Work Disability in a National Sample of RA Patients

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Work Disability in a National Sample of RA Patients

Category:  30 Health services research

Frederick Wolfe, Kaleb Michaud

National Data Bank for Rheumatic Diseases, Wichita, KS

Presentation Number: 140

Poster Board Number: 140

Keywords: Work, Work Disability, Rheumatoid Arthritis

Background. Work disability is a primary outcome of rheumatoid arthritis

(RA), and a measure of the effectiveness of therapy. Two previous US studies

have indicated rates of WD after 10 years of RA of 50% (Yelin, 1980s) and

30% (Wolfe, 1998). During the last 2 decades, however, almost all women have

become employed, and labor markets and disability rules have changed. Of

equal importance, the treatment of RA has improved substantially; and it is

possible that this improvement might be translated into a better overall

prognosis. In this report, we provide evidence of the current status of work

disability in a large cohort of RA patients cared for by 201 US

rheumatologists.

Methods. We investigated the rate of WD in 5,054 RA patients between the

ages of 25 and 65 years during 11,380 patient years of follow-up. Data

reported are at the last assessment (mean assessment date: January 2001). We

used 2 measures to assess work discontinuation events: the receipt of Social

Security Disability Insurance (SSDI) and the presence of work disability

(WD) (early retirement or work discontinuation due to RA).

Results. At a median duration of RA of 10.1 years, 23.3% had received Social

Security disability payments and 35.7% were work disabled. These rates did

not differ by sex, p> 0.650. When rates were adjusted to the ethnic status

and educational level of the US population, the rates and 95% CI for SSDI

and WD were 27.7% (25.7, 29.8) and 40.0% (37.8, 42.3), respectively. When

analyses were restricted further to only those patients who were employed at

the time of RA onset (83.2%), the population adjusted rates for SSDI and WD

were 27.8% (25.1, 30.7) and 39.2% (36.3, 42.2), respectively. SSDI was more

common in minorities (odds ratio 1.5 (95% CI 1.2, 1.)), non-college

graduates (OR 1.9, (1.6, 2.4)), non-high school graduates (OR 2.5, (2.0,

2.3)), and was strongly associated with functional disability, with an OR

for a 1 unit increase in HAQ of 8.2 (6.9, 9.6). Prednisone (OR 1.9 (1.6,

21.)), etanercept (OR 1.3 (1.1, 1.5)) and infliximab (OR 2.8 (2.1, 3.6)),

but not MTX or leflunomide, were all associated with SSD, reflecting

association of these treatments with disease severity.

Conclusions. Yelin¹s studies in the 1980s defined WD as stopping work for

any reason, while the current study refers to the award of SSDI or stopping

work because of RA. Therefore the apparent improvement noted here cannot be

directly compared with Yelin¹s work. Even so, the results of the current

study show that WD rates are similar for men and women, and that education

can play a strong protective role in preventing RA work disability.

Futhermore, approximately 37-40% of persons with RA are work disabled and

23-28% are receiving SSDI 10 years after the onset of RA.