First Advisor

Matthew Carlson

Date of Publication

Winter 3-13-2019

Document Type


Degree Name

Doctor of Philosophy (Ph.D.) in Sociology






Discrimination in medical care, Minorities -- Medical care, Workers' compensation, Race discrimination, Health and race



Physical Description

1 online resource (x, 148 pages)


Racial, ethnic, and linguistic minority workers suffer higher rates of work-related injuries and illnesses in the United States compared to their White counterparts. Explanations for these higher rates include potential socioeconomic causes (education, income, and wealth) and occupational segregation into more dangerous occupations. What is less studied are the post-injury sequelae for minority workers, which is their experiences in the workers' compensation system, as well as their health and return to paid employment. What is known comes primarily from qualitative literature, which includes themes of racial discrimination (from employers, health care providers, and workers' compensation employees), a lack of information on how to navigate the workers' compensation system, and linguistically inappropriate communication with those whose first language is not the majority language. In addition, qualitative studies have found differences in the treatment of minority workers, delays in receiving partial wage payments, and worse health outcomes. Most studies examining minority workers in the workers' compensation system have not provided a theoretical framework from which to test hypotheses as to why differences exist in a social insurance system based on race, ethnicity, and language.

The purpose of this dissertation was to test the role of racial discrimination in creating worse post-injury workers' compensation outcomes for minorities, compared to English speaking Whites. This dissertation utilized fundamental cause theory to frame the hypotheses and analyses in a cross-sectional investigation of differences in workers' compensation system outcomes, using both administrative data from the workers' compensation agency, as well as survey responses from a sample of 488 injured workers in Washington State.

The survey, conducted by Washington State University Social and Economic Science Research Center (SESRC), provided many variables not available in the WC administrative data including measures of perceived racial discrimination to test the hypotheses that racial discrimination is a fundamental cause of worse workers' compensation outcomes for minorities. Fundamental cause theory suggests that there are basic or fundamental reasons for health disparities that are not caused by mechanisms linking the fundamental cause with a health outcome; in fact, these mechanisms can and do change, but the relationship between the primary cause and the health disparity outcome will remain. In addition, a fundamental cause affects multiple outcomes via multiple mechanisms. Access to resources such as income, wealth, prestige, knowledge, and beneficial social connections can reduce the impact of a disease once it occurs.

The analytic chapters in this dissertation are organized first, to address racial discrimination in health care provider outcomes; second, to address racial discrimination in workers' compensation agency outcomes; and third, to address the role of pre-injury racial discrimination in post-injury return to work outcomes. Racial discrimination was tested in this dissertation as the fundamental cause of health-care provider disparities in timeliness of follow-up care, adequacy of care, and patient satisfaction. Racial discrimination was tested in the workers' compensation agency as the fundamental cause of administrative delays and difficulties: delays in diagnostic approval and wage replacement payments, as well as language appropriate communication, and higher counts of independent medical exams.

Racial discrimination was also tested as the fundamental cause of poor return-to-work outcomes (feeling a worker returned to work too early and overall general health). Workplace support, as a possible resource (social connection), was tested as a mediator in the relationship between racial discrimination and workplace outcomes.

Due to the survey nature of the study design, replicate weights were calculated based upon information available in both the surveyed and not-surveyed population to account for non-response bias, and all analyses were bootstrapped using Stata survey software. The results support the role of racial discrimination as a fundamental cause of outcomes for hypotheses in the workers' compensation agency with clear differences in delays for diagnostic services, a higher number of independent medical exams, as well as linguistically inappropriate communication for language minorities. Racial discrimination (prior to injury) was found to be significant in overall general health for minority workers, and for feeling they had returned to work too early. Workplace support (a potential social resource), was found to mitigate the role of racial discrimination in the workplace return-to-work outcomes. This study is an initial effort to examine racial discrimination as a fundamental cause of disparities in occupational health after an injury. As the majority of adults will spend one-fifth to one-third of their lives in paid employment, the ability to heal and return to full and active employment after a work-related injury is critical to ones' self-worth, as well as to the economic stability of individuals, families, and societies. If racial, ethnic, and language minorities suffer worse outcomes in their post-injury sequelae, these results will have long-lasting implications in any quest for a more equitable society.


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