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Multicenter Study
. 2025 Oct;31(11):1358-1369.
doi: 10.1177/13524585251349139. Epub 2025 Jul 9.

Unemployment, work hour reduction, and income loss: An international, multicentered, cross-sectional study of neuromyelitis optica spectrum disorder

Andrew Siyoon Ham  1 , Isabella Gomez Hjerthen  1 , De-Cai Tian  2 , Hongfei Gu  3 , Wen Gao  4 , Akshatha Sudhir  5 , Lekha Pandit  5 , Y Muralidhar Reddy  6 , Jagarlapudi Muralikrishna Murthy  6 , Sharareh Eskandarieh  7 , Mohammad Ali Sahraian  7 , Saeideh Ayoubi  7 , Roberto Rodríguez-Rivas  8 , Francisco González-González  8 , José de Jesús Flores Rivera  8 , Enedina Maria Lobato Oliveira  9 , Raquel Paiva Portugal  9 , Paloma Peter Travassos Zaidan  9 , Shanthi Viswanathan  10 , Karina Koh  11 , Su-Yin Lim  12 , Punchika Kosiyakul  13 , Jiraporn Jitprapaikulsan  13 , Sasitorn Siritho  13 , Saúl Reyes  14 , Jaime Toro  14 , Jairo Gaitán  14 , Deyanira Ramirez Navarro  15 , Raúl Comme-Debroth  15 , Josmarlin Patricia Medina Báez  15 , Maria Castillo  16 , Soto de Castillo Ibis  16 , Sandra Mendoza de Salazar  17 , Omaira Molina  16 , Amany Hussein Ragab  18 , Amr Mohamed Fouad  18 , Nirmeen Adel Kishk  18 , Juan Ignacio Rojas  19 , Edgardo Cristiano  20 , Liliana Patrucco  19 , Bade Gülec  21 , Ugur Uygunoglu  21 , Melih Tutuncu  21 , Aksel Siva  21 , Amelia Yun Yi Aw  22 , Kevin Tan  22 , Tianrong Yeo  22 , Raed Alroughani  23 , Samar Farouk Ahmed  24 , Malak Almojel  25 , Jera Kruja  26 , Ariola Verlaku  26 , Olga Qirjako  26 , Riwanti Estiasari  27   28 , Kartika Maharani  27   28 , Saif Huda  29 , Patricia Kelly  29 , Raffaele Iorio  30 , Eleonora Sabatelli  30 , Álvaro Cobo-Calvo  31 , Georgina Arrambide  31 , Javier Villacieros Álvarez  31 , Simon Broadley  32 , Unnah Leitner  32 , Fodé Abass Cissé  33 , Mohamed Lamine Touré  33 , Kab Conde  33 , Farrah J Mateen  1   34
Affiliations
Multicenter Study

Unemployment, work hour reduction, and income loss: An international, multicentered, cross-sectional study of neuromyelitis optica spectrum disorder

Andrew Siyoon Ham et al. Mult Scler. 2025 Oct.

Abstract

Objectives: To assess loss of employment, work hours, and wages of people with aquaporin-4 antibody-positive or double-seronegative/antibody status unknown neuromyelitis optica spectrum disorder (NMOSD) internationally.

Methods: An investigator-designed survey was administered to adults ages 18-70 years with NMOSD and distributed by neurologists in 23 countries, July 2022 to September 2023.

Results: There were 897 participants (635 aquaporin-4 antibody positive, 262 double-seronegative/untested; 81.4% female, average age 42.5 years, average disease duration 7.6 years, median 2 disease attacks since diagnosis). NMOSD impact was visual loss (34.0% unilateral; 28.2% bilateral), 61.8% with spinal cord disease, 55.6% with pain, 43.6% with fatigue, 38.2% with depressed mood, and 25.0% with gait aid use. In total, 92.6% took immunosuppressive therapy. Employment rates were 62.6% before and 36.3% after NMOSD diagnosis. In a multivariable model, statistically significant independent associations with unemployment in NMOSD were older age (odds ratio (OR) = 0.97, p < 0.001), being female (OR = 0.48, p < 0.001), bilateral visual loss (OR = 0.61, p = 0.02), highest frequency of depressed mood (OR = 0.29, p < 0.001), and walking aid use (OR = 0.38, p < 0.001).

Discussion: Approximately 1/3 of people living with NMOSD of potential working age are in the workforce. Unemployment in NMOSD is associated with previously recognized factors but also self-reported low mood, gait aid use, and bilateral visual loss.

Keywords: Employment; income; neurology; neuromyelitis optica; outcomes; socioeconomic factors.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr F.J.M. has received research funding for her institution from Alexion, Amgen, EMD Serono, Genentech, Novartis, and TG Therapeutics and consulting fees from Alexion, EMD Serono, Genentech, and Roche. Dr T.Y. has received honoraria from ASNA, Edanz Pharma, Euroimmun AG, Merck, Novartis, Roche, Terumo BCT for consulting services and speaker’s fees, and research grants from the National Medical Research Council (NMRC Singapore) and Roche. Dr A.S. has received research grants from The Turkish Multiple Sclerosis Society and research grants from The Scientific and Technological Research Council of Turkey & Istanbul University-Cerrahpasa Research Support Funds. Dr A.C.-C. has received a grant from the Instituto de Salud Carlos III, Spain; JR19/00007.

Figures

Figure 1.
Figure 1.
Participant selection and proportions of employed participants.
See this image and copyright information in PMC

References

    1. Hor JY, Asgari N, Nakashima I, et al. Epidemiology of neuromyelitis optica spectrum disorder and its prevalence and incidence worldwide. Front Neurol 2020; 11: 501. - PMC - PubMed
    1. Carnero Contentti E, Correale J. Neuromyelitis optica spectrum disorders: From pathophysiology to therapeutic strategies. J Neuroinflammation 2021; 18(1): 208. - PMC - PubMed
    1. Hjerthen IG, Trápaga Hacker C, Meador W, et al. Impact of neuromyelitis optica spectrum disorder on employment and income in the United States. Ann Clin Transl Neurol 2024; 11(4): 1011–1020. - PMC - PubMed
    1. World Bank Blogs. New World Bank country classifications by income level: 2021-2022, https://blogs.worldbank.org/en/opendata/new-world-bank-country-classific... (accessed 20 June 2024).
    1. World Bank Gender Data Portal. Labor force participation rate (% of population), https://genderdata.worldbank.org/en/indicator/sl-tlf-acti-zs (accessed 23 May 2024).

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