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罕见病对功能状态和工作能力的不均衡影响。

The Uneven Effect of Rare Diseases on Functional Status and Work Capacity.

作者信息

Oancea Corina, Gherman Despina Mihaela, Popescu Florina Georgeta, Aurelian Sorina Maria, Homentcovschi Corina

机构信息

Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania.

Department of Occupational Health, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania.

出版信息

Healthcare (Basel). 2025 Mar 8;13(6):594. doi: 10.3390/healthcare13060594.

DOI:10.3390/healthcare13060594
PMID:40150443
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11942041/
Abstract

Rare diseases are defined as clinical conditions that affect only a small number of persons in a population, considered fewer than 1 per 2000 in the European Union or fewer than 1 per 1600 in the United States They are serious, often chronic and progressive conditions, characterized by a pronounced clinical polymorphism that crosses all medical specialties. Multiple areas of life beyond just physical health are affected with significant impact on patients, families, and healthcare systems. To analyze the socio-demographic, medical, and vocational characteristics that correlate with functional status and work disability as a measure of quality of life in rare diseases. An observational retrospective study of adults with rare diseases evaluated for eligibility for social insurance rights in the National Institute of Medical Assessment and Work Capacity Rehabilitation Bucharest (INEMRCM, the Romanian abbreviation) over a 5-year period was made. Descriptive analysis was used to present sample characteristics. Means and standard deviations (SD) were calculated to describe numerical variables, frequencies were used to describe categorical variables, and logistic regression analysis was conducted to evaluate potential predictors of work capacity. All statistical analyses were performed by PSPP.3 software. < 0.05 was the cut-off for statistical significance with a 95% confidence interval. 90 consecutive persons were included in the survey. The mean age of the group was 44.5 years ± SD 10.61 years, with a female/male ratio of 48/42 persons. The mean disease duration was 10.61 years ± SD 9.76 years. Men had more severe disease (73.81%); = 0.018 and significantly younger retirement age, M/F = 39.10 ± 12.26/43.06 ± 9.32; = 0.037. Less disabling diseases were predominant autoimmune conditions (85.71% of cases); genetic conditions had a more severe functional impact in 63.75% of cases; = 0.037. People with multisystem diseases but with specific or targeted treatment can work more frequently (76.19%); those with visual impairment have more severe impairments (73.77%); < 0.001. All individuals who received specific therapy had a better functional status, unlike only 37.21% of those who received symptomatic treatment or treatment for complications; = 0.023. Logistic regression analysis indicated that the type of impairment and the availability of specific treatments could serve as predictors of a reduced likelihood of employment in rare disease cases. Education level and occupation were not correlated with functional impairment and work disability (NS). Several factors, including some that are modifiable, were associated with better outcomes, such as reduced disability and an increased potential for work participation. Sex, disease etiology, type of impairment, and treatment were all significantly linked to functional capacity. Among these, the type of impairment and the availability of specific treatments might be predictors of employment. Addressing these parameters requires a multidisciplinary team, involving specialized care and comprehensive support services to improve the overall quality of life of individuals affected by rare diseases.

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/75c4/11942041/dc5ccd76fe85/healthcare-13-00594-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/75c4/11942041/dc5ccd76fe85/healthcare-13-00594-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/75c4/11942041/dc5ccd76fe85/healthcare-13-00594-g001.jpg
摘要

罕见病被定义为在人群中仅影响少数人的临床病症,在欧盟被认为每2000人中少于1例,在美国则少于1600人中1例。它们是严重的,通常为慢性和进行性病症,其特征是具有跨越所有医学专业的显著临床多态性。不仅身体健康,生活的多个领域都会受到影响,对患者、家庭和医疗保健系统产生重大影响。为了分析与功能状态和工作残疾相关的社会人口统计学、医学和职业特征,以此作为衡量罕见病生活质量的指标。对在布加勒斯特国家医学评估和工作能力康复研究所(INEMRCM,罗马尼亚语缩写)接受为期5年的社会保险权利资格评估的成年罕见病患者进行了一项观察性回顾性研究。采用描述性分析来呈现样本特征。计算均值和标准差(SD)以描述数值变量,使用频率来描述分类变量,并进行逻辑回归分析以评估工作能力的潜在预测因素。所有统计分析均使用PSPP.3软件进行。P < 0.05为具有95%置信区间的统计显著性临界值。该调查纳入了90名连续的个体。该组的平均年龄为44.5岁±标准差10.61岁,女性/男性比例为48/42人。平均病程为10.61年±标准差9.76年。男性的病情更严重(73.81%);P = 0.018,退休年龄显著更年轻,男性/女性 = 39.10 ± 12.26/43.06 ± 9.32;P = 0.037。致残性较低的疾病主要是自身免疫性疾病(85.71%的病例);遗传性疾病在63.75%的病例中对功能有更严重的影响;P = 0.037。患有多系统疾病但接受了特定或针对性治疗的人更有可能工作(76.19%);视力障碍者有更严重的损伤(73.77%);P < 0.001。所有接受特定治疗的个体功能状态更好,而接受对症治疗或并发症治疗的个体中只有37.21%如此;P = 0.023。逻辑回归分析表明,损伤类型和特定治疗的可用性可作为罕见病病例就业可能性降低的预测因素。教育水平和职业与功能损伤和工作残疾无关(无显著性差异)。包括一些可改变的因素在内的几个因素与更好的结果相关,如残疾程度降低和工作参与潜力增加。性别、疾病病因、损伤类型和治疗均与功能能力显著相关。其中,损伤类型和特定治疗的可用性可能是就业的预测因素。解决这些参数需要一个多学科团队,包括专业护理和全面支持服务,以提高受罕见病影响个体的整体生活质量。

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