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Long-term trajectories of employment status, workhours and disability support pension status, after a first episode of CNS demyelination

journal contribution
posted on 2023-05-21, 16:13 authored by Amin Zarghami, Ingrid van der MeiIngrid van der Mei, Mohammad Akhtar Hussain, Susan ClaflinSusan Claflin, Bessing, B, Steve Simpson JRSteve Simpson JR, Ponsonby, A-L, Lechner-Scott, J, Broadley, S, Christopher BlizzardChristopher Blizzard, Bruce TaylorBruce Taylor

Background: People with multiple sclerosis face significant employment-related challenges, with little known of the drivers of these outcomes.

Objective: We examined prospective trajectories of employment-related outcomes up to 11 years following a first episode of central nervous system (CNS) demyelination (FCD).

Methods: Participants were aged 18-59 years, at FCD, with at least two observations and were employed at study entry or anytime during follow-up (n = 207). Outcomes were employment status (full-time, part-time and unemployed), average workhours per week and disability support pension (DSP; receiving/not receiving). We used group-based trajectory modelling to identify groups with common trajectories. Factors associated with trajectory membership were explored using log-multinomial regression.

Results: Distinct trajectories were identified for employment (4), workhours (4) and DSP (2). Compared with stable full-time, female sex was strongly associated with being in the stable part-time trajectory (risk ratio (RR): 5.35; 95% confidence interval (CI) = 2.56-11.20; p < 0.001). A greater level of disability at 5-year review (RR: 1.35; 95% CI = 1.19-1.53) and having more than two comorbidities at baseline (RR: 2.77; 95% CI = 1.37-5.64) were associated with being in early and late deteriorated employment trajectories, respectively. Compared with the increased part-time trajectory, every additional relapse during the 5 years post-FCD was associated with a 10% increased risk of being in the reduced part-time trajectory (RR = 1.10; 95%CI = 1.00-1.22). For every additional EDSS point at 5-year review, the risk of being in the DSP trajectory increased (RR = 1.21; 95% CI = 1.05-1.41).

Conclusion: These trajectories indicate substantial heterogeneity and the complex impact of MS on employment from its earliest timepoints. Understanding these trends could enable better targeting of interventions to facilitate workforce retention, particularly for females, those with a higher number of comorbidities, more frequent relapses and greater rate of disability accrual.

History

Publication title

Multiple Sclerosis

Volume

28

Issue

11

Pagination

1793–1807

ISSN

1352-4585

Department/School

Menzies Institute for Medical Research

Publisher

Arnold

Place of publication

Hodder Headline Plc, 338 Euston Road, London, England, Nw1 3Bh

Rights statement

© The Author(s), 2022.

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

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