SAT0072 THE IMPACT OF COMORBIDITIES ON ABSENTEEISM, PRESENTEEISM AND EMPLOYMENT STATUS IN PEOPLE LIVING WITH RHEUMATOID ARTHRITIS
Authors: A. Bradshaw, A. Bosworth, K. Walker-Bone, L. Lunt, S. Verstappen
Journal: Annals of the Rheumatic Diseases (2020)

Background: Many people with rheumatoid arthritis (RA) have comorbidities. However, there is limited research on the impact of multimorbidity on absenteeism (e.g. sick leave) and presenteeism (i.e. reduced productivity while at work due to ill health) in people with RA. Objectives: i) to explore the impact of comorbidities on absenteeism and presenteeism in patients with RA and ii) to evaluate the association between multimorbidity and employment status. Methods: A cross-sectional survey was conducted by the National Rheumatoid Arthritis Society (NRAS), UK, collecting information on: demographics, education, employment status (i.e. employed (Empl), stopped/retired early because of RA (Stop_RA), stopped/retired early because of other health issues (Stop_Health)), and disease related variables (e.g. symptom duration, rheumatoid arthritis impact of disease (RAID) questionnaire). Participants were asked to report whether they had or were treated for any of 15 predefined comorbidities (categorised into 0, 1, 2, 3, or ≥4 (Table)). Percentage of number of hours missed due RA (i.e. absenteeism) and presenteeism (10-point Likert scale) were assessed using the Work Productivity and Activity Impairment Questionnaire (WPAI-RA). For the purpose of this study both absenteeism and presenteeism outcomes were dichotomized (no presenteeism/absenteeism versus any) and only patients aged &lt;65yrs were included. Logistic regression analysis were applied to assess the association between number of comorbidities and absenteeism/presenteeism, adjusting for the categorical variables age, gender and education. Chi2-square test was applied to assess frequencies of individual comorbidities between the three employment status groups. Results: 868 participants were included; 91.7% women with a median symptom duration of 8.3 years [IQR 4.4-13.7]. The average RAID score was 5.2 (SD 2.2). 80.4% were in paid employment, including those currently on sick leave, 16.9% stopped early because of their RA and 2.7% reported stopping early because of other health reasons. In those employed most commonly occurring comorbidities were: back pain (28.8%%), osteoarthritis (21.5%), depression (26.3%) and anxiety (22.6%). Compared to people with RA with no comorbidities, the odds associated with time off work due to RA increased from 1.7 up to 3.4 with increasing number of comorbidities (Table). Although a similar trend was observed for presenteeism, the effect sizes were smaller. Significant differences (p&lt;0.05) in frequencies of the following comorbidities were observed between the three employment status groups (Empl, Stop_RA, Stop_Health, respectively): heart disease (3.9%, 7.9%, 20.0%), blood pressure (18.0%, 29.5%, 36.7%), lung disease (5.7%, 16.3%, 26.7%), diabetes (4.4%, 4.2%, 26.7%), ulcer (6.1%, 11.1%, 13.3%), cancer (3.3%, 2.6%, 13.3%), depression (26.3%, 33.6%, 50.0%), OA (21.5%, 44.7%, 63.33%), and back pain (28.8%, 48.4%, 60.0%). Absenteeism (yes/no ) Presenteeism (yes/no ) Number of comorbidities N OR 95%CI OR 95%CI 0 206 Ref. Ref. 1 174 1.70 1.06-2.71 1.66 1.00-2.73 2 136 1.77 1.08-2.92 1.99 1.13-2.86 3 85 1.75 1.00-3.08 1.53 0.82-2.86 4-15max 86 3.38 1.98-5.78 2.64 1.28-5.44 OR=odds ratio; 95%CI=95% confidence interval; Comorbidities included: heart disease, blood pressure, lung disease, diabetes, ulcer or stomach disease, kidney disease, liver disease, anaemia or other blood disease, cancer, depression, anxiety, OA, back pain, osteoporosis and Sjögren. Bold figures P &lt;0.05. Conclusion: Although the study is cross-sectional and no temporal association can be determined, this study shows that not only personal and work related contextual factors should be considered when preventing worker productivity loss, but also other comorbidities. Disclosure of Interests: A. Bradshaw: None declared, Ailsa Bosworth Speakers bureau: a number of pharmaceutical companies for reasons of inhouse training, advisory boards etc., K. Walker-Bone: None declared, Laura Lunt: None declared, Suzanne Verstappen Grant/research support from: BMS, Consultant of: Celltrion, Speakers bureau: Pfizer