Background Better insight into country- or system related differences in work outcomes is important when trying to take country specific measures aiming to improve short- and long-term work outcomes of patients with rheumatoid arthritis (RA).
Objectives We aimed to explore whether country of residence and specific country characteristics are associated with work outcomes in patients with RA.
Methods Data from the cross-sectional multinational study COMORA (17 countries) were used. Work outcomes were measured by the Work Productivity and Activity Impairment Questionnaire (WPAI) assessing employment (yes/no), absenteeism (% of time) and presenteeism (% of normal productivity). The contribution of country of residence, gross domestic product (GDP), human development index (HDI), unemployment rate, social protection expenditures (SPE) and world region to the work outcomes was investigated in logistic or ordinal logistic regression models after adjusting for clinical and sociodemographic factors.
Results The study sample consisted of 3,920 patients of whom the mean age was 56 (SD 13), 3,191 (82%) were female and 1,197 (31%) were employed. Large country differences were found for all work outcomes. The country with the best work outcome was used as reference. Morocco showed the lowest adjusted employment compared to the USA (OR 0.17; [95%CI 0.10; 0.30]) followed by Egypt (OR 0.37 [95% CI 0.24; 0.56]), Korea (OR 0.45 [95% CI 0.31; 0.65]), Venezuela (OR 0.53 [95% CI 0.34; 0.84]), Taiwan (OR 0.54 [95% CI 0.36; 0.80] and France (OR 0.66 [95% CI 0.46; 0.95]) (figure 1). Compared to Japan, absenteeism was highest in Morocco (OR 12.63 [4.45; 35.89]) followed by Hungary (OR 6.49 [95%CI 2.45; 17.23]) and Argentina (OR 3.25 [95%CI 1.25; 8.45]). Compared to Venezuela, presenteeism was highest in Taiwan (OR 13.81 [5.95; 32.04]) followed by Korea (OR 10.59 [95%CI 4.77; 25.13]) and Italy (OR 8.96 [95%CI 3.53; 22.76]). All country indices except SPE were significantly associated with the outcomes. Low GDP countries had lower odds of employment (OR 0.66; [0.54; 0.80]), higher odds of absenteeism (OR 2.68 [1.91; 3.76]), but a lower odds of presenteeism (OR 0.45 [0.32; 0.62]) compared to high GDP countries.
Conclusions Substantial differences in work outcomes among RA patients were observed between countries. Lower economic and human welfare were associated with worse employment, higher absenteeism but paradoxically also with lower presenteeism.
Disclosure of Interest None declared