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Musculoskeletal and injury 1
  1. M. Koehoorn1,
  2. F. Xu2,
  3. J. Village3,
  4. C. Trask3,
  5. K. Teschke1
  1. 1Department of Health Care and Epidemiology, University of British Columbia
  2. 2Centre for Health Services and Policy Research, University of British Columbia
  3. 3School of Occupational and Environmental Hygiene, University of British Columbia

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    Despite considerable research efforts, reducing the incidence of and work disability associated with back disorders has remained challenging. One of the major reasons is that the natural course of these disorders is poorly understood and therefore identifying new episodes of morbidity remains difficult. The objective of this study was to propose a definition of new onset back disorder for use in occupational studies.


    Medical services, hospitalisations and workers’ compensation data were linked to create a person-specific, longitudinal database (1992–2001) of health care contacts for a cohort of 116 268 workers employed in heavy industry. Contacts with back-related ICD-9 diagnoses were analysed using a semi-parametric mixture model (Nagin, 1999) to investigate trajectories of morbidity over time.


    During the follow-up period, 22.9% of the cohort had no back-related health care contacts. Among workers with at least one contact, four back morbidity trajectories provided the best fit of the data. The first trajectory of individuals had a high probability (>60%) of back morbidity every year of follow-up. The other three groups had episodic trajectories of increasing and decreasing probability of back morbidity over time (ranging from 0% to 55% per year). The three episodic groups are postulated to represent the same trajectory with different start dates. Based on health care contacts within these trajectories, a back disorder episode was defined by a minimum of two outpatient visits per year. Separate episodes were defined by a 3-year gap with no health care contacts. Individuals with chronic back disorders were defined by a minimum of four health care contacts per year with no gaps in contacts from year to year.


    These results provide useful information for defining new episodes of morbidity for use in aetiological studies of occupational back disorders. In this heavy industry cohort, those with no history of back disorders could be followed for …

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