Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Centre for Clinical Research Dalarna, Falun, Sweden.
Ann Rheum Dis. 2018 Mar;77(3):399-404. doi: 10.1136/annrheumdis-2017-212063. Epub 2017 Nov 23.
To examine the extent and cost of work disability among patients with gout compared with matched population controls and to analyse predictors of work disability.
A regional cohort study using data from Swedish national and regional registries from January 2000 through December 2012, including 4571 patients with gout of working age, with a first recorded diagnosis of gout in the years 2003-2009 and 22 482 population controls, matched by age, sex and place of residence. Differences in baseline characteristics (educational level, income, previous employment and comorbidities) and the number of work-loss days (absenteeism) due to sick leave and disability pension for 3 years after identification were calculated. Predictors for new-onset work absenteeism (>90 days/year) in a subset were determined by conditional logistic regression.
Patients with gout (median age 53 years) had significantly more comorbidities, lower income and lower level of education than matched controls. The average work absentee rate during the 3-year follow-up period was higher among patients with gout than controls, 22% and 14%, respectively (P<0.0001). New-onset absenteeism was in multivariate analyses significantly predicted by gout (OR 1.47; 95% CI 1.23 to 1.75). Other variables independently related to new-onset absenteeism were education ≤12 years, previous unemployment and history of sick leave, in addition to several comorbidities (renal disease, cardiovascular disease, alcohol abuse and obesity).
Gout is associated with substantially higher work absenteeism and costs for society due to productivity loss, after adjusting for associated comorbidities and socioeconomic differences. Whether more intensive treatment of gout is cost-effective needs to be addressed in future studies.
比较痛风患者与匹配人群对照的工作残疾程度和残疾成本，并分析工作残疾的预测因素。
这是一项基于瑞典全国和地区登记处数据的区域性队列研究，数据收集时间为 2000 年 1 月至 2012 年 12 月，纳入了 4571 名处于工作年龄的痛风患者，他们在 2003 年至 2009 年首次确诊为痛风，共 22482 名年龄、性别和居住地相匹配的人群对照。计算了两组患者在基线时的特征（教育程度、收入、以前的就业情况和合并症）差异以及因病假和残疾抚恤金而导致的 3 年缺勤天数（旷工）。通过条件逻辑回归确定了亚组中新发工作缺勤（>90 天/年）的预测因素。
与匹配对照组相比，痛风患者（中位年龄 53 岁）合并症更多，收入更低，教育程度更低。在 3 年随访期间，痛风患者的平均旷工率明显高于对照组，分别为 22%和 14%（P<0.0001）。多变量分析显示，痛风是新发缺勤的独立预测因素（OR 1.47；95%CI 1.23 至 1.75）。其他与新发缺勤独立相关的变量包括教育程度≤12 年、以前失业和病假史，以及多种合并症（肾脏疾病、心血管疾病、酒精滥用和肥胖）。
在调整了相关合并症和社会经济差异后，痛风患者的工作缺勤率明显更高，生产力损失导致社会成本增加。未来的研究需要探讨更积极的痛风治疗是否具有成本效益。
