Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: We sought to assess work productivity, factors associated with reduced productivity, and the relationship between work productivity and health-related quality of life (HRQoL) in systemic sclerosis (SSc).
Methods: This is a cross-sectional study of SSc patients identified through the Australian Scleroderma Cohort Study database. All patients were mailed 2 employment questionnaires (Workers Productivity and Activity Impairment Questionnaire (WPAI) and a self-made questionnaire) and 2 HRQoL questionnaires (SF-36 and PROMIS 29). Summary statistics, chi-square tests and linear regression were used to determine the associations of work productivity.
Results: Of 800 questionnaires, 476 were returned, equating to a response rate of 59.5%. Of those aged under 65 years (standard retirement age in Australia), 55.2% were employed. Unemployed patients were older at the time of survey completion (57.1 vs 53.7, p<0.001) and had longer disease duration from the first clinical manifestation of SSc (16.2 vs 14.9, p=0.01) than those who were employed. The mean age of unemployment was ten years less than the average Australian retirement age. Disease characteristics by employment status are outlined in Table 1. Of those in paid employment, 16.0% reported missing work (absenteeism) in the past week due to SSc, accounting for 32.9% of their working time. The mean number of missed work due to SSc was 11.4 (±10.9) hours. For all employed patients, the overall mean number of hours worked in the last week was 26.9 (±13.3), well below the average Australian full-time working week (38-hours). Only 27% of patients were working ≥38 hours a week. Of those working, 22% of their working time was impaired due to SSc (‘presenteeism’). The mean overall work impairment accounted for 24.4% of working time. Additionally, 37.9% of the patients’ daily activities had been prevented due to their SSc. Factors associated with overall work impairment (absenteeism and presenteeism) included a lack of tertiary education (p=0.04), synovitis (p=0.05) and sicca symptoms (p=0.03). Factors associated with impairments in daily activities included a lack of tertiary education (p=0.04), interstitial lung disease (p=0.01), digital amputation (p=0.005) and sicca symptoms (p=0.001). Unemployed patients had significantly lower HRQoL scores across a number of SF-36 domains compared with employed patients, which was mirrored in the PROMIS-29 (Table 2).
Conclusion: SSc is associated with substantial unemployment and reduced productivity, which is in turn associated with poor HRQoL. Raising awareness and identifying modifiable risk factors are possible ways of reducing this burden.
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Table 1 Patient characteristics according to employment status in those less than 65 years of age |
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|
Variables |
Employed mean±SD or n(%) |
Unemployed mean±SD or n(%) |
p-value |
| Total number of patients |
133 (55.2%) |
108 (44.8%) |
<0.001 |
| Female |
116 (87.2%) |
98 (90.7%) |
0.93 |
| Age at completion of survey years |
53.7±7.9 |
57.1±6.6 |
0.001 |
| Disease duration at survey, years |
14.9±8.3 |
16.2±9.7 |
0.31 |
| Age at unemployment, years |
n/a |
48.3 (9.1) |
|
| Race Caucasian Asian Aboriginal-Islander Hispanic Other |
117 (90.7%) 5 (3.9%) 3 (2.3%) 1 (0.8%) 3 (2.3%) |
93 (90.3%) 8 (7.8%) 2 (1.9%) 0 (0%) 0 (0%) |
0.31 |
| Tertiary education |
82 (63%) |
55 (52.9%) |
0.12 |
| Physical nature of job (current or past) |
39 (32.5%) |
44 (44.9%) |
0.06 |
| SSc subtype lcSSc dcSSc MCTD |
98 (73.7%) 34 (25.6%) 0 (0%) |
74 (68.5%) 32 (29.6%) 2 (1.9%) |
0.01 |
| Clinical manifestations# Gastrointestinal involvement Synovitis Small joint contractures in hands Digital ulcers Digital amputation Calcinosis Sicca symptoms PAH ILD Renal Crisis Myositis Tendon friction rubs Modified Rodnan Skin Score |
75 (56.4%) 24 (18.9%) 58 (43.6%) 67 (50.4%) 7 (5.3%) 55 (41.4%) 71 (53.4%) 0 (0%) 32 (24.1%) 1 (0.8%) 1 (0.8%) 13 (9.8%) 10.9 ± 8.7 |
74 (68.5%) 33 (31.4%) 64 (59.2%) 53 (49.1%) 4 (3.7%) 48 (44.4%) 68 (62.9%) 10 (9.3%) 29 (26.9%) 8 (7.4%) 6 (5.6%) 15 (13.9%) 13.1 ± 11.3 |
0.05 0.02 0.04 0.33 0.08 0.63 0.06 <0.001 0.62 0.01 0.01 0.32 0.09 |
| * age at unemployment according to self report in the questionnaire | |||
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Table 2. HRQoL according to employment status measured using SF- in those less than 65 years of age
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| Patient reported outcomes |
Employed mean±SD |
Unemployed mean±SD or n(%) |
p-value |
| Number of patients |
133 |
108 |
|
| SF 36 Domains Physical functioning Role physical Role emotional Vitality Mental Health Social functioning Bodily Pain General Health Physical component score Mental component score |
67.6±24.4 57.9±42.8 75.3±38.8 49.2±21.6 71.1±17.5 75.5±23.1 68.4±23.7 48.2±22.9 41.9±10.3 46.9±10.6 |
50.6±25.3 29.0±40.4 53.8±45.2 38.3±23.4 66.6±19.8 61.2±24.4 53.6±23.6 36.2±22.2 33.9±10.3 43.2±11.8 |
<0.001 <0.001 0.001 0.001 0.06 <0.001 <0.001 0.001 <0.001 0.01 |
| PROMIS 29 Domains Physical function Anxiety Depression Fatigue Sleep disturbance Satisfaction with participation in social roles Pain interference Pain intensity global (NRS 0-10) |
45.9 (±8.1) 52.2 (±9.8) 50.3 (±9.5) 54.4 (±10.4) 53.4 (±8.3) 75.5 (±23.2) 68.4 (±23.7) 2.8 ± 2.4 |
40.8 (±7.5) 53.6 (±9.9) 53.4 (±10.1) 58.6 (±10.2) 55.0 (±8.6) 61.2 (±24.4) 53.6 (±23.6) 4.3 ± 2.6 |
<0.001 0.27 0.01 0.002 0.13 <0.001 <0.001 <0.001 |
To cite this abstract in AMA style:
Morrisroe K, Huq M, Stevens W, Sahhar J, Proudman S, Nikpour M. Work Productivity in Systemic Sclerosis and Association with Health Related Quality of Life [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/work-productivity-in-systemic-sclerosis-and-association-with-health-related-quality-of-life/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/work-productivity-in-systemic-sclerosis-and-association-with-health-related-quality-of-life/