Gender Differences in Personal and Work-Related Determinants of Return-to-Work Following Long-Term Disability: A 5-Year Cohort Study Vale ´rie Lederer • Miche `le Rivard • Samia Djemaa Mechakra-Tahiri Ó Springer Science+Business Media, LLC 2012 Abstract Objective To assess the differential effect of personal and work-related psychosocial, physical and organizational determinants by gender on time to return- to-work (RTW) following long-term disability. Methods Data come from a larger study conducted in the province of Quebec, Canada. A cohort of 455 adults on long-term disability due to work-related musculoskeletal disorders at the back/neck/upper limb was followed for 5 years through structured interviews and administrative databases. Left- truncated Cox regression modeling stratified by gender was used to assess time to a first partial or full RTW of at least 3 days. Results Survival curves of time to RTW were similar between men and women on long-term disability (log-rank test p value = 0.920) but many personal and occupational factors influencing RTW differed by gender. Women’s risk factors included older age (HR = 0.734—in 10 years unit), poor to very poor perceived economic status (HR = 0.625), working C40 h/week and having depen- dents (HR = 0.508) and awareness of workplace-based occupational health and safety program (HR = 0.598); higher gross annual income (in $10,000 s) was a facilitator (HR = 1.225). In men, being over 55 years old (HR = 0.458), poor perceived economic status (HR = 0.653), working C40 h/ week and high perceived physical workload (HR = 0.720) and higher job insecurity (HR = 0.825) negatively influenced time to RTW. For both men and women, probabilities of not returning to work varied widely according to workers’ specific profile of personal and occupational factors (high or low risk profile). Conclusion Results confirm the importance of gen- der-sensitive strategies to investigate RTW determinants from a gender perspective. Keywords Sex Á Gender Á Return-to-work Á Prolonged Á Chronic Á Sickness absence Background Musculoskeletal disorders (MSDs) are a major concern in occupational health. They constitute the most prevalent cause of work disability among adults in the Western world [1]. In Quebec, nearly $121 million (Canadian) are paid annually to compensate workers with MSDs, representing 40 % of the compensation budget [2, 3]. Long-term dis- ability is increasingly seen as a key problem in modern societies [4]. Although those on long-term disability (C8 weeks) represent only about 10 % of compensated workers, they generate 75 % of compensation costs [2, 3]. Moreover, the longer disability lasts, the greater the risk it becomes permanent [4–6], bringing with it considerable financial and human consequences for workers, relatives and society at large (e.g. anxiety, loss of autonomy, expenses, absenteeism) [4, 7, 8]. Very little is known on long-term disability explored from a gender perspective [9]. Gjesdal et al. [6, 10] showed women on long-term sickness absence were slightly more likely to tran- sition to permanent disability than men. Broader literature on disability indicates that women face a higher prevalence and incidence of work-related MSDs [11–15], a higher incidence of work disability [16, 17], and a slightly longer duration of work disability [10, 12, 14, 17]. V. Lederer (&) Á M. Rivard Á S. D. Mechakra-Tahiri Department of Social and Preventive Medicine, University of Montreal, CP 6128, succ. Centre-ville, Montreal, QC H3C 3J7, Canada e-mail: valerie.lederer@umontreal.ca V. Lederer Á M. Rivard Á S. D. Mechakra-Tahiri Public Health Research Institute, University of Montreal, Montreal, QC, Canada 123 J Occup Rehabil DOI 10.1007/s10926-012-9366-0