How does work disability of patients with MS develop before and after diagnosis? A nationwide cohort study with a reference group

Abstract

ObjectivesWe compared work disability of patients with multiple sclerosis (MS) from 5 years before with 5 years after diagnosis, with that of matched controls, and analysed whether progression in work disability among patients with MS was associated with sociodemography.DesignPopulation-based cohort study.SettingThe adult Swedish general population.ParticipantsResidents aged 24–57 diagnosed with MS (n=3685) in 2003–2006 and 18 425 matched controls without MS.Primary and secondary outcome measuresAnnual net days of sickness absence (SA) and disability pension (DP), used as a proxy for work disability, followed from 5 years before to 5 years after diagnosis (ie, T−5–T+5). For patients with MS, regression was used to identify sociodemographic factors related to progression in work disability.ResultsWork disability of patients with MS increased gradually between T−5 and T−1 (mean: 46–82 days) followed by a sharp increase (T+1, 142 days), after which only a marginal increase was observed (T+5, 149 days). The matched controls had less work disability, slightly increasing during the period to a maximum of ∼40 days. Men with MS had a sharper increase in work disability before diagnosis. High educational level was associated with less progression in work disability before and around diagnosis.ConclusionsPatients with MS had more work disability days also 5 years before diagnosis. Several sociodemographic variables were associated with the absolute level and the progression in SA and DP.

Disposable income trajectories of working-aged individuals with diagnosed multiple sclerosis

“…Inverse trends were observed between earnings and work disability. 1,10,14,21,22 Despite previous associations of early SA with both lower DI and future SA and/or DP, 10,23 we observed comparably weak associations of the two work disabil- supporting our analysis of DI as a proxy for economic situation. This emphasises the importance of describing development within MS cohorts, and incorporating pre-diagnosis periods to observe both the progressive characteristics of MS and delays between onset and diagnosis.…”

“…The contrasts between the pre-and post-diagnosis periods were clearer within earnings ( Figure 1B) and work disability ( Figure 1C), than DI. 1,10,14 The differences observed in the sex-stratified analyses reflect the well-documented gender pay gap. Two clusters of trajectory groups (Groups Two, Three and Four along with Groups Five and Six) started with similar DI levels, respectively, but diverged prior to diagnosis.…”

“…1,[9][10][11][12][13][14] Despite such changes, studies suggest that mean annual DI is maintained around MS diagnosis. 1,[9][10][11][12][13][14] Despite such changes, studies suggest that mean annual DI is maintained around MS diagnosis.…”

“…The population-based study design with pre-and post-diagnosis periods considered the progressive nature and onset of MS, given previous findings of pre-diagnosis changes in incomes 13,14. Smaller municipalities have been collapsed with medium-sized municipalities, >180 net days of work disability into 90-180 days, and binary variables not displayed where necessary.years were selected to limit intra-cohort income variations from extraneous national and global events.…”

“…Previous studies have observed variations, already pre-diagnosis, in the morbidity-related transfer payment trajectories within MS cohorts, and lower levels of earnings in comparison with the general population. 1,[9][10][11][12][13][14] Despite such changes, studies suggest that mean annual DI is maintained around MS diagnosis. 1,11,15 However, the possible differences in DI among people with MS have not yet been studied.…”