Unemployment in chronic airflow obstruction around the world: results from the BOLD study.

Rune Grønseth,Sundeep Salvi,Daniel O Obaseki,Parvaiz A Koul,Michael Studnicka,Thorarinn Gislason,Andre F.S Amaral,Peter Burney,William M Vollmer,A Sonia Buist,Sanjay K Juvekar,Marta Erdal,Ane Johannessen,Wan C Tan

doi:10.1183/13993003.00499-2017

Abstract

We aimed to examine associations between chronic airflow obstruction (CAO) and unemployment across the world.Cross-sectional data from 26 sites in the Burden of Obstructive Lung Disease (BOLD) study were used to analyse effects of CAO on unemployment. Odds ratios for unemployment in subjects aged 40–65 years were estimated using a multilevel mixed-effects generalised linear model with study site as random effect. Site-by-site heterogeneity was assessed using individual participant data meta-analyses.Out of 18 710 participants, 11.3% had CAO. The ratio of unemployed subjects with CAO divided by subjects without CAO showed large site discrepancies, although these were no longer significant after adjusting for age, sex, smoking and education. The site-adjusted odds ratio (95% CI) for unemployment was 1.79 (1.41–2.27) for CAO cases, decreasing to 1.43 (1.14–1.79) after adjusting for sociodemographic factors, comorbidities and forced vital capacity. Of other covariates that were associated with unemployment, age and education were important risk factors in high-income sites (4.02 (3.53–4.57) and 3.86 (2.80–5.30), respectively), while female sex was important in low- to middle-income sites (3.23 (2.66–3.91)).In the global BOLD study, CAO was associated with increased levels of unemployment, even after adjusting for sociodemographic factors, comorbidities and lung function.

Highlights

Chronic airflow obstruction (CAO) is the primary characteristic of patients with chronic obstructive pulmonary disease (COPD) and affects up to one in five adults, depending on where they live, according to data from the Burden of Obstructive Lung Disease (BOLD) study [1]
In the PLATINO (Latin American Project for Research in Pulmonary Obstruction) study undertaken in five Latin-American countries, MONTES DE OCA et al [7] showed that the workforce participation among subjects with CAO was lower than in healthy subjects (41.8% versus 57.1%)
The association between CAO and unemployment varied across sites in crude analyses, but the site heterogeneity lost significance after adjustment for relevant covariates: CAO was an overall important risk factor for unemployment after adjusting for sex, age, smoking, education, comorbidities and even forced vital capacity (FVC)

Summary

Introduction

Chronic airflow obstruction (CAO) is the primary characteristic of patients with chronic obstructive pulmonary disease (COPD) and affects up to one in five adults, depending on where they live, according to data from the Burden of Obstructive Lung Disease (BOLD) study [1]. Three population-based studies have provided employment rates in CAO [5,6,7]. Controls were younger and had higher levels of education and the authors did not examine employment in multivariate analyses. JANSSON et al [6] examined CAO-specific disability in northern Sweden, but did not include a control group and did not report employment rates. In the PLATINO (Latin American Project for Research in Pulmonary Obstruction) study undertaken in five Latin-American countries, MONTES DE OCA et al [7] showed that the workforce participation among subjects with CAO was lower than in healthy subjects (41.8% versus 57.1%). In multivariable analyses they found that higher age, dyspnoea, number of comorbid conditions, female sex and lower education were associated with unemployment, whereas CAO was only of borderline significance

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