Clinical and psychosocial factors affecting work productivity among patients with hidradenitis suppurativa: A cluster analytical investigation

Abstract

To the Editor: The presence of hidradenitis suppurativa (HS) affects patients' psychosocial work functionality.1Shlyankevich J. Chen A.J. Kim G.E. Kimball A.B. Hidradenitis suppurativa is a systemic disease with substantial comorbidity burden: a chart-verified case-control analysis.J Am Acad Dermatol. 2014; 71: 1144-1150Google Scholar This cross-sectional study, conducted from October 2018 to December 2019, aimed to correlate work presenteeism and absenteeism with psychosocial and disease severity parameters. Adult patients ≥ 18 years, literate in English or French, and attending the HS clinic at the McGill University Health Centre participated in the study. Participants completed validated questionnaires on clinical characteristics, quality of life and psychiatric morbidity, HS severity, and work productivity. Psychiatric health was assessed using the Dermatology Life Quality Index (DLQI) and the Beck Depression Inventory. HS severity was assessed using Hurley staging, HS Physician Global Assessment (PGA), Severity Assessment of Hidradenitis Suppurativa (SAHS), and the International Hidradenitis Suppurativa Severity Score System (IHS4) (Supplemental Tables I and II, available at https://doi.org/10.1016/j.jaad.2021.02.066). Absenteeism was measured by the number of workdays missed in the previous 4 weeks due to HS. Presenteeism was gauged by the number of days in the preceding 4 weeks that a patient worked but was disturbed by HS during work. Patients graded the impact of HS on their work performance on a scale of 0-10. This rating was self-reported and liable to subjective reporting and recall bias. Most of the 131 participants were female (n = 76; 58.02%) and Caucasian (n = 82; 62.6%), with a mean age of 38.11 ± 14.32 years. Of 102 employed patients, 81 (79.41%) worked in office settings and 21 (20.59%) worked in field jobs. Absenteeism was reported in 44 (43.14%) with mean missed workdays of 1.76 (standard deviation [SD], 2.11). Presenteeism was more prevalent, reported by 79 (77.45%) with mean bothered days at work of 5.13 (SD, 5.11). A 2-step clustering algorithm (Fig 1) revealed a fair quality clustering solution with a poor productivity cluster comprising 55 (53.9%) participants and a high productivity cluster comprising 47 (46.1%) participants. Over the previous 4 weeks, poor productivity patients reported disturbance by HS on a mean of 6.51 (SD, 5.55) days compared with 3.23 (SD, 3.78) for high productivity patients. Poor productivity patients missed a mean of 2.13 (SD, 2.34) workdays, compared with 1.23 (SD, 1.55) days by high productivity patients. Poor productivity patients reported significantly worse scores on the DLQI and higher scores on the Beck Depression Inventory, body mass index, visual analog score for pain, Hurley staging, HS-PGA, IHS4, and SAHS scores. (Table I). HS impact on productivity correlated closest with Hurley staging and DLQI scores (Table I).Table IComparison of clinical and psychosocial characteristics of poor productivity and high productivity among hidradenitis suppurativa patientsVariablesPoor productivity clusterHigh productivity clusterP valueMeanSDMeanSDClinical profile Age35.9311.90539.0414.059.23 Delay in diagnosis (years)9.057.22511.5512.961.22 Hurley staging2.700.451.400.53<.001 DLQI18.207.5246.705.676<.001 Beck depression inventory15.8410.8327.776.789<.001 BMI30.9537.786928.5236.0472.09 VAS5.872.4572.812.410<.001 PGA3.641.1921.790.999<.001 IHS411.357.1392.532.244<.001 SAHS8.403.2294.001.732<.001Work productivity profile Missed days2.132.3561.231.547.07 Bothered days6.515.5543.233.779.002 Productivity on bothered days∗Productivity on bothered days 0-10 (self-reported).6.961.3097.041.835.83BMI, Body mass index; DLQI, Dermatology Life Quality Index; IHS4, International Hidradenitis Suppurativa Severity Score System; PGA, Physician Global Assessment; SAHS, Severity Assessment of Hidradenitis Suppurativa; SD, Standard deviation; VAS, visual analog score.∗ Productivity on bothered days 0-10 (self-reported). Open table in a new tab BMI, Body mass index; DLQI, Dermatology Life Quality Index; IHS4, International Hidradenitis Suppurativa Severity Score System; PGA, Physician Global Assessment; SAHS, Severity Assessment of Hidradenitis Suppurativa; SD, Standard deviation; VAS, visual analog score. Although presenteeism was more prevalent, only absenteeism was a significant predictor of perceived loss of productivity. In bivariate correlations, Hurley staging was significantly associated with bothered workdays (r = 0.28, P < .001) but not with missed days (r = 0.19, P = .09) or subjectively measured productivity (r = -0.13, P = .25). Chi-squared analysis revealed that patients in office-based settings most often reported bothered work (χ2 = 19.7, P < .001). In a multivariable regression analysis (Table I) adjusted for age and gender and controlling for both presenteeism and absenteeism, only absenteeism was a significant predictor of perceived productivity loss (B = -0.26, P = .01). This model revealed 21% variance in perceived productivity loss (F = 4.84, P < .01). Our data illustrate that the HS impact on work productivity correlates with the standard indicators of clinical severity, quality of life, and depression. None disclosed.