Racial and ethnic inequities in the return-to-work process

Key messages

Strong evidence indicates that, following a non-work-related injury or illness, non-white workers are less likely to return to work than white workers.

Moderate evidence indicates that Black workers face particularly pronounced obstacles to returning to work.

Limited information is available on the experiences of those with work-related injuries.

The racial inequities found in the review indicate a need for strategies that address racism in the return-to-work process.

There is limited evidence on other aspects of the return-to-work process such as access to workers’ compensation and income support, accommodation planning and stay-at-work. This suggests the need for enhanced data collection on race and ethnicity in the disability management field.

Published: July 2023

Research has shown that workers of colour face more frequent, severe and disabling work-related or non-work-related injuries and illnesses when compared to white workers. Studies show that non-white workers are disproportionately employed in jobs with high physical and psychological demands, hazardous working conditions, and limited regulatory and labour protections when compared to white workers.

Despite the disproportionate burden of injury and illness among non-white workers, it is unclear how race and ethnicity impact the process of returning to work after an injury or illness. The return-to-work (RTW) process, which involves multiple parties, includes injury reports, medical services and workers’ compensation benefits, rehabilitation services, accommodation plans, and work re-integration and stay-at-work services. The potential exists for structural and interpersonal racism to operate throughout this process, which may contribute to different outcomes between white and non-white workers–i.e., racial inequities.

Are there racial and ethnic inequities in the return-to-work process of workers with a work-related or non-work-related injury or illness?

How was the study conducted?

The systematic review team consisted of seven researchers from IWH and the University of Toronto. The team searched eight academic databases for studies published between January 2001 and April 2021. The decision to focus on articles published after 2000 was made to reflect growing research into the impact of racial and ethnic inequities on the health of the working population. The team searched for primary, quantitative research articles that examined the working population within high-income countries with a work-related or non-work-related injury or illness. Articles also had to include non-white workers as the population of interest and white workers as a comparison group. Studies that examined any outcome of the return-to-work process were eligible for inclusion.

The team identified a total of 15,289 articles, and after screening the articles for their relevance to the research question and their quality, the team narrowed it down to ten high quality and nine medium quality studies.

Sixteen studies were conducted in the United States, one was conducted in the United Kingdom, and two were conducted in Israel. Fifteen studies focused on workers with non-work-related injuries or illnesses including three on spine injury, three on cancer, two on limb trauma, two on burn injury and two on stroke. Of the other four studies on workers who sustained work-related injuries or illnesses, three focused on low back pain and one examined a wide-ranging group of workers’ compensation claimants.

In 15 studies, white workers were the comparison group. Thirteen studies included Black, Black non-Hispanic or African American samples. Eight studies included samples who were categorized as non-white. Eight studies included Latinx participants.

 

Table 1: Level of evidence
Level of evidence Minimum quality and quantity* Consistency Strength of message
Strong 3 high quality (H) studies 3 H studies agree; IF more than 3 studies, 3/4 of the H and M studies agree Recommendations
Moderate 2 H studies OR 2 medium quality (M) studies and 1 H study 2 H studies agree OR 2 M studies and 1 H study agree; IF more than 3 studies, more than 2/3 of the M and H studies agree Practice consideration
Limited 1 H study OR 2 M studies OR 1 M and 1 H study 1 H (if only one study); OR 2 M studies; OR 1 M and 1 H study; IF there are more than 2 studies, at least 1/2 of the M and H studies agree Not enough evidence to make recommendation or practice consideration 
Mixed 2 H and/or M studies Findings are contradictory Not enough evidence to make recommendation or practice consideration
Insufficient No H studies OR M studies do not meet criteria above   Not enough evidence to make recommendation or practice consideration
* High quality studies scored >85% in the assessment of their quality; medium quality studies scored 50-85%      

What were the main findings?

In general, studies showed that non-white worker groups reported more adverse return-to-work outcomes following an injury or illness when compared to white majority workers.

The review found strong evidence that:

  • non-white or ethnic minority workers are less likely to report returning to work following a non-occupational injury or illness and will benefit from specific policy and programmatic attention

The review found moderate evidence that:

  • Black workers may face obstacles to returning to work following non-occupational injury or illness and could benefit from policy and programmatic attention

The review found limited evidence about:

  • returning to paid employment following a non-occupational injury or illness (Latinx workers)
  • enrollment in RTW programming or employment services

The review found mixed evidence about:

  • receipt of social security or disability benefits following occupational injury or illness

The review found insufficient evidence about:

  • claim duration following occupational injury or illness
  • total workers’ compensation claim ($) following occupational injury or illness
  • financial struggle following occupational illness
  • total missed workdays following non-occupational injury or illness
  • RTW following occupational injury or illness
  • starting and completing trial work periods following non-occupational injury or illness
  • total work hours following non-occupational injury or illness

What do these findings mean?

This systematic review is the first of its kind to synthesize evidence concerning the impact of racial and ethnic inequities on the return-to-work process. There was strong evidence that non-white workers are less likely than white workers to return to work following a non-work-related injury or illness. There was also moderate evidence that Black workers may face particularly pronounced barriers to returning to work following a non-work-related injury or illness. These findings indicate the necessity of strategies and policies to address the obstacles that non-white workers face in the process of reintegrating into the labour market following an injury or illness. One such suggestion is to adopt an anti-racist approach to work disability management, which involves implementing educational and policy-level strategies that identify and eliminate racial inequities across the return-to-work process.

There is limited information on the experiences of those with work-related injuries, as well as broader return-to-work outcomes including health-care utilization, access to workers’ compensation and income support, accommodation planning and stay-at-work. This lack of information underscores the importance of enhancing the measurement and examination of race and ethnicity as it relates to this process. It is recommended that data on race and ethnicity be routinely collected to enhance our understanding of the challenges faced by workers throughout the return-to-work process, and to inform the design of equitable work disability management practices.

Conclusion

Despite long-standing evidence of racial inequities in health and labour market outcomes, we have a very limited understanding of the role that race and racism play in shaping the return-to-work process of workers who experience an injury or illness, particularly if they are work-related. Studies that do examine this issue indicate that racial inequities exist, suggesting racism is present within work disability management systems. Thus, there is a need both to enhance research on the topic, and to address racism and inequities seen in this process.