Joblessness and Lost Earnings after Acute Respiratory Distress Syndrome in a 1-Year National Multicenter Study

Abstract

Rationale: Following acute respiratory distress syndrome (ARDS), joblessness is common but poorly understood.

Objectives: To evaluate the timing of return to work after ARDS, and associated risk factors, lost earnings, and changes in healthcare coverage Methods: Over 12-month longitudinal follow-up, ARDS survivors from 43 U.S. ARDSNet hospitals provided employment and healthcare coverage data via structured telephone interviews. Factors associated with the timing of return to work were assessed using Fine and Gray regression analysis. Lost earnings were estimated using Bureau of Labor Statistics data.

Measurements and main results: Of 922 consenting survivors, 386 (42%) were employed before ARDS (56% male; mean ± SD age, 45 ± 13 yr), with seven dying by 12-month follow-up. Of 379 previously employed 12-month survivors, 166 (44%) were jobless at 12-month follow-up. Accounting for competing risks of death and retirement, half of enrolled and previously employed survivors returned to work by 13 weeks after hospital discharge, with 68% ever returning by 12 months. Delays in return to work were associated with longer hospitalization and older age among nonwhite survivors. Over 12-month follow-up, 274 (71%) survivors accrued lost earnings, averaging $26,949 ± $22,447 (60% of pre-ARDS annual earnings). Jobless survivors experienced a 14% (95% confidence interval, 5-22%; P = 0.002) absolute decrease in private health insurance (from 44% pre-ARDS) and a 16% (95% confidence interval, 7-24%; P < 0.001) absolute increase in Medicare and Medicaid (from 33%).

Conclusions: At 12 months after ARDS, nearly one-half of previously employed survivors were jobless. Post-ARDS joblessness is associated with readily identifiable patient and hospital variables and accompanied by substantial lost earnings and a shift toward government-funded healthcare coverage.

Keywords: employment; health insurance; income; intensive care unit.

Figure 1.

Patient flow chart. Some percentages do not add up to 100% because of rounding. ARDS = acute respiratory distress syndrome.

Figure 2.

Cumulative incidence of returning to work over 12-month follow-up, stratified by age and race, with retirement and death treated as competing risks.

Figure 3.

Primary healthcare coverage reported by acute respiratory distress syndrome (ARDS) survivors younger than 65 years old who were unemployed or disabled at each post-ARDS time point. Plotted values are proportions (and 95% confidence intervals) of 12-month survivors enrolled in each healthcare coverage category at each of these three time points: pre-ARDS baseline, 6 months after ARDS, and 12 months after ARDS.