Mau Wilfried, Listing Joachim, Huscher Doerte, Zeidler Henning, Zink Angela
Institute for Rehabilitation Medicine, Martin-Luther University Halle-Wittenberg, Halle, Germany.
J Rheumatol. 2005 Apr;32(4):721-8.
To compare labor force participation across chronic inflammatory rheumatic diseases in order to assess the influence of the disease, disease duration, sex, education, and labor market conditions on employment.
Data from the German rheumatological database on outpatients of working age (20-59 yrs) between 1993 and 2001 were analyzed. The patients had rheumatoid arthritis (RA; n = 26,071), ankylosing spondylitis (AS; n = 5564), psoriatic arthritis (PsA; n = 6041), systemic lupus erythematosus (SLE; n = 4603), systemic sclerosis (SSc; n = 802), or Wegener's granulomatosis (WG; n = 385). Using population data, standardized employment ratios (SER) and part-time employment ratios of observed versus expected cases with 95% CI were calculated by means of indirect standardization for age and year of documentation.
Across all diseases the overall employment rates were significantly lower than in the general population. Significant differences in SER were found between the diseases. The lowest SER of 0.76 to 0.81 (1.0 = population) were found in patients with RA, SLE, SSc, and WG. Higher SER were seen in AS (0.94) and PsA (0.92). In patients with a disease duration > 10 years the relative risk of being employed compared to RA, was 1.42 for AS, 1.26 for PsA, and 1.15, 1.03, 0.62 for PsA, SLE, SSc and WG, respectively. Comparing areas with low and high unemployment rates, a highly significant influence of labor market conditions on the SER was observed. The SER were significantly lower in patients with < 10 years of school education.
Differences between employment rates in the population and the rates for the diseases under study are smaller than assumed by most clinical studies, especially in AS and PsA. However, these differences increase with longer disease duration. Specific measures to prevent patients from losing their job are needed, especially in areas with overall high unemployment.
比较慢性炎性风湿性疾病患者的劳动力参与情况，以评估疾病、病程、性别、教育程度和劳动力市场状况对就业的影响。
分析德国风湿病数据库中1993年至2001年间工作年龄（20 - 59岁）门诊患者的数据。患者患有类风湿关节炎（RA；n = 26,071）、强直性脊柱炎（AS；n = 5564）、银屑病关节炎（PsA；n = 6041）、系统性红斑狼疮（SLE；n = 4603）、系统性硬化症（SSc；n = 802）或韦格纳肉芽肿（WG；n = 385）。利用人口数据，通过对年龄和记录年份进行间接标准化，计算观察病例与预期病例的标准化就业率（SER）和兼职就业率，并给出95%置信区间。
所有疾病患者的总体就业率均显著低于普通人群。各疾病之间的SER存在显著差异。RA、SLE、SSc和WG患者的SER最低，为0.76至0.81（1.0为普通人群）。AS患者（0.94）和PsA患者（0.92）的SER较高。病程> 10年的患者与RA患者相比，就业的相对风险分别为：AS为1.42，PsA为1.26，PsA、SLE、SSc和WG分别为1.15、1.03、0.62。比较失业率低和高的地区，观察到劳动力市场状况对SER有高度显著影响。受教育年限< 10年的患者SER显著较低。
所研究疾病患者的就业率与普通人群就业率之间的差异小于大多数临床研究的假设，尤其是在AS和PsA患者中。然而，这些差异会随着病程延长而增大。需要采取具体措施防止患者失业，尤其是在总体失业率高的地区。
