Work Disability Research Articles

Algorithm for the Classification of Type 1 and Type 2 Diabetes Mellitus for the Analysis of Routine Data

Diabetes mellitus is a disease of high public health relevance. To estimate the temporal development of prevalence, routine data of statutory health insurances (SHI) are being increasingly used. However, these data are primarily collected for billing purposes and the case definition of specific diseases remains challenging. In this study, we present an algorithm for differentiation of diabetes types analyzing SHI routine data. The basis for the analysis was an age and sex-stratified random sample of persons of the Barmer SHI with a continuous insurance duration from 2010 to 2018 in the magnitude of 1% of the German population. Diabetes was defined in the reporting year 2018, as documentation of (1) a "confirmed" ICD diagnosis E10.- to E14.- in at least two quarters, (2) a "confirmed" ICD diagnosis E10.- to E14.- in one quarter with an additional prescription of an antidiabetic drug (ATC codes A10), or (3) an ICD diagnosis E10.- to E14.- in the inpatient sector, outpatient surgery, or work disability. Individuals were assigned to a diabetes type based on the specific ICD diagnosis E10.- to E14.- and prescribed medications, differentiated by insulin and other antidiabetics. Still unclear or conflicting constellations were assigned on the basis of the persons' age or the frequency and observation of the diagnosis documentation over more than one year. The participation in a disease management program was considered in a sensitivity analysis. The prevalence of documented diabetes in the Barmer sample was 8.8% in 2018. Applying the algorithm, 98.5% of individuals with diabetes could be classified as having type 1 diabetes (5.5%), type 2 diabetes (92.6%), or another specific form of diabetes (0.43%). Thus, the prevalence was 0.48% for type 1 diabetes and 8.1% for type 2 diabetes in 2018. The vast majority of people with diabetes can be classified by their diabetes type on the basis of just a few characteristics, such as diagnoses, drug prescription, and age. Further studies should assess the external validity by comparing the results with primary data. The algorithm enables the analysis of important epidemiological indicators and the frequency of comorbidities based on routine data differentiated by type 1 and type 2 diabetes, which should be considered in the surveillance of diabetes in the future.

Healthcare costs and productivity losses in treatment-resistant depression in Finland

IntroductionDue to its relatively high prevalence and recurrent nature, depression causes a major burden on healthcare systems and societies.ObjectivesTo investigate healthcare resource utilization and costs associated with treatment-resistant depression (TRD) compared with non-TRD depression in Finland.MethodsOf all patients aged 16-65 years and diagnosed with depression in Finland during 2004-2016, persons with TRD (N=15 405) were identified from nationwide registers and matched 1:1 with comparison persons with depression but no TRD. TRD was defined as initiation of a third treatment trial after having failed two pharmacological treatment trials. Follow-up period covered five years after TRD or corresponding matching data (until end of 2018). Healthcare resource utilization was studied with negative binomial regression and average excess costs of TRD with generalized estimating equations, by adjusting for baseline costs, comorbidity and baseline severity of depression.ResultsPersons with TRD (mean age 38.7, SD 13.1, 60.0% women) had more healthcare utilization and work disability (sick leaves and disability pensions), adjusted incidence rate ratio for work disability days was 1.72 (95% CI 1.64-1.80). This resulted in higher total costs for persons with TRD, adjusted mean difference 7572 (95% CI 7215-7929) EUR per patient per year, higher productivity losses (due to sick leaves and disability pensions, mean difference 5296, 95% CI 5042-5550) and direct healthcare costs (2002, 95% CI 1853-2151) compared with non-TRD patients. Mean difference was highest during the first year after TRD (total costs difference 11760, 95% CI 11314-12206).ConclusionsTreatment-resistant depression is associated with a significant cost burden.DisclosureThis study was funded by Janssen-Cilag Finland and the Finnish Ministry of Social Affairs and Health through the developmental fund for Niuvanniemi Hospital. ML was partly funded by personal grants from the Finnish Medical Foundation and Emil Aaltonen fou

The Cross-Country Comparison Model for Labor Participation (CCC Model for LP) of Persons with Chronic Diseases

Purpose To design a model based on the three pillars of new institutional theory (NIT), that facilitates cross-country comparison of labor participation (LP) of people with chronic diseases. This model should support getting a comprehensive overview of factors representing country differences, understanding these differences and should support estimating cross-country transferability of policies and interventions in the context of Work Disability Prevention. Methods Based on NIT, a draft model was designed by means of (1) a literature review of empirical studies; (2) theoretical books and articles; (3) a focus group with six expert researchers. This draft model was (4) adapted in the context of academic education. Literature was searched on Web of Science and EBSCO host. Feedback on (use of) the model was received from the focus group, four different academic courses at 28 occasions and two international conferences. Results The cross-country comparison model for labor participation (CCC model for LP) of persons with chronic diseases is proposed consisting of five factors: (1) Legislation; (2) Norms & values in practice; (3) Culture; (4) Organization of WDP in practice; (5) Labor market characteristics. Within these factors and based on (in)direct empirical evidence, subfactors are distinguished. The feedback received led to renaming (sub) factors, improved visual representation and a tool for estimating transferability. Conclusions The CCC model for LP of persons with chronic diseases allows for a comprehensive understanding of country differences and cross-country transferability of policies and interventions. The CCC model can be used for other populations when population-specific subfactors are included.

Professional Reintegration after Pelvic and Acetabular Trauma

Introduction: Pelvic ring and acetabulum injuries are complex injuries varying in severity and complications resulting in serious morbidity in surviving individuals which as a result can be a major contributor to reintegration of patients in professional services. Therefore its important to evaluate to what extent affected patients can return to pre injury work status and how their quality of life is affected. The objective of this study is to evaluate reintegration of affected patients in profession in a two year follow up after acetabular and pelvic ring injuries Material and Methods: Using local Trauma Registry of Orthopedic Trauma department in Shaheed Mohtarma Benazir Bhutto Institute of Trauma (SMBBIT) a retrospective Cohort study was conducted. All patients between age 18 to 60 who had a Acetabulum or Pelvic Ring fracture presented in SMBBIT during July 2017 to July 2019 and were treated by Orthopedic Trauma department were included in study. Multivariate logistic regression analysis was used to model reintegration to profession. Affected patients were classified as “Reintegrated to profession” if they have earned a month salary after 13 to 24 months rehabilitation post treatment. For unemployed patients along with majority of women who were domestic home makers, reciprocate basic household chores to pre injury injury level were classified as “ Reintegrated “ Fracture classification, Age, Gender, Fracture of Spine , Nerve Injuries of Lumbo Sacral Spine and/or lower limb and work status before injury were considered prognostic covarities. Results: Almost 70 percent of 180 researched patients were classified reintegrated. This means a reduction of 20 percent in employment for Pelvic ring injuries and 10 percent reduction in employment for acetabular fractures post treatment. Employment status before injury was the main predictor for reintegration. Older patients had a less chance to return to work in comparison to young individuals. Patients with Nerve injuries and fracture of spine had almost 80 percent higher risk for not being reintegrated. Conclusion: Acetabular fractures and Pelvic ring injuries currently lead to greater loss of reintegration to profession or domestic work. Trauma to Pelvis and Acetabulum threatens the social security of patients. Therefor rehabilitation and follow up care should be optimized to reduce post traumatic disability and reduce the economic burden of work disability.

Inclusive design within industry 4.0: A literature review with an exploration of the concept of complexity

Digitalisation giving rise to Industry 4.0 is said to bring significant change to shop floor workplaces in industrial production. Prior research anticipates challenges of new skills demanded from workers, but also opportunities to employ disabled workers. Inclusive Design could be able to augment this potential of digitalisation towards the inclusion of disabled workers. This paper reports a literature review to understand the state of affairs of Inclusive Design within Industry 4.0. The analysis shows Inclusive Design is underexplored in Industry 4.0, and identifies four key concepts, which are discussed in the paper: complexity, human-centredness, Industry 4.0 as assistive technology, and measuring workers. The concept of complexity is discussed as a source for future research in Inclusive Design in Industry 4.0.

The Impact of Osteoporotic Fractures on Patients with Rheumatoid Arthritis in Work Disability

Osteoporosis is the one of most common chronic metabolic bone disease, which is characterized by increased bone fragility, which is highly affected by age and menopause.1 According to the International Osteoporosis Foundation, one in three women over the age of 50 experience at least once in a lifetime a fracture as a result of osteoporosis, which on another hand is a cause for work disability.2,3
 Objective: The purpose of the study is to evaluate the economic and social impact of work disability, caused by fractures as a result of osteoporosis on patients with RA.
 Material and Methods: The study included 50 patients, diagnosed with RA and osteoporosis, which have had at least one fracture during their course of disease. The data were obtained in the Regional Hospital of Elbasan and the main focus was the duration of work disability.
 Results: The research concluded that approximately 20% of the patients required a long term disability benefit after suffering a fracture. Furthermore, the majority of the patients were reluctant to go back to work after suffering the consequences of the fracture, mainly due to pain and inability to properly move.
 Conclusion: Fractures due to osteoporosis on patients with RA have an increasing impact in work disability and life quality. The majority of the patients taken into research have benefited from work disability policies, whether short or long-term.

Development and validation of a prediction model for unemployment and work disability among 55 950 Dutch workers

BackgroundThis study developed prediction models for involuntary exit from paid employment through unemployment and disability benefits and examined if predictors and discriminative ability of these models differ between five common chronic diseases.MethodsData from workers in the Lifelines Cohort Study (n = 55 950) were enriched with monthly information on employment status from Statistics Netherlands. Potential predictors included sociodemographic factors, chronic diseases, unhealthy behaviours and working conditions. Data were analyzed using cause-specific Cox regression analyses. Models were evaluated with the C-index and the positive and negative predictive values (PPV and NPV, respectively). The developed models were externally validated using data from the Study on Transitions in Employment, Ability and Motivation.ResultsBeing female, low education, depression, smoking, obesity, low development possibilities and low social support were predictors of unemployment and disability. Low meaning of work and low physical activity increased the risk for unemployment, while all chronic diseases increased the risk of disability benefits. The discriminative ability of the models of the development and validation cohort were low for unemployment (c = 0.62; c = 0.60) and disability benefits (c = 0.68; c = 0.75). After stratification for specific chronic diseases, the discriminative ability of models predicting disability benefits improved for cardiovascular disease (c = 0.81), chronic obstructive pulmonary disease (c = 0.74) and diabetes mellitus type 2 (c = 0.74). The PPV was low while the NPV was high for all models.ConclusionTaking workers’ particular disease into account may contribute to an improved prediction of disability benefits, yet risk factors are better examined at the population level rather than at the individual level.

Physicians’ perspectives and future vision on disability assessments by phone during the COVID-19 pandemic: a cross-sectional survey

BackgroundPhysicians, who perform disability assessments for the Dutch Social Security Institute, were urged to conduct phone consultations from their homes to prevent the spread of COVID-19. The purpose of the study was to evaluate the perspectives of physicians regarding phone consultations during the COVID-19 pandemic. Additionally, to explore physicians’ views on a more widespread future use of phone consultations in the context of work disability assessments.MethodsAn electronic survey conducted from June to August 2020 included 41 statements categorized into themes previously identified in both the literature on physicians’ phone consultations and emerging from daily practice. All 1081 physicians working at the Dutch Social Security Institute were invited by e-mail to participate in the survey. Participants indicated on a 5-point Likert scale whether they strongly disagreed, disagreed, neither agreed nor disagreed, agreed or strongly agreed with the statements. The collected data were analysed using descriptive statistics.ResultsIn general, physicians had become accustomed to perform phone consultations. Negative experiences included difficulties in getting an impression of patients and assessing patients’ functional limitations. About half of physicians found that phone consultations took more effort, 61% asked more questions due to no direct patient observations. According to 67%, it is mostly necessary to perform an in-person consultation to adequately assess functional limitations of a patient with persistent medically unexplained physical symptoms. A great majority did not prefer telephone consultations to in-person consultations. However, more than half of physicians perceive a greater preference for phone consultations in the future than previously. 56% thought that replacement of in-person consultations with phone consultations in the future might lead to more complaints.ConclusionsPerspectives and future views varied among physicians performing disability assessments by phone. A majority of physicians experienced difficulties with different aspects of the assessment. Despite these difficulties, most physicians support to continue the wider use of phone consultations. To improve remote disability assessments it is required to gain more insights into conditions under which a phone assessment can be as diligent as an in-person assessment.

The work disability trap: manifestations, causes and consequences of a policy paradox

Purpose This article focuses on the risk that work disability policies lock people into work disability rather than promote durable health and return to work. We outline the concept of a work disability trap as a heuristic device to explore this policy paradox inherent in the design of most social insurance systems. Materials and methods This is a conceptual paper drawing on examples from existing research. Results We identify three manifestations of the disability trap: not overcoming disability; underperforming; and returning to work prematurely. The causes of these manifestations are identified as structural rather than based on malingering clients, while negative consequences are identified both on client and system levels. Conclusion We emphasize the need for systems built on trust and reasonable expectations, and the need for providing rehabilitation support independently of economic compensation. Universal basic income is introduced as a potential tool to ameliorate some of the consequences of the disability trap. Implications for rehabilitation Compensation systems focusing too prominently on early return to work may have counter-productive effects on rehabilitation. Overly suspicious assessment systems nurture a view of people as malingerers. Rehabilitation professionals need to be attentive to system-generated effects which may prevent overcoming work disability.

Differences between men and women in their risk of work injury and disability: A systematic review.

BackgroundHealth responses associated with occupational exposures can vary between men and women.AimsThis study reviewed the work injury and disability risks associated with similar types of occupational exposures for men and women within and across occupations.Materials & MethodsA systematic review was undertaken of observational studies published between 2009 and 2019. Studies were required to empirically compare men and women for associations between occupational exposures and work injury or disability outcomes. Included studies were appraised for methodological quality and medium to high rated studies were compared for risk differences between men and women.ResultsOf 14,006 records identified, 440 articles were assessed for methodological quality, and 33 medium to high rated studies were included and reviewed. Among all occupations, the association between physical exposures, job demands, noise, and repetitive tasks, and injury risk were stronger among men. The relationship between repetitive tasks and sickness absence was stronger among women. Most studies examining psychological exposures found no risk differences for men and women across occupations. Men were at higher injury risk in certain occupations in primary and secondary industry sectors involving physical exposures and some chemical/biological exposures. Women were at higher injury risk for the physical demands and repetitive tasks of health care and aluminum production occupations.ConclusionThis review found that men and women can have different work injury and disability risks, both across and within the same occupations, for some physical exposures and to a lesser extent for some chemical and biological exposures. These differences might be a result of occupation‐specific task differences.

Associations between low parental education, childhood adversities and sickness absence in midlife public sector employees.

Parental education and childhood adversities are associated with long-term work disability but their contribution to sickness absence is largely unknown. We aimed to examine the associations between parental education, childhood adversities and self-certified and medically-certified sickness absence among midlife employees. The Helsinki Health Study baseline survey data (2000-2002) of 40-to-60-year-old municipal employees were linked with sickness absence data from the employer's register. Self-certified (1-3 days) and medically-certified (>3 days) sickness absence spells were followed from 2003 until the end of 2008. The study included 5728 employees. The analyses were made by Poisson regression and the results are presented as rate ratios (RRs) and their 95% confidence intervals (CIs). Low maternal education was associated with self-certified sickness absence (RR 1.32, 95% CI 1.13-1.55) among women only whereas both low maternal (1.49, 1.26-1.77) and low paternal education (1.48, 1.32-1.67) were associated with medically-certified sickness absence. Adjustment for own occupational class mainly abolished these associations. Having experienced any childhood adversity was associated with self-certified (1.18, 1.12-1.25) and medically-certified (1.22, 1.15-1.30) sickness absence. In addition, childhood economic difficulties, childhood illness, parental divorce, parental mental illness, parental alcohol problems and bullying were each associated both with self-certified and with medically-certified sickness absence. The associations mainly remained after adjustments for occupational class, marital status, working condition, body mass index and health behaviours. Low parental education and childhood adversities contributed to midlife sickness absence. Promoting well-being of families with children might help sustain adult work ability and prevent sickness absence still in midlife.

Understanding the vocational functioning of autistic employees: the role of disability and mental health

Purpose Employment rates for autistic people are low, despite increasing employment-focused programmes. Given the reported complexities for autistic people in finding and keeping work and flourishing there, further exploration is needed to understand how best to help employers accommodate autistic employees. Material and methods We assessed 88 employed autistic adults, without comorbid intellectual disability and examined whether self-reported disability and mental health symptoms were associated with two measures of vocational functioning: disability days off work and vocational disability. Results Nearly half (47%) reported at least one disability day absence in the previous month. Autism severity and IQ were not associated with either measure of vocational functioning. Greater disability and higher mental health symptoms were associated with both types of vocational functioning. However, the associations of anxiety and stress with both vocational outcomes were attenuated to null in a multivariable model. Disability (B = 6.74, p = 0.009; B = 1.18, p < 0.001) and depression (B = 4.46, p = 0.035; B = 1.01, p = 0.049) remained independently associated with both outcomes. Conclusions Clinicians and vocational support programmes addressing modifiable factors may need to focus on addressing mental health comorbidities, specifically depression rather than anxiety, or core features of autism to improve vocational outcomes for autistic people. Implications for Rehabilitation Individual-level interventions that reduce disablement, particularly in social areas, and depressive symptoms as a way of reducing days off work and improving workplace activities in autistic employees are recommended. Organisations can accommodate autistic employees by encouraging use of mental health programmes or looking at how the workplace environment can be adapted to limit social disability.

Return to work factors and vocational rehabilitation interventions for long-term, partially disabled workers: a modified Delphi study among vocational rehabilitation professionals

BackgroundLong-term disability has a great impact on both society and workers with disabilities. Little is known about the barriers which prohibit workers with long-term disabilities from returning to work and which interventions are best suited to counteract these barriers. The main purpose of this study was to obtain consensus among professionals on important return to work (RTW) factors and effective vocational rehabilitation (VR) interventions for long-term (> 2 years), partially disabled workers. Our three research questions were: (1) which factors are associated with RTW for long-term disabled workers?; (2) which factors associated with RTW can be targeted by VR interventions?; and (3) which VR interventions are the most effective to target these factors?MethodsA modified Delphi Study was conducted using a panel of 22 labour experts, caseworkers, and insurance physicians. The study consisted of several rounds of questionnaires and one online meeting.ResultsThe multidisciplinary panel reached consensus that 58 out of 67 factors were important for RTW and that 35 of these factors could be targeted using VR interventions. In five rounds, the expert panel reached consensus that 11 out of 22 VR interventions were effective for at least one of the eight most important RTW factors.ConclusionsConsensus was reached among the expert panel that many factors that are important for the RTW of short-term disabled workers are also important for the RTW of long-term partially disabled workers and that a substantial number of these factors could effectively be targeted using VR interventions. The results of this study will be used to develop a decision aid that supports vocational rehabilitation professionals in profiling clients and in choosing suitable VR interventions.

Evaluation of the Effectiveness of Technology Transfer in the Process of Wood Crafts for Workers with Disabilities

Technological changes are important to increase productivity, quality of products produced, and provide safety and health for workers. The purpose of this paper is to evaluate the application of wood craft machinery technology by persons with disabilities. The first step is an initial survey of the existing wood craft production process, which related to the equipment used, work methods, and work results (productivity quality) as well as the level of accidents/health problems at work. Small enterprises for disabled workers were used as research objects to check the impact of technological changes on the production process. Changes in technology used in the form of cutting machine, carving chisel, small CNC machine, smoothing machine, and paint machine (finishing process). The Unified Theory of Acceptance and Use of Technology (UTAUT) was adopted to approach the assessment of the impact of the technology implementation of the wood carving process. Data was collected through several activities such as interviews and direct observation. The success measurement parameters were divided into several main points, including performance, effort, user behavior, experience, facility design, environmental impact, and the level of worker safety/health. In short, it can be said that technology can improve the quality and productivity of work for disabled workers while still paying attention to the ergonomic value of the human-machine relationship at the right workstation.

Trends in Permanent Work Disability Associated With Rheumatoid Arthritis in the United States, 1999-2015.

Advances in treatment over the past 20 years have resulted in improved control of rheumatoid arthritis (RA). The objective of our study was to investigate whether there has been a decrease in permanent work disability associated with RA in the US. Medicare data from 1999 to 2015 were used to identify beneficiaries age 20-59 years with RA who became eligible for Medicare coverage under Social Security Disability Insurance. Diagnosis of RA was based on physician claims in the first year of enrollment. Annual rates of enrollment were sex- and age-standardized to the 2000 US population. The study included 97,787 beneficiaries with RA and Social Security Disability Insurance across all years. Medicare enrollment was 26.0 per million in 1999 and 26.0 per million in 2015. Rates increased following the Great Recession of 2008-2009 before returning to prerecession levels. There was no linear trend over time after adjusting for the annual national unemployment rate (relative risk 0.99 per year [95% confidence interval 0.99-1.00]; P = 0.69). Risks of work disability were much higher among workers over age 50 years. Based on Medicare enrollment by recipients of Social Security Disability Insurance, there was no decrease in permanent work disability among young and middle-age workers with RA in the US between 1999 and 2015.

A conceptual framework addressing the complex labour market dynamics of the work-to-retirement process

The way in which retirement is conceptualized and measured is likely to influence the research findings. The previous literature has addressed a wide range of elements related to the complex work-to-retirement process, such as early, late and partial retirement, statutory retirement, work disability and unemployment paths to retirement, or different types of bridge employment. However, conceptual clarity in terms of connections between the different elements is called for. We introduce a conceptual framework of the work-to-retirement process to guide its future measurement. Together with information on the statutory retirement age, the main elements of the framework are based on employment and pension receipt, acknowledging that these may overlap. The framework is flexible to the user, providing the possibility to add various specifications—e.g. of types of employment, types of pension receipt, unemployment, and being outside the labour force—depending on the study context and aims. The framework highlights the complexity of the work-to-retirement process, bringing forth its multifaceted, multiphased and multidirectional features. Accounting for such complexity in later-life labour market dynamics helps to elaborate what is actually addressed when investigating “retirement”. Our conceptual framework can be utilized to enhance well-defined, precise and comparable measurement of the work-to-retirement process in studies.

Comprehensive approach to reintegration of disability benefit recipients with multiple problems (CARm) into the labour market: results of a randomized controlled trial

Purpose Although most clients on work disability benefits face multiple problems, most traditional interventions for (re)integration focus on a single problem. The aim of this study was to evaluate the “Comprehensive Approach to Reintegrate clients with multiple problems” (CARm), which provides a strategy for labour experts to build a relationship with each client in order to support clients in their needs and mobilize their social networks. Methods This study is a stratified, two-armed, non-blinded randomized controlled trial (RCT), with a 12-month follow-up period. Outcome measures were: having paid work, level of functioning, general health, quality of life, and social support. Results We included a total of 207 clients in our study; 97 in the intervention group and 110 in the care as usual (CAU) group. The clients’ mean age was 35.4 years (SD 12.8), 53.1% were female, and 179 (86.5%) reported multiple problems. We found the CARm intervention to have no significant effects superior to those of the CAU group on all outcomes. Conclusion As we found no superior effect of the CARm intervention compared to CAU, we cannot recommend widespread adoption of CARm. A process evaluation will give more insight into possible implementation failure of the intervention. IMPLICATIONS FOR REHABILITATION Most traditional interventions for (re)integration into the labour market are problem-centred, i.e., focusing on a single problem, and have limited effectiveness in persons with multiple problems. A strength-based intervention may be suitable for vocational rehabilitation and disability settings, since it contains many elements (e.g., being strength-based, focused on clients’ wishes and goals, and involving activation of the social environment) also likely to improve chances of re-employment of persons with multiple problems. In this study a strength-based intervention did not show a superior effect on paid employment and functioning within one year follow-up compared to care as usual in people with multiple problems on a work disability benefit.

Critical disability studies and the affirmative non-tragedy model: presenting a theoretical frame for disability and child protection

The purpose of this article is to present an integrated theoretical frame for the subject matter of disability and child protection. Substantive complexities, alluded to in existing literature, surround disability in child protection work. The high stakes and emotionally provocative practice of child safeguarding is often made even more complex by the presence of disability. Difficult balances must be struck, and with a plurality of approaches to understanding disability now available, the proposition is that one emerging theoretical alliance may be of particular utility. Specifically, when used for the subject matter of child protection, an affirmative non-tragedy model of disability within overarching critical disability studies theory, is useful in dealing with the multiple possibilities surrounding disability and child protection. The intention is to present this theoretical frame along with some possibilities for its extension, as a means for all stakeholders to reconsider the complexity that disability and child protection entails. Points of interest Disability is linked to some unique problems in the context of child protection such as that disabled children are more likely to be abused than non-disabled children. Other problems include that disability can mix with other identities in a way that makes risk more complex. Intellectually disabled parents can also experience prejudice and practitioners can struggle to understand and respond effectively to disability. Theorists within disability studies ought to deal with these problems. Part of the problems with disability and child protection is the way in which disability is thought about. The article presents an area of theory known as critical disability studies and a model known as the affirmative non-tragedy model and suggests that these are helpful in understanding issues to do with disability and child protection. Critical disability studies is about criticality and new thinking around disability. The non-tragedy model aims to prevent disability being linked to negativity.

Kernel Equations for a Modified Disability Income Insurance Model

A disabled worker does not earn enough for a living. Disability income insurance is a long-term guarantee that provides supplementary income when a worker is disabled or dies. In the standard model for disability income insurance, people who recovered from a disability condition are assumed to return to the initial healthy condition (i.e., before being disabled). This assumption might not be realistic. In this paper, we present a modification of the standard disability income insurance model, in which the recovery state is separated from the initial healthy/active state. Disability benefit is given in terms of annuities while the policyholder is disabled. The annuities cease as he/she recovers and resume if he/she becomes disabled again. The death benefit is given if the policyholder dies. To make the model more realistic, we apply semi-Markov assumptions. In this assumption, the length of staying in a condition affects the probability of leaving that condition. We present the kernel equations for the model and take a case study using the US Social Security Administration data for workers born in 1996 with an age range of 20 to 62 years. We calculate the transition probabilities and premiums for some examples of insurance products.

P094 Occupation and work productivity in individuals with early inflammatory arthritis: results from the National Early Inflammatory Arthritis Audit

Abstract Background/Aims To continue working, work in the same occupation or work the same number of hours is one of the most important outcomes for individuals with inflammatory arthritis but is often diminished during the very early phases of disease. Our objectives were to describe occupation and work status in individuals with early inflammatory arthritis (EIA) from the National Early Inflammatory Arthritis Audit (NEIAA) and assess the impact of occupation and treatment response on work disability. Methods NEIAA is an observational cohort of adults with newly diagnosed EIA seen in rheumatology services in England and Wales between May 2018 and March 2020. Self-reported occupation was coded using the UK Standard Occupational Classification and classified using the National Statistics Socio-Economic Classification (NS-SEC). Work disability was assessed at diagnosis, 3 months, and 12 months, using the work productivity and activity impairment (WPAI) score, with absenteeism data dichotomized between those who reported any sick-leave and those who did not. Multilevel mixed-effects linear regression models were used to examine associations between occupation and WPAI score at baseline and over 12 months. Variables for adjustment were decided a priori and included only age and sex. Results There were 12,663 individuals with EIA, with 5999 (48%) in paid work defined as greater than 20 hours per week. Occupation data were available for 3720 individuals, with the highest proportion of patients in lower managerial, administrative, professional (n = 773) and semi-routine (n = 761) roles. At diagnosis, 171 patients (4.7%) had stopped work and 336 (9.2%) had changed jobs because of their EIA. Absenteeism was reported by 685 patients (29.5%). Compared to the higher managerial, administration and professional occupation group, the other occupational types demonstrated a greater level of productivity loss due to presenteeism and overall work impairment. Individuals in semi routine and routine occupations were more likely to stop work due to EIA. In the 12 months after diagnosis, absenteeism, presenteeism and overall impairment improved across all occupations. Achieving a good EULAR response at 3 months, but not occupational type, was associated with improvement in work outcomes over time (p value &amp;lt;0.001). Conclusion Work disability is prevalent in individuals with EIA at diagnosis, with variation across occupation types. In the first 12 months after diagnosis improvements in all work outcomes are seen, with the greatest change in those who achieve a good EULAR response. Disclosure K. Bechman: None. E. Cook: None. A. Houssien: None. P. Amlani-Hatcher: None. J. Ledingham: None. J. Galloway: Consultancies; Sanofi, Novartis, Pfizer, Janssen, UCB. Grants/research support; Eli Lilly. K. Walker-Bone: None.