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Title: Long-term trajectories of employment status, workhours and disability support pension status, after a first episode of CNS demyelination
Authors: Zarghami, Amin;van der Mei, Ingrid;Hussain, Mohammad Akhtar ;Claflin, Suzi B;Bessing, Barnabas;Simpson-Yap, Steve;Ponsonby, Anne-Louise;Lechner-Scott, Jeanette;Broadley, Simon;Blizzard, Leigh;Taylor, Bruce V
Affliation: Central Coast Local Health District
Gosford Hospital
Issue Date: 28-Oct-2022
Source: 28(11):1793-1807.
Journal title: Multiple Sclerosis
Department: Public Health
Abstract: People with multiple sclerosis face significant employment-related challenges, with little known of the drivers of these outcomes. We examined prospective trajectories of employment-related outcomes up to 11 years following a first episode of central nervous system (CNS) demyelination (FCD). Participants were aged 18-59 years, at FCD, with at least two observations and were employed at study entry or anytime during follow-up (n = 207). Outcomes were employment status (full-time, part-time and unemployed), average workhours per week and disability support pension (DSP; receiving/not receiving). We used group-based trajectory modelling to identify groups with common trajectories. Factors associated with trajectory membership were explored using log-multinomial regression. Distinct trajectories were identified for employment (4), workhours (4) and DSP (2). Compared with stable full-time, female sex was strongly associated with being in the stable part-time trajectory (risk ratio (RR): 5.35; 95% confidence interval (CI) = 2.56-11.20; p < 0.001). A greater level of disability at 5-year review (RR: 1.35; 95% CI = 1.19-1.53) and having more than two comorbidities at baseline (RR: 2.77; 95% CI = 1.37-5.64) were associated with being in early and late deteriorated employment trajectories, respectively. Compared with the increased part-time trajectory, every additional relapse during the 5 years post-FCD was associated with a 10% increased risk of being in the reduced part-time trajectory (RR = 1.10; 95%CI = 1.00-1.22). For every additional EDSS point at 5-year review, the risk of being in the DSP trajectory increased (RR = 1.21; 95% CI = 1.05-1.41). These trajectories indicate substantial heterogeneity and the complex impact of MS on employment from its earliest timepoints. Understanding these trends could enable better targeting of interventions to facilitate workforce retention, particularly for females, those with a higher number of comorbidities, more frequent relapses and greater rate of disability accrual.
DOI: 10.1177/13524585221089900
Publicaton type: Journal Article
Keywords: Employment
Appears in Collections:Health Service Research

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