Regions, hospitals and health outcomes over time: A multi-level analysis of repeat prevalence among a cohort of health-care workers

Background: The relative importance of region, workplace, and individual determinants of health burden is debated. Objective: To model the contribution of hospital characteristics to employee mental and musculoskeletal disorders. Methods: We linked employment records of nurses and support services' staff with health records, neighbourhood census, and hospital administrative data. We conducted multi-level logistic regression analyses with three levels: year (I), employee characteristics (II), and hospital characteristics (III). Results: Northern region hospitals experienced lower disorder prevalences (odds ratios (OR) 0.58. 95% confidence intervals (0.40, 0.82) for mental and 0.56 (0.44, 0.73) for musculoskeletal disorders). Hospitals with yearly workloads of the highest versus lowest quintiles of inpatient days/1000 employee hours (>86.0 vs. <42.6) and surgical cases/1000 employee hours (>10.5 vs. <3.9) had greater odds of mental (1.29 (1.05, 1.57): 1.22 (1.05, 1.42)) and musculoskeletal (1.38 (1.21, 1.58): 1.21 (1.09, 1.34)) disorders. Conclusion: Opportunities exist for reduction in burden with hospital workload reduction. Further exploration of regional effects is needed. (C) 2009 Elsevier Ltd. All rights reserved.