Work disability and its economic effect on 55-64-year-old adults with rheumatoid arthritis

Boston University, Boston, Massachusetts, USA.
Arthritis & Rheumatology (Impact Factor: 7.76). 08/2005; 53(4):603-8. DOI: 10.1002/art.21326
Source: PubMed


To examine the extent and financial impact of work disability among older workers with rheumatoid arthritis (RA).
Year 2002 data from 5,419 subjects with RA < 65 years of age in the National Data Bank for Rheumatic Diseases were used, along with US population data. Measures of work disability were employment status, part-time work, sick day use, and limitation in work demands; the latter was assessed by the Work Limitations Questionnaire (WLQ). Measures of financial status were median household income and poverty level income. Statistical procedures included logistic and linear regression, Wilcoxon's rank sum test, and chi-square test.
Despite being better educated, subjects with RA ages 55-64 years had lower employment rates than individuals of the same age in the US (women 40% versus 53% and men 54% versus 66%). These older subjects with RA had stopped working more often than younger subjects with RA, and more worked part time (40% versus 34%; P < 0.01). However, the older subjects used sick time less often than younger subjects (35% versus 41%; P < 0.01) and were similarly limited in job demands, e.g., physical demands (mean WLQ subscale score 27.0 versus 26.6; P = 0.65). Median household income of older employed subjects was 20,000 dollars greater than that of retired subjects; 56% of retired subjects had incomes lower than US median income versus 32% of employed subjects, and 11% had income below the poverty level.
Premature work cessation in persons with RA ages 55-64 years is a serious problem that needs to be addressed.

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Available from: Michael P Lavalley, Sep 04, 2014
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    • "RA patients not only suffer from pain when disease activity is high, but also experience an impaired quality of life (QoL) and increased prevalence of fatigue [2] [3]. Therefore, both newly diagnosed and longstanding RA patients have a high prevalence of work disability, which is associated with a significant socioeconomic burden [4] [5]. "
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    ABSTRACT: Rheumatoid arthritis (RA) is a chronic disabling disease that can jeopardize the ability of affected individuals to participate in paid work. Our objective was to evaluate the effectiveness of a 6-month course of tumor necrosis factor (TNF) antagonist (adalimumab) on work ability, overall health, and fatigue in RA patients. Between October 2012 and February 2014, this prospective, observational study enrolled 63 consecutive patients with established adult RA at outpatient clinics in Makkah, Jeddah, Riyadh and Abha (Saudi Arabia). Patients received subcutaneous injections of adalimumab (40 mg every 2 weeks). Outcomes were measured at baseline and 6 months using the following tools: Work Productivity and Activity Impairment (WPAI), Health Assessment Questionnaire Disability Index (HAQ-DI), Fatigue Severity Scale (FSS), Visual Analog Scale for Fatigue (VAS-F), and work disability self-assessment. All outcomes showed improvements after 6 months of adalimumab therapy. Significant improvements from baseline were observed in absenteeism (64% ± 11.62 to 11.60% ± 11.17 [p<0.0001]), presenteeism (62.15% ± 20.11 to 34.92% ± 20.61 [p<0.0001]), overall work impairment (69.08% ± 18.86 to 40.73% ± 22.29 [p<0.0001]), overall activity impairment (68.46% ± 18.58 to 36.46% ± 20.79 [p<0.0001]), HAQ score (1.69 ± 0.57 to 0.81 ± 0.61 [p<0.0001]), and FSS score (47.08 ± 9.55 to 27.86 ± 13.43 [p<0.0001]). A 6-month course of adalimumab improved work ability, fatigue, and overall health assessments in patients with established RA. Our findings encourage randomized controlled trials investigating the cost-effectiveness and long-term effects of TNF inhibitors on work disability.
    Full-text · Article · Aug 2015 · The Open Rheumatology Journal
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    • "The societal costs of work disability in the USA are tremendous , with estimates showing 234 billion dollars spent annually on work losses (Allaire et al., 2005; Burton et al., 2006). "
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    ABSTRACT: Work disability is common among people with chronic conditions. The terminology in the field is variable and often used interchangeably and there is a lack of comprehensive frameworks to describe work as an outcome. Varied operationalization of work disability makes it difficult to establish precise estimates of the impact of chronic musculoskeletal conditions on work. A new conceptual framework was developed using the International Classification of Functioning, Disability and Health and was named 'Work Activity and Participation Outcome (Work APO) Framework' which clarified definitions in the field. Applying the framework to people at risk of work disability and evaluating their outcomes could advance the literature.
    Full-text · Article · Feb 2015 · International Journal of Rehabilitation Research
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    • "However, current measures tend to ignore productivity issues within the home and participation in social activities. A notable proportion of people with RA drop out of the workforce due to their disability, and yet they still need to do work around the house or someone has to do it for them; therefore, the impact of the condition on unpaid work also warrants consideration [10]. "
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    ABSTRACT: The rheumatoid arthritis-specific Work Productivity Survey (WPS-RA) measures the impact of rheumatoid arthritis (RA) and treatment on patient productivity within and outside the home. It contains nine questions addressing employment status, productivity within and outside the home, and daily activities. The objective of this paper was to evaluate the discriminant validity, responsiveness, and reliability of the WPS-RA in patients with active RA. Two hundred twenty subjects (mean age was 53.8 years, 83.6% were female, mean disease duration was 9.54 years, mean number of disease-modifying anti-rheumatic drugs failed was 2, and 38.6% were employed outside the home) in a phase III, 24-week, double-blind, placebo-controlled trial completed the WPS-RA at baseline and every 4 weeks until withdrawal/study completion. Validity was evaluated via known groups using baseline data (first and third quartiles of subjects' Health Assessment Questionnaire--Disability Index [HAQ-DI] scores and Short Form-36 health survey [SF-36] scores). To evaluate responsiveness, mean changes in WPS-RA at week 24 were compared between American College of Rheumatology 20% improvement criteria (ACR20) (or HAQ-DI) responders and non-responders. Standardized response mean (SRM) was also used to quantify responsiveness. All group comparisons were conducted using a non-parametric bootstrap-t method. Subjects with lower HAQ-DI or SF-36 scores generally had statistically greater RA-associated losses in productivity within and outside the home compared with subjects with higher scores (25 of 32 evaluations were statistically significant). Smallest differences between groupswere seen in work absenteeism and days with outside help. At week 24, ACR20 and HAQ-DI responders reported large improvements in productivity within and outside the home; non-responders reported mainly a worsening in productivity (P <or= 0.05). Effect size for productivity changes in ACR20 or HAQ-DI responders was moderate to large for six out of eight items (SRM = 0.48 to 1.12). The effect size was small for work absenteeism and days with outside help. (SRM = 0.4 and 0.24, respectively). In non-responders, the magnitude of change was negligible (SRM < 0.1) or small (SRM < 0.3). The WPS-RA has demonstrated properties of discriminative validity, reliability, and responsiveness for the measurement of productivity within and outside the home in subjects with active RA.
    Full-text · Article · Jun 2009 · Arthritis research & therapy
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