Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas; and.
Baker Institute for Public Policy and Department of Economics, Rice University, Houston, Texas.
Clin J Am Soc Nephrol. 2018 Feb 7;13(2):265-273. doi: 10.2215/CJN.06470617. Epub 2018 Jan 18.
Patients with ESRD face significant challenges to remaining employed. It is unknown when in the course of kidney disease patients stop working.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We examined employment trends over time among patients ages 18-54 years old who initiated dialysis in the United States between 1996 and 2013 from a national ESRD registry. We compared unadjusted trends in employment at the start of dialysis and 6 months before ESRD and used linear probability models to estimate changes in employment over time after adjusting for patient characteristics and local unemployment rates in the general population. We also examined employment among selected vulnerable patient populations and changes in employment in the 6 months preceding dialysis initiation.
Employment was low among patients starting dialysis throughout the study period at 23%-24%, and 38% of patients who were employed 6 months before ESRD stopped working by dialysis initiation. However, after adjusting for observed characteristics, the probability of employment increased over time; patients starting dialysis between 2008 and 2013 had a 4.7% (95% confidence interval, 4.3% to 5.1%) increase in the absolute probability of employment at the start of dialysis compared with patients starting dialysis between 1996 and 2001. Black and Hispanic patients were less likely to be employed than other patients starting dialysis, but this gap narrowed during the study period.
Although working-aged patients in the United States starting dialysis have experienced increases in the adjusted probability of employment over time, employment at the start of dialysis has remained low.
终末期肾病（ESRD）患者在就业方面面临着重大挑战。目前尚不清楚患者在肾病病程的何时阶段停止工作。
设计、设置、参与者和测量方法：我们在美国 1996 年至 2013 年间的全国 ESRD 登记处中，检查了年龄在 18-54 岁之间开始透析的患者随时间推移的就业趋势。我们比较了透析开始时和 ESRD 前 6 个月的未调整就业趋势，并使用线性概率模型，在调整患者特征和当地普通人群失业率后，估计随时间推移的就业变化。我们还检查了特定脆弱患者群体的就业情况以及透析开始前 6 个月的就业变化。
在整个研究期间，开始透析的患者的就业率一直较低，为 23%-24%，而在 ESRD 前 6 个月就业的 38%的患者在开始透析时停止工作。然而，在调整观察到的特征后，就业的可能性随着时间的推移而增加；与 1996 年至 2001 年开始透析的患者相比，2008 年至 2013 年开始透析的患者在透析开始时就业的绝对概率增加了 4.7%（95%置信区间，4.3%至 5.1%）。与其他开始透析的患者相比，黑人患者和西班牙裔患者就业的可能性较低，但这种差距在研究期间缩小。
尽管美国开始透析的工作年龄段患者随时间推移调整后的就业概率有所增加，但透析开始时的就业率仍然较低。
