Background In the pre-biologics era, employment of patients with ankylosing spondylitis (AS) was decreased when compared to the general population. However, information on standardized employment since the introduction of biologicals is lacking. Also, while mastery (control over disease) has been identified as strong predictor of work outcome within patients with AS, it is not known whether such personality trait plays a similar role in patients compared to population subjects.
Objectives To update the knowledge on employment and contributing factors, in particular personal factors, among Dutch patients with AS compared to general population subjects.
Methods Data from patients and population controls participating in the Dutch cross-sectional multicenter survey-based Social Participation in AS Study (SPASS) and ≤65 years were used. Standardized employment ratios (SERs) were calculated using indirect standardization after adjusting for age, gender and education and were stratified by disease duration tertiles. Adjusted absolute employment rate (%) was calculated as “SER[AS]*employment rate [controls]”. Modified Poisson regressions were performed to understand the role of mastery as a personal factor (Pearlin's Mastery scale) in patients opposed to controls, independent of socio-demographics (age, gender, education) and health-related factors (comorbidities, Physical Component Summary (PCS) of the SF-36).
Results 214 patients and 470 controls (127 [59.3%] and 323 [68.7%] males; mean age of 48.3 [SD 10.4] and 39.3 [SD 12.7] years, respectively) completed the online questionnaire in 2011. SERs (95% CI) of patients with AS with controls set as reference (1.00) were 0.83 (0.69–0.98) for the total group, 0.84 [0.67–1.04] for males and 0.83 [0.59–1.07] for females. There was no significant difference in SER between those with short or long disease duration (Figure 1). Adjusted absolute employment rate (%) of patients with AS was 14% lower compared to controls (69% vs. 84%). In both patients and controls, higher PCS (SF-36) was associated with being employed. While AS patients with higher (better) mastery were more likely to be employed, such association was not seen in controls (p<0.01 for interaction group*mastery) (Table).
Conclusions In the biologics era, employment among Dutch patients with AS remains reduced when compared to the general population, also in those with less than 15 years disease duration. As mastery in patients is independently associated with work outcome, it is worthwhile exploring whether improving personal self-management skills supports future worker participation.
Disclosure of Interest None declared