Work loss and work entry among persons with systemic lupus erythematosus: Comparisons with a national matched sample

Rosalind Russell Medical Research Center for Arthritis, University of California, San Francisco, CA 94143, USA.
Arthritis & Rheumatology (Impact Factor: 7.76). 02/2009; 61(2):247-58. DOI: 10.1002/art.24213
Source: PubMed


To prospectively track work loss among those employed and work entry among those not employed in a cohort of persons with systemic lupus erythematosus (SLE), assess risk factors for these outcomes, and compare rates of the outcomes with a matched national sample.
The present study analyzed 4 years of data from the Lupus Outcomes Study (LOS), augmented by information on the local labor market from the Census Bureau and the Bureau of Labor Statistics. We used the Kaplan-Meier method to assess time from study initiation until work loss or work entry, and Cox proportional hazards regression to estimate factors affecting these outcomes. Finally, we compared rates of work loss and work entry in the LOS with rates in the Survey of Income and Program Participation (SIPP).
At study initiation, 394 LOS participants (51%) were employed, of whom 92 (23.4%) experienced work loss. In multivariate analysis, older age, lower cognitive and physical functioning, and higher reports of depressive symptoms predicted work loss. In comparison with the SIPP sample, rates of work loss did not differ. Of the 376 LOS participants not employed, 76 (20.2%) experienced work entry. In multivariate analysis, less disease activity, fewer lung manifestations, better physical functioning, and shorter time since last employment predicted work entry. In comparison with the SIPP, rates of work entry were only lower between ages 35 and 55 years.
Until age 55 years, low rates of employment among persons with SLE may be due to lower rates of work entry rather than higher rates of work loss. Beyond age 55 years, both high rates of work loss and low rates of work entry contribute to low rates of employment.

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Available from: Patricia P Katz, Jun 16, 2014
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    • "Among the most prevalent chronic health conditions affecting employment are rheumatic diseases like arthritis [16–20]. Arthritis is associated with giving up work, increased sick leave, absenteeism and at-work productivity loss (presenteeism) [19, 21–30]. Challenges in working with arthritis include dealing with ongoing or intermittent disease symptoms like pain and fatigue, as well as activity limitations with work tasks [31–35]. "
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    Journal of Occupational Rehabilitation 12/2013; 24(3). DOI:10.1007/s10926-013-9490-5 · 2.80 Impact Factor
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    • "The present study uses up to seven years of longitudinal follow-up data. Based on our previous finding from a prospective analysis showing the importance of SLE status on work outcomes relative to working conditions, including physical demands of jobs [Yelin, 2009 #1835], wee hypothesize that, among employed subjects, the hazards for job loss would be higher among those who incur an incident SLErelated manifestation or an increase in disease activity. The examination of the impact of changes in participants' health over a study period can help identify risk factors that are important to measure repeatedly during follow-up "
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    ABSTRACT: There is increasing evidence of the impact of systemic lupus erythematosus (SLE) on employment, but few studies have had sufficient sample size and longitudinal followup to estimate the impact of specific manifestations or of increasing disease activity on employment. Data were derived from the University of California, San Francisco, Lupus Outcomes Study, a longitudinal cohort of 1,204 persons with SLE sampled between 2002 and 2009. Of the 1,204 persons, 484 were working at baseline and had at least 1 followup interview. We used the Kaplan-Meier method to estimate the time between onset of thrombotic, neuropsychiatric, or musculoskeletal manifestations, or of increased disease activity, and work loss. We used Cox proportional hazards regression to estimate the risk of work loss associated with the onset of specific manifestations, the number of manifestations, and increased activity, with and without adjustment for sociodemographic, employment, and SLE duration characteristics. By 4 years of followup, 57%, 34%, and 38% of those with thrombotic, musculoskeletal, and neuropsychiatric manifestations, respectively, had stopped working, as had 42% of those with increased disease activity. On a bivariable basis, the risk of work loss was significantly higher among persons ages 55-64 years and those with increased disease activity and each kind of manifestation. In multivariable analysis, older age, shorter job tenure, thrombotic and musculoskeletal manifestations, greater number of manifestations, and high levels of activity increased the risk of work loss. Incident thrombosis and musculoskeletal manifestations, multiple manifestations, and increased disease activity are associated with the risk of work loss in SLE.
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