Background Osteoarthritis (OA) is a very common and disabling rheumatic condition with its onset often while people are still in paid employment. OA may generate difficulties in performing work tasks, leading to early exit from work.
Objectives We aim to examine the association between OA and early exit from work by using large real-world observational data.
Methods EpiReumaPt (Portuguese Epidemiological Study of Rheumatic Diseases) was a national, cross-sectional, population-based study conducted from September 2011 to December 2013. EpiReumaPt involved a three-stage approach: Phase 1 - face-to-face interview randomly performed at participants' households; Phase 2 - all subjects that screened positive for at least one musculoskeletal condition in Phase 1, and also 20% of individuals with no musculoskeletal complaints were referred to a rheumatologist observation; Phase 3 – all diagnosis and clinical data were reviewed considering previously validated classification criteria. Thus, EpiReumaPt randomly surveyed 10,661 inhabitants in order to capture and characterize all cases of rheumatic diseases within a representative sample of the Portuguese population, which were stratified by administrative territorial units (NUTSII). In this analysis we used all participants aged near the official retirement age (i.e. 50 to 65 years old). The association of clinically confirmed OA and early exit from paid work (including early retirement, unemployment, unpaid homemakers and disability pensions) was tested using individual level logistic regression, Multivariable models were adjusted for age, gender, region (NUTSII), education level (primary school or less, medium and high), household income and other chronic diseases. All estimates were computed as weighted proportions, in order to take into account the sampling design.
Results The estimated prevalence of OA in the Portuguese population with ages between 50 and 64 years old is 29.7% (knee: 18.6%; hand: 12.6%; hip: 3.6%). Among these, 61.8% were out of paid work versus 47.6% for those without OA (p=0.004). A non-statistically difference was observed when analyzing specifically official early retirement (32.6% vs. 29.1%, respectively; p=0,437). Thus, OA is associated with early exit from work (unadjusted OR: 1.78; CI: 1.19-2.65; p=0.005. Adjusted OR: 1.83; CI: 1.12-2.96; p=0.015), but not with official early retirement (OR: 1.18; CI: 0.78-1.79; p=0.437). Of particular note, knee OA seems to be strongly associated with early exit from work (unadjusted OR: 2.21; CI: 1.49-3.29; p<0.0001. Adjusted OR: 1.96; CI: 1.20-3.21; p=0.008), while none significant association was observed for hand OA (OR: 1.20; CI: 0.78-1.86; p=0.405) and hip OA (OR: 0.99; CI: 0.33-2.98; p=0.998).
Conclusions In this nationwide epidemiological study, we measured the high prevalence of OA in critical ages for early retirement. Moreover, we found a significant association between OA and early exit from work, but not with early official retirement. This likely mean that while society somehow avoid official retirement due to OA, other routes of early withdrawal from paid work are taking place. Identification of these alternative routes and setting up interventions to reduce or discourage them is crucial for the future sustainability of social protection policies.
Disclosure of Interest None declared