The Role of Individual and Country-Level Socio-Economic Factors in Work Participation in Patients with Spondyloarthritis across 22 Countries Worldwide: Results from the Comospa Study

Santiago Rodrigues Manica^1,2, Alexandre Sepriano^3,4, Sofia Ramiro^5,6, Fernando Pimentel-Santos^1,2, Polina Putrik⁷, Elena Nikiphorou^8,9, Anna Moltó^10,11, Maxime Dougados^11,12, Désirée van der Heijde¹³, Robert B.M. Landewé¹⁴, Filip van Den Bosch¹⁵ and Annelies Boonen⁷, ¹CEDOC, NOVA Medical School, Lisbon, Portugal, ²Rheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal, ³CEDOC, NOVA Medical School, Lisboa, Portugal, ⁴Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ⁵Rheumatology, Department of Rheumatology, LUMC, Leiden, Netherlands, Leiden, Netherlands, ⁶R. Câmara Pestana 6, CEDOC, NOVA Medical School, Lisbon, Portugal, ⁷MUMC+, Maastricht, Maastricht, Netherlands, ⁸Whittington Hospital, London, United Kingdom, ⁹Academic Rheumatology Department, King's College London, London, United Kingdom, ¹⁰Rheumatology B Department, Paris Descartes University, Cochin Hospital, AP-HP,Paris, Paris, France, ¹¹7 INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France, ¹²Paris, Paris, France, ¹³Leiden University Medical Center, Leiden, Netherlands, ¹⁴Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam and Atrium Medical Center, Heerlen, Netherlands, ¹⁵Rheumatology, Ghent University Hospital, Gent, Belgium

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Economics, Health equity, outcomes and spondylarthritis, Work Disability

Session Information

Date: Tuesday, November 7, 2017

Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster III: Outcomes, Outcome Measures, and Comorbidities

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Spondyloarthritis (SpA) carries substantial financial costs, including direct costs (use of medical services and treatments) and indirect costs (loss of work productivity). While disease related factors have been repeatedly shown to be associated with work outcomes, information on the role of individual socio-economic (SE) factors (education) and country wealth is scarce.

To explore the role of individual and country SE factors on employment, absenteeism and presenteeism, across 22 countries, from different world regions.

Methods: Patients with a clinical diagnosis of SpA, fulfilling the ASAS SpA criteria and in working age (≤65 years old) from the evaluation of co-morbidities in spondyloarthritis (COMOSPA) were included. Outcomes explored were employment-status, absenteeism and presenteeism (the last 2 only in employed patients, in the last 7 days) according to the Work Productivity and Activity Impairment Specific Health Problem (WPAI-SHP) questionnaire. Three multivariable models were built (one for each outcome) using a multilevel mixed-effects binomial regression (for work status) and ordinal regression (for absenteeism and presenteeism), with country as random-effect.

Independent contribution of individual (education) and country level socio-economic factors (human development index (HDI), country healthcare expenditures and gross domestic product (GDP) (all low vs medium/high tertiles) were assessed in models adjusted for clinical factors.

Results: In total 3,114 patients were included (mean (SD) age 40.9 (11.8) years; 66% males; and 63% employed). Unadjusted employment rates ranged from 28% (Colombia) to 83% (Canada). After adjustment for relevant confounders, differences between countries in work status persisted (p<0.01). At the individual level, higher education was positively associated with being employed (OR=4.21 [95%CI 3.14;5.64]) and lower presenteeism (OR=0.61 [95%CI=0.40;0.93]) (table). At a country level, a higher healthcare expenditure was associated with being employed (OR=2.32; [95%CI=1.48;3.63]) and a higher HDI was associated with a higher employment (OR=1.89 [95%CI=1.19;3.27]) and lower absenteeism (OR=0.48 [95%CI=0.24;0.95]). No significant association was found for GDP. No significant association between any country SE indicators and presenteeism was found.

Conclusion: Individual- and country-level SE factors are associated with work participation in SpA. Work outcomes vary significantly across countries and better socio-economic wealth and welfare seem to be associated with more SpA patients remaining at work and productive.

Disclosure: S. Rodrigues Manica, None; A. Sepriano, None; S. Ramiro, None; F. Pimentel-Santos, None; P. Putrik, None; E. Nikiphorou, None; A. Moltó, None; M. Dougados, None; D. van der Heijde, None; R. B. M. Landewé, None; F. van Den Bosch, None; A. Boonen, None.

To cite this abstract in AMA style:

Rodrigues Manica S, Sepriano A, Ramiro S, Pimentel-Santos F, Putrik P, Nikiphorou E, Moltó A, Dougados M, van der Heijde D, Landewé RBM, van Den Bosch F, Boonen A. The Role of Individual and Country-Level Socio-Economic Factors in Work Participation in Patients with Spondyloarthritis across 22 Countries Worldwide: Results from the Comospa Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-role-of-individual-and-country-level-socio-economic-factors-in-work-participation-in-patients-with-spondyloarthritis-across-22-countries-worldwide-results-from-the-comospa-study/. Accessed .

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