Musculoskeletal Collaboration (Epidemiology Group), School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
Rheumatology (Oxford). 2014 May;53(5):953-6. doi: 10.1093/rheumatology/ket483. Epub 2014 Jan 31.
ANCA-associated vasculitis (AAV) commonly affects those of working age. Since survival rates have been transformed by immunotherapeutics, the measurement of other outcomes has become increasingly relevant. Work disability is an important outcome for both patient and society that has yet to be fully evaluated in AAV. We aimed to assess employment status in AAV patients and identify putative predictors of their work disability.
A cross-sectional study was undertaken. AAV cases were recruited according to consecutive clinic attendance. Subjects completed a questionnaire that determined employment status and other psychosocial measures. Clinical factors were concurrently recorded by the attending physician. From the data of those subjects of working age, a multivariable model was developed using forward stepwise logistic regression to identify the independent associations of work disability, defined by those subjects reporting unemployment secondary to ill-health. Results are expressed as odds ratios (ORs) and 95% CIs.
Of the 410 participants (84.4% response rate), 149 (36.7%) were employed, 197 (48.6%) retired and 54 (13.3%) unemployed secondary to ill health. Of those of working age, 26.0% were considered work disabled. Fatigue (OR 7.1, 95% CI 1.5, 33.1), depression (OR 4.4, 95% CI 1.8, 10.8), severe disease damage [Vasculitis Damage Index (VDI) > 4 (OR 3.9, 95% CI 1.01, 14.7)] and being overweight (OR 3.4, 95% CI 1.3, 8.9) were independently associated with their unemployment.
A quarter of working-age AAV subjects reported unemployment as a result of ill health and are characterized by high levels of fatigue, depression, disease damage and being overweight. These potentially modifiable factors may inform future multidisciplinary interventions aimed at alleviating work disability.
抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）常影响工作年龄段人群。由于免疫疗法改变了生存率，因此其他结果的测量变得越来越重要。工作残疾是患者和社会的一个重要结果，但在 AAV 中尚未得到充分评估。我们旨在评估 AAV 患者的就业状况，并确定导致其工作残疾的潜在预测因素。
进行了一项横断面研究。根据连续就诊情况招募 AAV 病例。受试者完成了一份问卷，该问卷确定了就业状况和其他社会心理测量。同时由主治医生记录临床因素。从那些处于工作年龄的受试者的数据中，使用向前逐步逻辑回归建立多变量模型，以确定工作残疾的独立关联，工作残疾定义为那些因健康不佳而失业的受试者。结果表示为比值比（OR）和 95%置信区间（CI）。
在 410 名参与者中（84.4%的回复率），149 名（36.7%）在职，197 名（48.6%）退休，54 名（13.3%）因健康不佳而失业。在那些处于工作年龄的人中，26.0%被认为工作能力丧失。疲劳（OR 7.1，95%CI 1.5，33.1）、抑郁（OR 4.4，95%CI 1.8，10.8）、严重疾病损害[血管炎损害指数（VDI）>4（OR 3.9，95%CI 1.01，14.7）]和超重（OR 3.4，95%CI 1.3，8.9）与失业独立相关。
四分之一的工作年龄 AAV 患者因健康不佳而失业，其特点是疲劳、抑郁、疾病损害和超重水平较高。这些潜在的可改变因素可能为未来旨在减轻工作残疾的多学科干预提供信息。
