cohort appear to bedifferent with respect to their use ofIA, even prior to the index injury

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