Labor Market Integration of People with Disabilities: Results from the Swiss Spinal Cord Injury Cohort Study

Abstract

Objectives: We aimed to describe labor market participation (LMP) of persons with spinal cord injury (SCI) in Switzerland, to examine potential determinants of LMP, and to compare LMP between SCI and the general population.

Methods: We analyzed data from 1458 participants of employable age from the cross-sectional community survey of the Swiss Spinal Cord Injury Cohort Study. Data on LMP of the Swiss general population were obtained from the Swiss Federal Statistical Office. Factors associated with employment status as well as the amount of work performed in terms of full-time equivalent (FTE) were examined with regression techniques.

Results: 53.4% of the participants were employed at the time of the study. Adjusted odds of being employed were increased for males (OR = 1.73, 95% CI 1.33-2.25) and participants with paraplegia (OR = 1.78, 95% CI 1.40-2.27). The likelihood of being employed showed a significant concave relationship with age, peaking at age 40. The relation of LMP with education was s-shaped, while LMP was linearly related to time since injury. On average, employment rates were 30% lower than in the general population. Males with tetraplegia aged between 40 and 54 showed the greatest difference. From the 771 employed persons, the majority (81.7%) worked part-time with a median of 50% FTE (IRQ: 40%-80%). Men, those with younger age, higher education, incomplete lesions, and non-traumatic etiology showed significantly increased odds of working more hours per week. Significantly more people worked part-time than in the general population with the greatest difference found for males with tetraplegia aged between 40 and 54.

Conclusions: LMP of persons with SCI is comparatively high in Switzerland. LMP after SCI is, however, considerably lower than in the general population. Future research needs to show whether the reduced LMP in SCI reflects individual capacity adjustment, contextual constraints on higher LMP or both.

Fig 1. Distribution of amount of work performed for males and females as percent of full-time equivalent in the general population.

Fig 2. Adjusted marginal predictions of employment rates for continuous predictor variables in Table 2.

Predictions are at means for all other variables in the multivariable model with grey areas indicating the 95% confidence interval.

Fig 3. Age- and gender-standardized difference in employment rates between persons with SCI and the general population.

For stratified estimates of overall employment rate in paraplegia and tetraplegia, see Table 1.

Fig 4. Marginal prediction of the relative distribution of participants over the ordinal levels of the amount of work performed (FTE, %) in relation to sociodemographic and lesion characteristics.

Display is restricted to the two highest level categories with 60%-90% or >90% FTE noting that the two lowest categories predictably showed opposite marginal differences, essentially producing a balancing mirror image. Estimates are at mean values for other parameters using the stereotype logistic regression model in Table 3. Open symbols indicate the reference category for each parameter; solid symbols and error bars the percent difference with 95% confidence interval for other parameter classes as well as for continuous variables. Reading example: Given the overall gender distribution, men are overrepresented by 12.6% (95% CI: 8.3%-16.9%) in the >90% work load category.