Urban-rural differences in work disability duration

Where workers live can play an important role in predicting how long they will remain off work after a job-related injury. Despite universal health coverage in Canada, previous research has shown an urban-rural inequity in access to health care—an important factor in return to work. Several studies have examined urban-rural differences in work disability outcomes. However, they have not explored variations across different types of urban and rural settings—e.g. large cities, small towns, rural communities near urban centres, remote rural areas, etc.—or across various industries. By drawing on workers’ compensation data across several provinces, this study set out to do so.

The study drew on compensation claims data from six provinces: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and New Brunswick. The research team focused on non-fatal, work-related injuries and musculoskeletal disorders that took place between 2011 and 2015 and resulted in at least one day of compensated lost time. The analysis focused on the cumulative number of paid disability days within one year of the injury. (For example, over a year, a claimant who receives wage replacement benefits for three weeks, then none for a period of vocational rehabilitation, then another two weeks of benefits would be counted as having five weeks of disability days.)

Claimants were sorted into six different types of geographical settings: large cities, small cities, and rural areas of strong, moderate, weak or no metropolitan influence. This category of metropolitan influence, used by Statistics Canada, is based on the percentage of working residents who commute to a larger centre for work. In areas of strong influence, at least 30 per cent of the labour force commutes; in areas of weak influence, between one and five per cent of the labour force does so.        

Drawing on claims data, the team also took into consideration claimants’ age, sex, occupation, type of injury, industry and size of employer, among many other factors. The team also examined how patterns of urban-rural differences changed as the duration of disability lengthened.  

In general, people who live in more remote areas have more disability days following a work-related injury than people who live in large cities. However, no simple relationship was found between remoteness from urban centres and work disability duration. Disability days are highest in the most remote rural areas where no one commutes to an urban centre, but they are second highest in rural areas where high proportions of workers (30 per cent or more) commute. These are followed by rural areas with smaller proportions of commuters.

The urban-rural differences were more pronounced in some sectors (e.g. construction and transportation/warehousing) and less so in others (e.g. manufacturing and health care/social assistance). Moreover, urban-rural differences were most pronounced among claimants with long durations of disability (the top 15 per cent of disability durations).

Most of the study findings are consistent with previous research that found rural residents have longer work disability durations than their urban counterparts. However, the finding that, among rural residents, disability duration is second longest (and not the shortest, as one might expect) for those in areas with high proportions of commuters is notable. That may be due to a combination of work characteristics, commuting behaviour and modified work availability. Higher proportions of people in these areas work in construction, trades, transport and equipment operator jobs. Commuting to jobs in the cities, these workers may have greater access to modified work, but the long commute time may undermine the effectiveness of returning to work via modified duties. 

Another key contribution of this study is its ability to show that urban-rural differences in work disability vary by industry. Geographical variations in the nature of work and the size and location of employers may provide some explanation to the findings. In general, workplaces in the manufacturing and health care/social assistance sectors tend to be large facilities. In contrast, the construction sector is characterized by small employers operating at different locations; challenges in providing modified work in this industry can vary greatly between urban and rural areas. 

A strength of this study is its span across many provinces and its ability to examine urban-rural differences across industry sectors. Another is its use of a methodology that goes beyond a simple urban-rural dichotomy. A limitation of this study is its reliance on the cumulative number of paid disability days as an outcome; this measure does not capture days when workers were off work while receiving long-term disability benefits or taking part in vocational rehabilitation. Another limitation is its inability to track workers who moved residences during their disability leave. In addition, any estimates of commuting patterns based on workers’ residential and employers’ postal codes would not necessarily be a true representation of their commuting behaviour.