Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Center, Lisbon, Portugal.
Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Lisbon, Portugal.
BMC Public Health. 2018 Apr 11;18(1):472. doi: 10.1186/s12889-018-5381-1.
Osteoarthritis (OA) is a leading cause of pain and disability, which may be a source of productivity losses. The objectives of this study were to describe the impact of OA, namely through pain and physical disability, on early exit from work and to calculate its economic burden.
We analysed data from the national, cross-sectional, population-based EpiReumaPt study (Sep2011-Dec2013) in which 10,661 individuals were randomly surveyed in order to capture all cases of rheumatic diseases. We used all participants aged 50-64, near the official retirement age, who were clinically validated by experienced rheumatologists (n = 1286), including OA cases. A national database was used to calculate productivity values by gender, age and region, using the human capital approach. The impact of OA on the likelihood of early exit from work and the population attributable fractions used to calculate due economic burden (indirect costs) were obtained at the individual level by logistic regression. All results were based on weighted data.
Almost one third of the Portuguese population aged 50-64 had OA (29.7%; men: 16.2% and women: 43.5%) and more than half were out of paid work (51.8%). Only knee OA is associated with early exit from work (OR: 2.25; 95%CI: 1.42-3.59; p = 0.001), whereas other OA locations did not reach any statistical difference. Furthermore, we observed an association between self-reported longstanding musculoskeletal pain (OR: 1.55; 95%CI: 1.07-2.23; p = 0.02) and pain interference (OR: 1.35; 95%CI: 1.13-1.62; p = 0.001) with early exit from work. We also detected a clear relationship between levels of disability, measured by the Health Assessment Questionnaire (HAQ), and the probability of work withdrawal. The estimated annual cost of early exit from work attributable to OA was €656 million (€384 per capita; €1294 per OA patient and €2095 per OA patient out-of-work).
In this study, we observed an association between OA and early exit from work, largely dependent on pain and disability. This relationship translates into a meaningful economic burden amounting to approximately 0.4% of the national Gross Domestic Product (GDP). The high prevalence and the impact of this disabling chronic disease highlight the need to prioritize policies targeting early exit from work in OA.
骨关节炎（OA）是疼痛和残疾的主要原因，可能是生产力损失的来源。本研究的目的是描述 OA 通过疼痛和身体残疾对提前退出工作的影响，并计算其经济负担。
我们分析了全国性、横断面、基于人群的 EpiReumaPt 研究（2011 年 9 月至 2013 年 12 月）的数据，该研究对 10661 名患者进行了随机调查，以捕捉所有风湿性疾病的病例。我们使用了所有年龄在 50-64 岁、接近法定退休年龄的参与者，由经验丰富的风湿病专家进行临床验证（n=1286），包括 OA 病例。使用人力资本方法，通过按性别、年龄和地区计算生产力值，利用全国数据库。通过逻辑回归在个体水平上获得 OA 对提前退出工作的可能性和人群归因分数，以计算因经济负担（间接成本）。所有结果均基于加权数据。
葡萄牙 50-64 岁人群中近三分之一（29.7%；男性：16.2%，女性：43.5%）患有 OA，超过一半（51.8%）没有从事有偿工作。只有膝关节 OA 与提前退出工作有关（OR：2.25；95%CI：1.42-3.59；p=0.001），而其他 OA 部位则没有达到统计学差异。此外，我们观察到自我报告的长期肌肉骨骼疼痛（OR：1.55；95%CI：1.07-2.23；p=0.02）和疼痛干扰（OR：1.35；95%CI：1.13-1.62；p=0.001）与提前退出工作有关。我们还发现残疾程度（由健康评估问卷测量）与退出工作的概率之间存在明显关系。由于 OA 提前退出工作的年估计经济成本为 6.56 亿欧元（384 欧元/人；每例 OA 患者 1294 欧元，每例 OA 患者失业 2095 欧元）。
在这项研究中，我们观察到 OA 与提前退出工作之间存在关联，这主要取决于疼痛和残疾程度。这种关系转化为具有重要经济意义的负担，约占国内生产总值（GDP）的 0.4%。这种致残性慢性疾病的高患病率和影响突出表明，需要优先制定针对 OA 提前退出工作的政策。
