Background/Purpose Employment is linked to prosperity, identity, and the ability to contribute to society.  Lower employment is well documented among adults with arthritis, but less is known about trajectories of stopping or starting work and subgroups particularly at risk for not working.  Our purpose was to describe longitudinal patterns in work stopping and starting among three groups of U.S. adults ≥18 years: 1) those with no arthritis (arthritis^_), those with arthritis but no arthritis-attributable work limitation (AAWL-), and those with arthritis and AAWL (AAWL+).

Methods We analyzed data for those in the 2009 National Health Interview Survey (an ongoing nationally representative survey of the U.S. civilian, noninstitutionalized population) Sample Adult Core who were subsequently followed for 5 rounds in the 2010-2011 Medical Expenditures Panel Survey (n=24,870; response rate=57.2%).  AAWL+ was “yes” to: “Do arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do?”  Among those working in 2009, we examined baseline characteristics (sociodemographic [age, sex, race/ethnicity, education], chronic health condition, and job) and estimated risk of stopping work with hazard ratios (HR) and 95% confidence intervals (CIs) using unadjusted and multivariable adjusted models for the 3 groups; among those not working in 2009, we used the same methods to examine starting work.

Results At baseline, the proportion working was substantially lower among those with AAWL+ (28.6%; 95% CI=26.1-31.1) compared with AAWL- (47.3%; 45.1-49.4) and arthritis^_ (66.9%; 66.0-67.8).  A significantly higher proportion with AAWL+ (24.2%; 21.7-26.5) had not finished high school compared with AAWL- (13.6%; 12.3-14.8) and arthritis^_  (14.2%; 13.5-15.0),  and more of those with AAWL+ (39.5%; 37.0-42.0) had high functional limitations compared with AAWL- (8.5%; 7.6-9.4) or arthritis^_  (2.1%; 1.8-2.3).  Multivariable adjusted HRs for stopping work (referent: arthritis^_) were 1.1 (0.8-1.6) for AAWL- and 2.0 (1.4-3.1) for AAWL+ (unadjusted HRs were virtually identical).  Multivariable adjusted HRs (referent: arthritis^_) for starting work were 1.1 (0.7-1.7) for AAWL- and 0.5 (0.3-0.9) for AAWL+; unadjusted HRs were 0.4 [0.2-0.6] for AAWL- and 0.3 [0.2-0.6] for AAWL+.

Conclusion Over two years of follow-up, the presence of AAWL+ was a substantial and significant risk factor for stopping work (HR = 2.0) and not starting work (HR=0.5), even after adjusting for baseline differences, including characteristics (e.g., low educational attainment) associated with not working.  Those with AAWL- followed the same pattern as those with arthritis^_.  For starting work, adjustment attenuated arthritis effects only among AAWL-, whereas AAWL+ consistently identifies a unique group of individuals at risk for increased work loss and reduced work entry over time.  Identification  of AAWL+ may be a useful indicator for offering clinical, public health, job accommodation, and other interventions to retain and gain employment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/does-arthritis-status-predict-starting-or-stopping-work-over-a-2-year-period/