Large country differences in work outcomes in patients with RA \u2013 an analysis in the multinational study COMORA

Antje Van Der Zee-Neuen,Maxime Dougados,Polina Putrik,Andras P Keszei,Ihsane Hmamouchi,Sofia Ramiro,Annelies Boonen

doi:10.1186/s13075-017-1421-y

Abstract

BackgroundWe aimed to explore whether country of residence or specific country characteristics are associated with work outcomes in rheumatoid arthritis (RA).MethodsData from the 17 countries participating in the Comorbidities in RA (COMORA) study were used. Work outcomes were measured by the Work Productivity and Activity Impairment Questionnaire, addressing employment (yes/no), absenteeism (percentage of time; 3 categories) and presenteeism (percentage of at-work productivity restrictions; 4 categories). Contribution of country of residence, gross domestic product (GDP), Human Development Index (HDI), unemployment rate, social protection expenditures (SPE) or world region to work outcomes was investigated in adjusted (ordered) logistic regressions.ResultsThe patients (n = 2395) were younger than 60 years; mean age 48 (SD 9.2) years, 1972 (84%) female and 1065 (45%) employed. Large country differences were found. Taking the country with the best work outcome as reference, Moroccan patients had the lowest odds of being employed (OR 0.2 (95% CI 0.1; 0.3) vs. Germany) and highest odds of absenteeism (OR 13.2 (3.6; 48.3) vs. Japan). Patients in Taiwan had the highest odds of presenteeism (OR 13.0 (5.5; 30.9) vs. Venezuela). All country indices except SPE were associated with work outcomes. For example, patients in low-GDP countries had lower odds of employment (OR 0.6 (0.5; 0.8)), higher odds of absenteeism (OR 2.8 (2.0; 4.1)), but lower odds of presenteeism (OR 0.5 (0.4; 0.7)) compared to higher-GDP countries.ConclusionSubstantial differences in work outcomes among patients with RA were observed between countries. Lower economic wealth and human development of countries were associated with worse employment and higher absenteeism, but lower presenteeism.

Highlights

We aimed to explore whether country of residence or specific country characteristics are associated with work outcomes in rheumatoid arthritis (RA)
Chung et al observed a higher hazard of withdrawal from work due to RArelated work disability in Finland compared to the United States of America (USA), for similar clinical and sociodemographic characteristics [5], and suggested the more supportive Finnish social security system with favorable disability allowance in case of disease-related work disability partly explained such differences
Overall 1,065/2359 (45.2%) of persons ≤ 60 years were employed with the highest percentage of employment in Germany (n = 71/113; 62.8%) and the lowest in Morocco (n = 33/181; 18.2%)

Summary

Introduction

We aimed to explore whether country of residence or specific country characteristics are associated with work outcomes in rheumatoid arthritis (RA). There is increasing evidence that environmental contextual factors such as nature of work or support from colleagues influence work outcome independent of biomedical and personal contextual factors [1, 2]. On this line, limited data suggest that system-level environmental factors, such as the prosperity or development of a country, play a decisive role. The QUEST RA study among 32 countries showed that patients in low-income countries continued to work with high levels of disease activity [6]

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