Spatial and temporal distribution of the prevalence of unemployment and early retirement in people with multiple sclerosis: A systematic review with meta-analysis

Abstract

Background We aimed to summarise the prevalence of unemployment and early retirement among people with MS and analyze data according to a spatio-temporal perspective. Methods We undertook a systematic search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect, and Web of Science. We included any peer-reviewed original article reporting the prevalence of unemployment and early retirement in the working-age population with MS. We excluded articles off-topic, with other study designs, whose study sample were unlikely to be representative of the MS population and in case of unavailability of the full text or essential information. A random-effects meta-analysis was used to measure overall prevalence estimates of unemployment and early retirement. We used meta-regression and subgroup analysis to evaluate potential moderators of prevalence estimates and the leave-one-out method for sensitivity analyses. Results Our research identified 153 studies across 29 countries encompassing 188436 subjects with MS. The pooled overall effect size for unemployment and early retirement was 35.6% (95% CI 32.8–38.4; I2 = 99.31) and 17.2% (95% CI 14.6–20.2; I2 = 99.13), respectively. The prevalence of unemployment varied according to the year of publication (p < 0.001) and there was a statistically significant decrease in the prevalence of unemployment over time (p = 0.042). Regarding early retirement, only seven (31.8%) estimates obtained from studies that were published before 2010 were below the overall effect size in comparison to 27 (60.0%) estimates extracted from data published between 2010 and 2021 (p = 0.039). There was a significant difference in prevalence according to countries (p < 0.001). Psychiatric illness was an important clinical feature responsible for patients leaving the workforce in regions with a high MS prevalence. Conclusions Unemployment and early retirement due to MS remain highly prevalent, despite a slight decline in the last decade. The prevalence of unemployment and early retirement varies globally.

Employment status, productivity loss, and associated factors among people with multiple sclerosis

“…Overall, the unemployment rate of 25% found in this cohort is below the pooled estimate of 35% provided by a recent meta-analysis, 6 which is likely explained by the lower severity of disability and shorter disease duration for participants in the CanProCo cohort, as well as the regional and temporal differences also outlined in the meta-analysis. As for productivity loss among the employed, results are consistent with those from our previously published study in a CanProCo sub-cohort.…”

“…5 Even though there is some variability across countries and, in the last years, the proportion of unemployed pwMS has decreased (potentially related to advances in disease-modifying therapy (DMT)), pooled estimates for unemployment and early retirement remain 35.6% and 17.2%, respectively. 6 Furthermore, many pwMS that are still working experience substantial productivity losses even at low severity levels, as reported in our previous study in Canada, which showed an estimated 60 hours of productivity lost among employed pwMS during a 3-month period, including, presenteeism, absenteeism, and unpaid work loss. 7 The relationship among demographic, clinical, physical, and cognitive impairment factors and employment and work-related outcomes (including employment status, working hours, and productivity loss) have been studied previously.…”

“… 7 A comprehensive account, as the one presented here, of productivity losses among all pwMS is missing from the literature. Existing research reports separately on employment status, 6 , 8 productivity losses among those working for pay, 11 , 22 and costs associated with early retirement and work disability. 4 The addition and comparison of productivity losses among unemployed pwMS, including unpaid work losses, is an important contribution of this study.…”

Recent trends in disease-modifying therapy use and associated sickness absence and disability pension among people with multiple sclerosis in Sweden

“…14 A recent systematic review also showed an overall decrease in the prevalence of unemployment among PwMS, attributed partly to the use of DMTs which was more pronounced since 2010, when the number of high-efficacy DMTs started to increase. 15 There is limited literature on the long-term DMT use trends and corresponding work disability measured with SADP days. In a recent register-based study, we assessed the trajectories of DMT use over 10 years from MS onset, using sequence analysis.…”

“… 14 A recent systematic review also showed an overall decrease in the prevalence of unemployment among PwMS, attributed partly to the use of DMTs which was more pronounced since 2010, when the number of high-efficacy DMTs started to increase. 15 …”