Total disability days in interprovincial and home‐province workers injured in Alberta, Canada: A mixed‐methods study with matched‐pair analysis of compensation data and participant interviews

INTRODUCTION: Workers moving between states or provinces to find employment are reported to take longer to return to work after the injury. METHODS: The Alberta Workers Compensation Board (WCB) identified all workers from four Canadian Atlantic provinces who sustained a work injury in Alberta resulting in greater than 5 total temporary disability days (TTDDays) from January 2015 to June 2017. Each was matched on sex, age, and injury date with an Alberta claimant also with greater than 5 TTDDays. WCB information extracted included employment, injury, cost and place of treatment, and modified work. Cox regression identified factors associated with TTDDays. Semi-structured interviews were also undertaken. RESULTS: Two-hundred forty pairs were identified and 60 interviews completed. Those from the Atlantic provinces had more TTDDays (median 63 days) than Alberta (median 22 days) with an unadjusted hazard ratio (HR) 0.50 (95% confidence interval [CI], 0.42-0.61). When adjusted for all factors, the HR moved closer to unity (HR = 0.62; 95% CI, 0.50-0.76). Total health care costs were the strongest predictor, with modified work, injury type, and claim status also explanatory factors. Among the Atlantic workers, leaving Alberta for treatment was strongly related to a lower likelihood of ending wage replacement (HR = 0.45; 95% CI, 0.32-0.62). Participants in the interview study emphasized the importance of returning to the family after injury and the financial difficulties of maintaining a second home with reduced income after the injury. CONCLUSION: The higher costs of wage replacement associated with extended time off work may be inherent to the practice of employing out-of-province workers for jobs for which there is a shortage of local labor.