Background RA is an important cause of disability and job loss, and financial pressures attributed to RA may increase applications and eligibility for social security benefits. Better understanding of these social impacts of early RA may help develop and target interventions.
Objectives This study assessed the rate of job loss and new social security benefits claims in a cohort of early RA.
Methods ERAN is an inception cohort of patients with early RA, given standard care in the UK and Eire. At baseline, and during each annual study visit, participants (n=1235) were asked to report employment, job loss, retirement and whether they were claiming social security benefits due to RA. Associations of patient and disease characteristics with baseline employment and benefit status were determined by logistic regression. Survival analyses of the time to first self-reported job loss and benefits claim were by Cox regression.
Results Participants at baseline had median age of 58 years and 66% were female. At baseline, 47% reported they were employed and 52% were not (mostly retired); also 17% reported claiming benefits due to RA and 79% did not. At baseline, non-workers were older, and had more females, disease activity and disability. Baseline benefits claimants had higher pain, disability and symptom duration, and more fulfilled 1987 ACR criteria.
The median (IQR) follow up period was 3 (1 – 4) years. Due to RA, 10% (49/475) of working participants lost their employment and 20% (179/905) began to claim benefits. Most loss of employment or new benefits claims were within 2 years of baseline assessment.
Univariate Cox regression found baseline disability, pain, poorer mental health, low vitality, smoking history and disease activity were all associated with shorter time to job loss or benefits claim. Independent baseline predictors of earlier job loss were bodily pain and low vitality (see Table 1). In contrast disability and extra-articular disease predicted early benefits claim (Table 1).
Conclusions Peak onset of RA is around retirement age, which was younger for females at the time. Job loss due to RA, however, was not predicted by age or gender. Benefits claims due to RA target the economic burden of disability, probably explaining associations with HAQ. Job loss due to RA was predicted by high pain and low vitality, rather than disease activity. Further research should investigate whether interventions targeting these symptoms can help job retention.
Disclosure of Interest D. Mcwilliams Grant/Research support from: Pfizer Ltd, A. Young: None Declared, P. Kiely: None Declared, D. Walsh Grant/Research support from: Pfizer Ltd, Consultant for: Pfizer Ltd