Trends in work participation among patients with inflammatory rheumatic musculoskeletal diseases (iRMDs): Data from the German National Database (2010-2022)

Abstract

Objective: To analyse work participation among patients with inflammatory rheumatic musculoskeletal diseases (iRMDs), namely rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and ANCA-associated vasculitis (AAV).

Methods: A cross-sectional sample of 16 421 patients from the National Database of the German Collaborative Arthritis Centers, aged <65 years were analysed. For each diagnosis, yearly rates of absenteeism, employment and disability pensions were analysed from 2010 to 2022. Population data were used to calculate standardised employment ratios (SERs), adjusted for age, sex, federal state and vocational qualification. The analysis was additionally stratified by sex, adjusting for other factors.

Results: Over the observed time span, large employment increases were found across all diagnoses, namely in RA (54%-68%), PsA (58%-72%), SSc (47%-66%), AAV (43%-61%), SLE (48%-60%) and axSpA (65%-73%). SERs were for RA 0.88 (95% CI 0.86 to 0.90), axSpA (0.88 (0.84 to 0.91)), PsA (0.88 (0.85 to 0.91)), SSc (0.83 (0.75 to 0.91)), SLE (0.76 (0.72 to 0.80)) and AAV (0.73 (0.63 to 0.83)). In RA, axSpA, PsA and AAV, SERs were higher in men while in SLE and SSc men had lower SER. Median of yearly absenteeism due to the disease decreased by 5 (RA), 1 (axSpA), 6 (PsA), 11 (SLE), 4 (SSc) and 10 days (AAV) in the time span. Except for SSc, the proportion of disability pension receivers decreased for all diagnoses.

Conclusion: Since 2010, work participation has improved for patients with iRMDs, as reflected in higher employment, reduced absenteeism and less disability retirement. However, patients have not reached population employment rates.

Keywords: Economics; Epidemiology; Health services research.

Figure 1. Flow chart showing the respective sample sizes for the years 2010–2022. NDB, National Database of the Collaborative Arthritis Centers.

Figure 2. Percentage of employed patients (employment ratio) by diagnoses for men and women along with sample sizes (n) for the first and last year from 2010 to 2022. AAV, ANCA-associated vasculitis; axSpA, axial spondyloarthritis; PsA, psoriatic arthritis; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; SSc, systemic sclerosis.

Figure 3. Percentage of employed patients (employment ratio) by diagnoses and sex, as well as for the German population by sex, aggregated for 5 year age groups from 20 to 60 along with sample sizes (n) for the age groups 20–25 and 60–65. Data points with less than 10 patients are not shown. axSpA, axial spondyloarthritis; PsA, psoriatic arthritis; RA, rheumatoid arthritis.

Figure 4. Standardised employment ratio (SER) after adjusting for age, sex, federal state and vocational qualification, along with 95% CIs of the mean. AAV, ANCA-associated vasculitis; axSpA, axial spondyloarthritis; PsA, psoriatic arthritis; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; SSc, systemic sclerosis.

Figure 5. Percentage of patients of working age receiving disability pension by disease duration (less than 5 years, 5–10 years and 10 years and more). AAV, ANCA-associated vasculitis; axSpA, axial spondyloarthritis; PsA, psoriatic arthritis; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; SSc, systemic sclerosis.