The impact of biologic therapy on work capacity and workforce attachment in patients with severe asthma

Abstract

Introduction: Severe asthma impacts work capacity, but little is known about the effects of biologic therapy on patients' ability to work. We aimed to assess the impact of biologic therapy for severe asthma on work capacity and workforce attachment.

Methods: This cohort study used the Danish Severe Asthma Register, comprising all Danish patients with severe asthma initiating biologic therapy. Earned income, hours worked, and workforce attachment were tracked in national databases from one year prior to biologic therapy as well as during 2 years of biologic therapy. Outcomes were compared to age-, sex-, cohabitation- and residence-matched controls from the general population.

Results: Overall, 381 patients aged 20-62 years (52% females) were included. Annual weeks worked were lower among patients with severe asthma (adjusted incidence rate ratio (aIRR) 0.82 (0.80-0.84)), driven by increases in sick leave (aIRR 2.77 (2.58-2.98)), unemployment (aIRR 1.38 (1.30-1.46)) and disability pension (aIRR 1.85 (1.76-1.94)). After initiating biologic therapy, patients saw modest increases in annual hours worked during the second year of treatment (aIRR 1.03 (1.03-1.04)). However, patients remained at risk for temporary (OR 1.83 (1.15-2.93)) and permanent (OR 2.67 (1.16-6.16)) workforce withdrawal. Patients achieving on-treatment remission worked significantly more hours compared to non- and clinical responders and had lower unemployment-, sick-leave and disability pension rates both at baseline and after two years.

Conclusion: Biologic therapy resulted in a modest increase in hours worked, yet patients remain at significant risk of early workforce withdrawal. Patients achieving remission had a stronger attachment to the workforce, also prior to biologic therapy.

Keywords: Unemployment; cohort study; rehabilitation; remission; too late asthma.