Labour market attachment before and after hospitalisation for sepsis: a Danish cohort study.

BACKGROUND

Sepsis survivors often experience cognitive, physiological, and functional impairments that may limit return to work (RTW). We aimed to describe changes in workforce attachment among working-age patients with sepsis, both overall and stratified by treatment in general wards versus the intensive care unit (ICU). Additionally, we aimed to evaluate the impact of educational level and to identify factors associated with RTW.

METHODS

A register-based cohort study including all patients aged 20-63 years with incident community-acquired sepsis admitted to a hospital in the Region of Southern Denmark between 1 January 2016 and 20 March 2018. Labour market attachment was illustrated using area charts, overall and stratified by treatment in general wards versus the ICU. Further, the overall area chart was stratified by educational level. Patients were classified as part of the workforce or non-workforce. A subgroup of the workforce comprised those working. RTW was estimated for the workforce and those working after 12, 52, 104, and 156 weeks. Factors associated with RTW were identified using cause-specific hazards.

RESULTS

Of the 1610 patients with sepsis included, 651 were part of the workforce, with 488 working. After 12 weeks, 69.0% of workforce patients (excluding those censored) had returned to work. This proportion increased to 81.6%, 87.5%, and 90.4% after 52, 104, and 156 weeks, respectively. Among patients working before sepsis, RTW proportions were higher. Several baseline variables and in-hospital measures were associated with RTW among the workforce including younger age (20-39 years), HR = 1.33 (95% CI, 1.05-1.68), no ICU admission, HR = 2.64 (95% CI, 1.81-3.86), lactate < 4 mmol/L, HR = 2.19 (1.13-4.24), and single organ failure, HR = 2.33 (95% CI, 1.16-4.69). While ICU admission had impact on RTW in both the workforce and those working, educational level was unrelated to RTW among those working.

CONCLUSIONS

Most working-age patients with sepsis were outside the workforce. Working before sepsis was the strongest predictor of RTW. While educational level influenced whether patients were part of the workforce, it was not associated with RTW among those working. No ICU admission was associated with RTW.