Background During the past two decades, the overall incidence of disability pensions (DP) in Germany has decreased tremendously, mainly due to changes in the labour market and in the practice of retirement. In 2010, the rates of new DP in the statutory pension insurance fund were only 52% of those in 1993. When analysing incidence rates of DP among patients with rheumatoid arthritis, these changes in the population have to be taken into account.
Objectives To compare the incidence of DP in patients enrolled in the German biologics register RABBIT with the expected incidence based upon the general population.
Methods We used data from 2,385 patients with rheumatoid arthritis (RA) aged 40 to 59 who were enrolled in RABBIT at initiation of a biologic or synthetic DMARD after at least one DMARD failure and did not receive any kind of pension at baseline. Further, we used published data on DP by year, age, and sex from the German statutory pension insurance fund. We applied indirect standardization following the standardized mortality ratio approach and divided the cases observed in RABBIT by the number of cases expected for the age and sex matched population leading to a standardized disability pension ratio (SDR). The observation time was censored by either year of DP, 60th birthday or date of last information on occupational status.
Results 343 cases with incident DP were observed within 7.437 patient years. The SDR for DP in the RABBIT data compared to the population declined from 10.3 to 3.4 between 2001 and 2010 (Table 1). In the first years of the register, patients who were enrolled at start of a biologic DMARD had a higher risk of DP than those on synthetic DMARDs. This difference disappeared in the last observed years.
Conclusions Taking the overall population trend into account, the risk of early retirement in patients with RA observed in a large cohort has declined tremendously during the last decade. Patients treated with biologic DMARDs, even though more severely ill at inclusion, now have the same chance of remainig gainfully employed as those with less severe disease under treatment with synthetic DMARDs. This supports the evidence that the prognosis of RA has improved considerably due to better strategies and options of treatment.
Supported by a joint unconditional grant from Abbott, Amgen/Swedish Orphan Biovitrum, Bristol Myers Squibb, Essex/MSD, Pfizer, Roche, and UCB.
Disclosure of Interest None Declared
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