Staying in the labor force among patients with rheumatoid arthritis and associated factors in Southern Brazil

Gomes, Rafael Kmiliauskis Santos; Schreiner, Luana Cristina; Vieira, Mateus Oliveira; Machado, Patrícia Helena; Nobre, Moacyr Roberto Cuce

doi:10.1186/s42358-018-0009-9

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Research • Adv. rheumatol. 58 • 2018 • https://doi.org/10.1186/s42358-018-0009-9 copy

Staying in the labor force among patients with rheumatoid arthritis and associated factors in Southern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Rheumatoid arthritis primarily affects the working-age population and may cause key functional and work limitations. As the disease progresses, individuals become increasingly unable to conduct daily activities, which has a substantial personal and socioeconomic impact. Fairly recent prior studies showed that patients with RA stop working 20 years earlier than age-matched controls. Factors related to sociodemographic, clinical, care and disease profiles might affect the loss of work capacity. The purpose of this study was to assess the factors associated with the prevalence of working patients with rheumatoid arthritis in the municipality of Blumenau.

Methods:

A cross-sectional, population-based study was conducted between July 2014 and January 2015, with 296 individuals aged 20 years or older, male and female, living in Blumenau, Santa Catarina state, Brazil, and diagnosed with rheumatoid arthritis according to the 1987 American College of Rheumatology criteria. The prevalence of working patients with RA was assessed by employment status self-reporting during the interview. The chi-squared test, Wald test and Poisson regression analysis were used to test the possible associations between the independent variables and outcome.

Results:

The prevalence of working patients with rheumatoid arthritis was 44.3%. Patients aged 20 to 59 years had a 90% higher prevalence of outcome than subjects aged 60 years or older. The prevalence of working patients was 132% and 73% higher among individuals with low income and high functional disability, measured using the Health Assessment Questionnaire (HAQ), respectively.

Conclusion:

The prevalence of working RA patients was highest among adult patients with low income and high functional disability. The first variable is directly related to the individual characteristic, the second reflects the socioeconomic context of the patient, and the third reflects the degree of disability caused by the disease, which may be modifiable by health professionals.

Keywords:
Rheumatoid arthritis; Occupation; Job market

Variables		Sample		Working Patients
		n ^* * Number of working patients with rheumatoid arthritis who were on sick leave or were disability retirees	%	Prevalence (%) 95% CI	p
Total		185	100.0	44.3 (37.0-51.5)
Sex (n = 185)					0.943^ Chi-squared test
	Male	32	17.3	43.7 (25.5-61.9)
	Female	153	82.7	44.4 (36.4-52.4)
Age in years (n = 185)					0.025^* ***** Wald test
	20-59 (adults)	133	71.9	48.8 (40.2-57.4)
	≥ 60 (elderly)	52	28.1	32.6 (19.5-45.8)
Income in minimum wages (n = 154)					0.001^* ***** Wald test
	0-2	117	75.9	34.1 (25.5-42.9)
	>2	37	24.1	64.8 (48.2-81.0)
Education in completed years (n = 176)					0.000^* ***** Wald test
	0-4	60	34.1	25.0 (13.7-36.2)
	>4	116	65.9	54.3 (45.1-63.5)
Self-reported skin color (n = 178)					0.686^ Chi-squared test
	White	165	92.7	44.2 (36.5-51.9)
	Brown and black	13	7.3	38.4 (7.8-69.0)
Presence of comorbidities (n = 181)					0.016^ Chi-squared test
	No	87	48.1	52.8 (42.1-63.5)
	Yes	94	51.9	35.1 (25.2-44.9)
Consultation with another rheumatologist (n = 181)					0.900^ Chi-squared test
	No	50	27.6	44.0 (29.7-58.2)
	Yes	131	72.4	45.0 (36.4-53.6)
Number of visits in the last 12 months (n = 176)					0.111^* ***** Wald test
	0-2	74	42.1	51.3 (39.6-63.0)
	≥3	102	57.9	39.2 (29.5-48.8)
Type of medical care (n = 163)					0.637^ Chi-squared test
	SUS	72	44.1	40.2 (28.6-51.8)
	Private and Public-Private Partnership	91	55.9	43.9 (33.5-54.3)
Diagnostic delay in months (n = 178)					0.982^* ***** Wald test
	0-3	46	25.9	45.6 (30.6-60.6)
	≥4	132	74.1	45.4 (36.8-54.0)
Disease time in months (n = 185)					0.681^* ***** Wald test
	0-24	20	10.9	4.0 (16.4-63.5)
	≥ 25	165	89.1	44.8 (37.1-52.5)
Current use of DMARDs (n = 168)					0.724^ Chi-squared test
	No	46	27.3	45.6 (30.6-60.6)
	Yes	122	72.7	42.6 (33.7-51.5)
Current use of biologicals (anti-TNF) (n = 172)					0.162^ Chi-squared test
	No	116	67.4	42.2 (33.1-51.3)
	Yes	56	32.6	53.5 (40.0-67.0)
HAQ score (n = 110)					0.009^* ***** Wald test
	0-1	45	41.0	62.2 (47.4-76.9)
	1.1-3	65	59.0	36.9 (24.8-48.9)
Rheumatoid factor (n = 160)					0.873^ Chi-squared test
	0-60 (normal or low titer)	90	56.2	45.4 (35.0-56.0)
	≥ 61 (high titers)	70	43.8	44.2 (32.3-56.2)
Radiography of hands with joint erosion (n =151)					0.375^ Chi-squared test
	No	62	41.0	50.0 (37.1-62.8)
	Yes	89	59.0	42.6 (32.2-53.1)

Variables		Crude analysis		Adjusted analysis
		PRc (95% CI)	p	PRa (95% CI)	p
Sex (n = 185)			0.943^* * Excluded from the adjusted analysis (p value > 0.20)		NS
	Male	0.98 (0.70-1.38)
	Female	1
Age in years (n = 185)			0.023		0.001
	20-59 (adults)	1.33 (1.04-1.71)		1.90 (1.31-2.75)
	≥ 60 (elderly)	1		1
Income in minimum wages (n = 154)			0.007		0.008
	0-2	1.87 (1.18-2.96)		2.32 (1.24-4.36)
	>2	1		1
Education in completed years (n = 176)			0.000		0.676^ Excluded from the final model (p value > 0.05)
	0-4	1.64 (1.28-2.10)		1.08 (0.74-1.58)
	>4	1		1
Self-reported skin color (n = 178)			0.669^* * Excluded from the adjusted analysis (p value > 0.20)		NS
	White	1
	Black + Brown	1.1 (0.70-1.73)
Presence of comorbidities (n = 181)			0.019		0.464^ Excluded from the final model (p value > 0.05)
	No	1		1
	Yes	1.37 (1.05-1.80)		1.08 (0.74-1.58)
Consultation with another rheumatologist (n = 181)			0.900^* * Excluded from the adjusted analysis (p value > 0.20)		NS
	No	1
	Yes	0.98 (0.73-1.31)
Number of visits in the last 12 months (n = 176)			0.121		0.619^ Excluded from the final model (p value > 0.05)
	0-2	1.03 (0.99-1.08)		0.91 (0.65-1.28)
	≥3	1		1
Type of medical care (n = 163)			0.637^* * Excluded from the adjusted analysis (p value > 0.20)		NS
	SUS	1.06 (0.81-1.38)
	Private + Public-Private Partnership	1
Diagnostic delay in months (n = 178)			0.982^* * Excluded from the adjusted analysis (p value > 0.20)		NS
	0-3	1
	≥4	1.01 (0.73-1.36)
Disease time in months (n = 185)			0.667^* * Excluded from the adjusted analysis (p value > 0.20)		NS
	0-24	1
	≥ 25	0.91 (0.62-1.35)
Current use of DMARDs (n = 168)			0.729^* * Excluded from the adjusted analysis (p value > 0.20)		NS
	No	0.94 (0.69-1.28)
	Yes	1
Current use of biologicals (n = 172)			0.184		0.481^ Excluded from the final model (p value > 0.05)
	No	1.24 (0.90-1.71)		1.17 (0.79-1.73)
	Yes	1		1
HAQ (n = 110)			0.017		0.017
	0-1	1		1
	1.1-3	1.66 (1.09-2.54)		1.73 (1.10-2.72)
Rheumatoid factor (n = 160)			0.873^ Excluded from the final model (p value > 0.05)		NS
	0-60 (normal or low titer)	1
	≥ 61 (high titers)	1.02 (0.77-1.35)
Radiography of hands with joint erosion (n =151)			0.385^ Excluded from the final model (p value > 0.05)		NS
	No	1
	Yes	1.14 (0.84-1.55)

Sociedade Brasileira de Reumatologia Av. Brigadeiro Luís Antônio, 2466, Jardim Paulista, 01402-000 - São Paulo, SP, Tel.: +551132897165 - São Paulo - SP - Brazil
E-mail: rbreumatol@terra.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Correspondence: gomesmed2002@ibest.com.br