Work productivity loss in mild to moderate COPD: lessons learned from the CanCOLD study

Abstract

Little attention has been given to the impact of chronic obstructive pulmonary disease (COPD) on work productivity loss. Individuals with COPD are at risk of reduced working hours, absenteeism, presenteeism and early retirement [1]. Studies have been focused mostly on patients attending outpatient clinics [2], which exclude individuals with undiagnosed COPD, thus limiting the external validity of the findings. There are very few population-based cohort studies [3-6], few reports on presenteeism [5], and a lack of objective measures to define COPD [6]. There would be value in knowing the extent of work productivity loss in individuals with mild COPD, or those who are yet undiagnosed. This could further translate into the allocation of health management programmes in the workplace. We evaluated work productivity loss (measured as absenteeism and/or presenteeism) between individuals with mild to moderate COPD and those without COPD. We hypothesised that working individuals with COPD, having mild and moderate airflow obstruction with a high symptom burden would have greater work productivity loss than those with a low symptom burden. Our study was embedded in the Canadian Cohort Obstructive Pulmonary Disease (CanCOLD) study, an ongoing multicentre study involving subjects with COPD, sampled from the general population (see BOURBEAU et al. [7], for full details). For the purpose of the current study, inclusion criteria for employed COPD and non-COPD control subjects were as follows: ⩾40 years old, having paid employment at the time of study enrolment and a post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) <0.70 for COPD versus FEV1/FVC ⩾0.70 for non-COPD. All participants provided written informed consent and the study was approved by the respective institutional ethical review boards. Subjects with spirometrically defined COPD, who reported prior physician-diagnosed COPD, chronic bronchitis, or emphysema upon entering the CanCOLD study were identified as "diagnosed" subjects, and subjects with spirometrically defined COPD, who had not received a COPD diagnosis prior to enrolment in the study, were identified as having "undiagnosed" COPD. The overall work productivity loss, i.e. absenteeism and/or presenteeism, was measured by the health and labour questionnaire (HLQ) [8], a generic and validated instrument. Absenteeism refers to health-related absence from work, whereas presenteeism refers to the act of attending work while sick, e.g. decreased work quality or quantity. Symptom burden was measured using the COPD Assessment Test (CAT) [9]. Subjects with CAT scores <10 were classified as low symptom burden and those with CAT scores ⩾10 as high symptom burden [10]. Comparisons between groups for descriptive summaries were performed using ANOVA or the Kruskal-Wallis test for continuous variables, and the Chi-squared test for dichotomous variables. The level of significance was set at p<0.05. All analyses were carried out using the SAS version 9.1.3 software (SAS Institute Inc., Cary, NC...

Costs of Workplace Productivity Loss in Patients With Fibrotic Interstitial Lung Disease

“…Dyspnea and cough severity were independently associated with workplace productivity loss, indicating that subjective symptoms are more important than objective measures of oxygenation and physiology. Similarly, previous studies in COPD have shown that symptom burden, and particularly dyspnea severity, is the predominant factor associated with workplace productivity loss, 33,35,37 including both absenteeism and presenteeism. 35 The strong association of common ILD symptoms with low workplace productivity suggests the potential for symptom-based management strategies to improve the ability of patients with ILD to remain and participate more fully in the workforce.…”

“…The impact of ILD on workplace productivity was greater than that reported in a 2017 publication from the Canadian Cohort of Obstructive Lung Disease (CanCOLD) study, which reported workplace productivity loss in 30% of employed patients with COPD who had an average age of 60 years and high symptom burden (COPD Assessment Test score $ 10). 33 In comparison, 55% of employed patients in the current ILD cohort had workplace productivity loss with an average age of 69 years and mild to moderate ILD severity. Similar to previous studies in asthma and COPD, 34,35 we found that presenteeism accounts for the majority of workplace productivity loss despite it typically being underrecognized.…”

The Canadian Cohort Obstructive Lung Disease (CanCOLD): New Insights for Primary Care Application

“…The largest contribution of COLD/Can-COLD-related publications may be seen to have advanced knowledge and understanding surrounding appropriate diagnostic approaches and disease characterisation with impact on recommendations for health care services and interventions. More specifically, the larger proportion of studies to date have served to appropriately quantify COPD prevalence and disease determinants 3,4 spirometry testing and prediction equations [5][6][7][8][9] , diagnosis performance and early detection [10][11][12][13][14][15] , novel methods of assessing COPD 16,17 , and COPD clinical impact [18][19][20][21][22] . Consequently, we have elected for this manuscript to summarise key learnings from the CanCOLD study that are relevant to the primary care setting.…”

“…In COPD individuals with mild airflow obstruction, those with a high symptom burden (CAT ≥10), experience increased work productivity loss (i.e. combined absenteeism and presenteeism) compared to COPD subjects with a low symptom burden (CAT <10), and non-COPD subjects 18 .…”

“…Importance of assessing symptom burden in mild COPD. CanCOLD provides a comprehensive overview of work productivity loss (absenteeism and/or presenteeism) among a representative population-based sample of individuals with mild-to-moderate COPD 18 . Work productivity loss in subjects with a high symptom burden (CAT ≥ 10) was about 3-fold higher than in COPD subjects with a low symptom burden (CAT < 10) and in non-COPD subjects.…”