High local unemployment rates limit work after lung transplantation

Abstract

Most lung transplant (LTx) recipients recover sufficient functional status to resume working, yet unemployment is common after LTx. Weak local labor markets may limit employment opportunities for LTx recipients. United Network for Organ Sharing data on first-time LTx recipients 18-60 years old who underwent transplant between 2010 and 2014 were linked to American Community Survey data on unemployment rates at the ZIP Code level. Multivariable competing-risks regression modeled the influence of dichotomous (≥8%) and continuous local unemployment rates on employment after LTx, accounting for the competing risk of mortality. For comparison, analyses were duplicated in a cohort of heart transplant (HTx) recipients who underwent transplant during the same period. The analysis included 3,897 LTx and 5,577 HTx recipients. Work after LTx was reported by 300 (16.3%) residents of low-unemployment areas and 244 (11.9%) residents of high-unemployment areas (p < 0.001). Multivariable analysis of 3,626 LTx recipients with complete covariate data found that high local unemployment rates limited employment after LTx (sub-hazard ratio = 0.605; 95% confidence interval = 0.477, 0.768; p < 0.001), conditional on not working before transplant. Employment after HTx was higher compared with employment after LTx, and not associated with local unemployment rates in multivariable analyses. LTx recipients of working age exhibit exceptionally low employment rates. High local unemployment rates exacerbate low work participation after LTx, and may discourage job search in this population.