Risk persists more than 10 years after injury: Study
People who are permanently impaired by work-related injuries face a higher risk of early death, according to a study from the Institute for Work & Health (IWH) in Toronto.
This risk persists more than 10 years after the injury itself takes place and the highest jump in mortality risks is faced by workers who are permanently impaired following an injury early in their career.
"There is a slightly elevated risk of premature mortality among the group of Ontario workers who were awarded a permanent impairment," said IWH president Cameron Mustard.
Between 18 and 28 per cent of serious injuries experienced by adults in Canada occur at work, according to the institute. One in every 10 individuals who report a work-related injury will experience some degree of permanent impairment.
"Long-term mortality risk in individuals with permanent work-related impairment," published in the Canadian Journal of Public Health, was led by IWH associate scientist Heath Scott-Marshall, who linked data from Statistics Canada with data from the Workplace Safety and Insurance Board in Ontario to determine the long-term mortality risk in individuals with permanent impairment.
The study examined 19,000 Ontarians with permanent impairment resulting from a work-related injury over a period of 19 years. Each individual in the sample was paired with as many as 10 people who did not experience a work injury but shared similar characteristics such as age, sex and income level.
The overall rate of death for men with permanent impairments was 14 per cent compared to nine per cent in the non-injured control group. The overall rate of death for women with permanent impairment was six per cent compared to four per cent in the non-injured control group. This represents a 55 per cent and 50 per cent higher risk of mortality, respectively.
For both men and women, a work-related injury causing permanent impairment at a young age (25 to 29) resulted in a higher likelihood of early death.
Many would find it surprising that youth has a negative impact on the risk of premature mortality, said John Illingworth, a partner at Gowling Lafleur Henderson’s employment and labour group in Kitchener, Ont.
"What that suggests to me is that there is a significant mental health component to the return to work that we are only beginning to explore," Illingworth said. "Studies like this would suggest that we need to pay closer attention to the impact of a significant work-related injury on a worker’s mental health as well as their physical well-being."
The care for workers’ physical well-being following a work-related injury is fairly standardized across Canada, he said. Employers are governed by respective workers’ compensation regimes and are required to co-operate in the worker’s early and safe return to work following an injury.
"What that generally means is that employers have an obligation to return workers as quickly as possible to a job position that is safe for them to perform," Illingworth said. "That can be their original job with accommodation or it could be some other form of modified work, depending on what’s considered the appropriate return-to-work plan in the circumstances. Employers who handle these situations best tend to approach them on a case-to-case basis.
Additionally, employers have a concurrent obligation to accommodate disabled workers pursuant to human rights legislation. The legal obligation is to accommodate to the point of undue hardship.
When it comes to addressing mental health using a similarly standardized method, Illingworth said, there’s a lot of work to be done. He pointed to the precedent-setting Supreme Court of Canada ruling Wallace v. United Grain Growers Ltd. (1997).
The ruling underscored the importance society attaches to employment, saying, "A person’s employment is an essential component of his or her sense of identity, self-worth and emotional well-being… Thus, for most people, work is one of the defining features of their lives. Accordingly, any change in a person’s employment status is bound to have far-reaching repercussions."
Mustard concurred that permanent impairment has far-reaching consequences, affecting workers’ lives in a multitude of ways.
"Regardless of the cause of the impairment — whether it’s work-related or not work-related, whether it’s congenital or acquired — it is the case in this country and in most countries that the life span of people with a disability or impairment is shorter than the lifespan of people without it," he said .
And while the IWH study did not specifically investigate why permanent impairment leads to a greater risk of early mortality, Mustard said it is possible to speculate.
In some cases the injury itself — for example, a severe crush injury or the loss of a limb — can in and of itself result in a shortened lifespan. But, for the most part, Mustard said, it is the way permanent impairment prevents many employees from fully returning to work that increases risk.
Some workers struggle with chronic pain, which precludes them from returning to their previous jobs. Others suffer from a residual loss of function — in mobility, dexterity or sensory function — that prevents them from performing tasks necessary in their old employment. Many workers with visible impairments are passed over for positions because of deeply ingrained stereotypes or prejudices, Mustard said.
All of these barriers to re-employment can lead to prolonged periods of low income and even poverty, which can play a significant role in premature mortality.
"People who are, very often, very committed to going back to work just can’t succeed in the workplace as well as they could before," Mustard said.
The IWH study concluded more research is necessary to better understand work disability as well as psycho-social health and well-being and their contribution to premature mortality.
