Background Work environment factors influence patients’ (life) satisfaction and well being. The model of effort-reward imbalance (ERI) was developed to identify health-adverse effects produced by a stressful psychosocial job-related environment. Research on ERI might contribute to the understanding of factors related to the health status of patients (pts) with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
Objectives We studied the ERI model and the association with the self-reported health status.
Methods In a cross-sectional study a set of standardized self-administered questionnaires was applied to RA pts, SLE pts and a control group without an inflammatory rheumatic disease capable for work. General health rating (SF36 item 1) and ERI scales (effort, reward, overcommitment) were studied by logistic regression models with diagnosis (RA and SLE vs controls) as explanatory factor and appropriate confounder control. Odd ratios were calculated. Ethical approval was obtained.
Results 519 pts (267 RA, 90.2% female) and 177 controls (c) (90.3% female) contributed data. Pts mean age was 44.0±10.4 (c 42.8±9.8) years, mean disease duration 9.7±7.1 years, mean HAQ 1.0±0.5 (c 0.4±0.1). 85.7% self-reported at least one comorbidity (range 0-10), (c 45.2%, range 0-4). After adjustment for age, sex and number of comorbidities, RA and SLE patients (compared to controls) have an odds ratio (95%CI) of 10 (5-19) and 7 (3-14) for poor health status, respectively. For odds ratios (OR) per unit increase of the corresponding ERI scales see table 1. All ERI scales are stable during controlling. Effort and reward scales have a significant impact on self reported health status (p < 0.05).
Conclusions ERI provides a useful tool for identifying health-adverse effects of work. The effort and reward scales were strongly associated to the self-reported health status. For example, an increase in the effort scale by 2 units leads to an 1.21 (=1.10²)-fold risk for poor health status. Presence of RA or SLE leads to a 10 or 7-fold extra increase, respectively. Thus improvement of these issues seems reasonable and needs a multidisciplinary approach, especially for persons with RA or SLE. Further analysis will address pts’ perceptions of their job-related burden to develop appropriate support strategies.
Acknowledgements Unrestricted grants Ministry of Innovation, Science, Research and Technology of the German State North Rhine-Westphalia, Deutsche Rheuma-Liga e.V., German LE Self-Help Community, Abbott Immunology Germany, Hiller Foundation
Disclosure of Interest None Declared