Murley Chantelle, Tinghög Petter, Karampampa Korinna, Hillert Jan, Alexanderson Kristina, Friberg Emilie
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171-77 Stockholm, Sweden
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171-77 Stockholm, Sweden.
BMJ Open. 2020 Dec 29;10(12):e039228. doi: 10.1136/bmjopen-2020-039228.
To explore sequences of annual states of activity and sickness absence (SA) or disability pension (DP) (SA/DP) among working-aged people with multiple sclerosis (PwMS) as well as characteristics associated with the identified types of working-life sequences.
Nationwide Swedish register-based cohort study from 1 year prior to 5 years after the year of multiple sclerosis (MS) diagnosis.
Sweden.
PwMS diagnosed in 2008-2011 when aged 20-55 (n=2652, 69.9% women).
Individual-level sequences spanning 7 years were constructed with annual states regarding activity (income from paid work, student allowances, parental leave or unemployment compensation) and/or SA/DP. Types of working-life sequences were identified among the individuals' sequences using hierarchical cluster analysis with optimal matching dissimilarity measures.
Six types of working-life sequences were identified. The largest cluster, Stable High Activity, represented 48.4% of the cohort. Other types were: Stable High SA/DP (14.5%); Other (4.5%); and three types with mixed activity and varying SA/DP regarding the number of days/year and timing (32.6%). Characteristics of the different identified types of sequences were subsequently investigated. All types of sequences had lower odds for university education (OR range: 0.18-0.72) compared with Stable High Activity. Increasingly higher odds of having anxiety/depression compared with Stable High Activity were observed across the types of sequences, by increasing proportions of SA/DP. Stable High SA/DP sequences were less likely than Stable High Activity to be prescribed MS drugs in the MS diagnosis year (OR 0.61; 95% CI 0.47 to 0.78). All types of sequences had higher disposable income in the final study year than the first, except for Stable High SA/DP sequences (Swedish Krona 4669, 95% CI -1892 to 11 230).
Diversity in working life was influenced by sociodemographic and clinical characteristics resulting in different activity and SA/DP patterns across the six identified types of working-life sequences.
探讨多发性硬化症（PwMS）患者在工作年龄段的年度活动状态以及病假（SA）或残疾抚恤金（DP）（SA/DP）情况，以及与所确定的工作生活序列类型相关的特征。
基于瑞典全国登记册的队列研究，从多发性硬化症（MS）诊断年份前1年至诊断后5年。
瑞典。
2008年至2011年诊断为MS的20至55岁的PwMS患者（n = 2652，69.9%为女性）。
构建涵盖7年的个人层面序列，包括年度活动状态（有偿工作收入、学生津贴、育儿假或失业补偿）和/或SA/DP。使用具有最优匹配差异度量的层次聚类分析在个体序列中识别工作生活序列类型。
识别出六种工作生活序列类型。最大的聚类，即稳定高活动型，占队列的48.4%。其他类型包括：稳定高SA/DP型（14.5%）；其他型（4.5%）；以及三种在活动和SA/DP天数/年以及时间安排方面混合的类型（32.6%）。随后研究了不同识别类型序列的特征。与稳定高活动型相比，所有类型的序列接受大学教育的几率较低（OR范围：0.18 - 0.72）。随着SA/DP比例增加，与稳定高活动型相比，在各类序列中焦虑/抑郁的几率越来越高。在MS诊断年份，稳定高SA/DP序列比稳定高活动型序列接受MS药物治疗的可能性更小（OR 0.61；95% CI 0.47至0.78）。除稳定高SA/DP序列外，所有类型的序列在最终研究年份的可支配收入均高于第一年（瑞典克朗4669，95% CI -1892至11230）。
工作生活的多样性受到社会人口统计学和临床特征的影响，导致在所识别的六种工作生活序列类型中出现不同的活动和SA/DP模式。
