Current Risk Factors for Work Disability Associated With Rheumatoid Arthritis: Recent Data From a US National Cohort

Boston University School of Medicine, Boston, Massachusetts 02118, USA.
Arthritis & Rheumatology (Impact Factor: 7.76). 03/2009; 61(3):321-8. DOI: 10.1002/art.24281
Source: PubMed


To explore, using recent data, whether and how risk factors for rheumatoid arthritis (RA) work disability may differ from previous studies.
Subjects were 953 individuals with RA from a US cohort who provided data semiannually over 18 months (years 2002-2005). A nested case-control design was used with matching on time of baseline data collection. All subjects were employed at baseline; cases were consistently not employed at followup, whereas controls remained employed. Hierarchical conditional logistic regression assessed the roles of demographic, RA disease, general health, and work factors as predictors of work disability. Recursive partitioning and causal modeling procedures were also used.
Sample characteristics were mean age 51 years, 82% female, and 92% white. Older age (odds ratio [OR] 1.2, 95% confidence interval [95% CI] 1.1-1.4) and lower income (OR 1.7, 95% CI 1.0-2.7) predicted work disability, whereas more hours worked (OR 0.9, 95% CI 0.8-0.9) and preference to work full time (OR 0.2, 95% CI 0.1-0.4) or part time (OR 0.4, 95% CI 0.2-0.6) versus not to work were protective in the regression analysis. In recursive partitioning analyses, RA disease factors predicted work disability among older subjects, and functional limitation was the fourth most important factor. Job physical demand was not a significant or important factor.
In this contemporary data from a large RA cohort, older age, lower income, fewer working hours, and preference not to work were the risk factors for work disability. The impact of disease factors was limited to subjects ages >or=56 years. Job physical demand level had little impact.

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Available from: Michael P Lavalley
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    • "There is abundant evidence that markers of low socioeconomic status (SES) are associated with worse self-reported health status123456789and greater disease activity[1,3,4,6,9]among people with rheumatoid arthritis (RA), who number an estimated 1.3 million in the United States. Pathways underlying these inequities are hypothesized to include and extend beyond variations by SES in health be- haviors[10], occupational or environmental exposures, and in the access to, utilization and receipt of health ser- vices[11,12]. "
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    ABSTRACT: Background There is abundant evidence that low socioeconomic status (SES) is associated with worse health outcomes among people with Rheumatoid Arthritis (RA); however, the influence of socioeconomic disadvantage in early life has yet to be studied within that population. Methods Data originated from the cross-sectional arm of the Consortium Evaluation of African-Americans with Rheumatoid Arthritis (CLEAR II), which recruited African-Americans with RA from six sites in the Southeastern United States. We used linear regression models to evaluate associations of parental homeownership status and educational level at participant time of birth with participant-reported fatigue (Visual Analog scale, cm), pain (Visual Analog scale, cm), disability (Health Assessment Questionnaire) and helplessness (Rheumatology Attitudes Index), independently of participant homeownership status and educational level. Models included random effects to account for intra-site correlations, and were adjusted for variables identified using backward selection, from: age, disease-duration, sex, medication use, body-mass index, smoking history. Results Our sample included 516 CLEAR II participants with full data on demographics and covariates. 89 % of participants were women, the mean age was 54.7 years and mean disease duration was 10.8 years. In age adjusted models, parental non-homeownership was associated with greater fatigue (β = 0.75, 95 % CI = 0.36–1.14), disability (β = 0.12, 95 % CI = 0.04–0.19) and helplessness (β = 0.12, 95 % CI = 0.03–0.21), independently of participant homeownership and education; parental education had a further small influence on self-reported fatigue (β = 0.20, 95 % CI = 0.15–0.24). Conclusions Parental homeownership, and to a small extent parental education, had modest but meaningful relationships with self-reported health among CLEAR II participants.
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    • "This broad array of RA-related effects on work ability is challenging to assess in retrospective studies, since these must rely on patient-reported data [12], which may fail to accurately reflect the contribution to the total cost of RA of work difficulties versus other factors [6]. Prospective cohort studies are more straightforward to interpret but require the availability of registries, which are difficult to develop [13] [14] [15] [16] [17]. Other approaches rely on randomized trials comparing the effects on productivity of various treatments used "

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    • "Ces différentes conséquences de la PR sont difficiles à appréhender dans les enquêtes rétrospectives car elles sont basées sur les déclarations des personnes elles-mêmes [12] et elles soulèvent des questions délicates d'imputabilité [6]. Les études de cohortes prospectives soulèvent moins de problèmes d'interprétation mais doivent s'appuyer sur des registres difficiles à mettre en place [13] [14] [15] [16] [17]. D'autres approches s'appuient sur des études randomisées comparant les effets sur la productivité de différentes modalités de traitement de la PR. "
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    ABSTRACT: Étudier les conséquences de la polyarthrite rhumatoïde (PR) sur la trajectoire professionnelle des patients, l’employabilité et la productivité.
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