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Clinical and epidemiological research
Work participation in spondyloarthritis across countries: analysis from the ASAS-COMOSPA study
  1. Santiago Rodrigues Manica1,2,
  2. Alexandre Sepriano2,3,
  3. Sofia Ramiro2,3,
  4. Fernando Pimentel Santos1,2,
  5. Polina Putrik4,
  6. Elena Nikiphorou5,
  7. Sam Norton5,6,
  8. Anna Molto7,8,
  9. Maxime Dougados7,8,
  10. Désirée van der Heijde3,
  11. Robert B M Landewé9,
  12. Filip E van den Bosch10,11,
  13. Annelies Boonen12,13
    1. 1 Department of Rheumatology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
    2. 2 NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
    3. 3 Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
    4. 4 MUMC, Maastricht, The Netherlands
    5. 5 Academic Rheumatology, King’s College of London (KCL), London, UK
    6. 6 Psychology Department, King’s College of London (KCL), London, UK
    7. 7 Rheumatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
    8. 8 INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
    9. 9 Amsterdam and Atrium MC Heerlen, Amsterdam, The Netherlands
    10. 10 Department of Internal Medicine, VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
    11. 11 Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
    12. 12 Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
    13. 13 Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
    1. Correspondence to Dr Santiago Rodrigues Manica, Rheumatology department, Hospital de Egas Moniz, Lisboa, 1349-019, Portugal; santiagorodriguesma{at}gmail.com

    Abstract

    Objectives To explore the role of individual and country level socioeconomic (SE) factors on employment, absenteeism and presenteeism in patients with spondyloarthritis (SpA) across 22 countries worldwide.

    Methods Patients with a clinical diagnosis of SpA fulfilling the ASAS classification criteria and in working age (≤65 years) from COMOSPA were included. Outcomes of interest were employment status, absenteeism and presenteeism, assessed by the Work Productivity and Activity Impairment Specific General Health questionnaire. Three multivariable models were built (one per outcome) using mixed-effects binomial (for work status) or ordinal regressions (for absenteeism and presenteeism), with country as random effect. The contribution of SE factors at the individual-level (eg, gender, education, marital status) and country-level (healthcare expenditure (HCE) per capita, Human Development Index (HDI) and gross domestic product per capita) SE factors, independent of clinical factors, was assessed.

    Results In total, 3114 patients with SpA were included of which 1943 (62%) were employed. Physical function and comorbidities were related to all work outcomes in expected directions and disease activity also with absenteeism and presenteeism. Higher education (OR 4.2 (95% CI 3.1 to 5.6)) or living in a country with higher HCE (OR 2.3 (1.5 to 3.6)) or HDI (OR 1.9 (1.2 to 3.3)) was positively associated with being employed. Higher disease activity was associated with higher odds for absenteeism (OR 1.5 (1.3 to 1.7)) and presenteeism (OR 2.1 (1.8 to 2.4)). No significant association between individual-level and country-level SE factors and absenteeism or presenteeism was found.

    Conclusions Higher education level and higher country SE welfare are associated with a higher likelihood of keeping patients with SpA employed. Absenteeism and presenteeism are only associated with clinical but not with individual-level or country-level SE factors.

    • spondyloarthritis
    • economic evaluations
    • epidemiology
    • outcomes research

    https://doi.org/10.1136/annrheumdis-2018-213464

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      Footnotes

      • Handling editor Josef S Smolen

      • Contributors SARM wrote the first draft of the manuscript, which was then reviewed and edited by AS, SR, FPS, PP, EN, SN, AM, MD, DvdH, RBML, FEvdB and AB. The study was conceptualised by SARM, AS, SR, FPS, PP, EN, SN and AB. The statistical analyses were carried out by SARM with the advice and support from AS, SR, FPS, PP, EN, SN and AB.

      • Funding The COMOSPA study was conducted with the financial support of Abbvie, Pfizer and UCB, who provided an unrestricted grant to ASAS to fund the study.

      • Disclaimer The funders did not have any role in the design or conduct of the study. This ancillary study did not receive any funding, and the sponsors of COMOSPA did not have any interference with this current study.

      • Competing interests None declared.

      • Patient consent Not required.

      • Ethics approval The study was conducted according to guidelines for good clinical practice in all countries with all local ethics committees approving the ASAS-COMOSPA study protocol.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Collaborators (1) Fadoua Allali, MD, Mohamed Vth University, URAC 30, Department of Rheumatology, El Ayachi Hospital, Salé, Faculty of Medicine and Pharmacy, Rabat, Morocco. fadouaallali@yahoo.fr (2) Raquel Almodovar González, MD, Hospital Fundación Alcorcón, Madrid, Spain. ralmodovar@fhalcorcon.es (3) Elena Alonso Blanco-Morales, MD, Hospital Universitario Juan Canalejo, La Coruña, Spain. elena.alonso.blanco.morales@sergas.es (4) Alejandro Alvarellos, MD. aalvarellos@gmail.com Hospital Privado de Córdoba, Argentina. (5) Maria Aparicio Espinar, MD, Hospital Universitario Bellvitge, Barcelona, Spain. maparicioe@bellvitgehospital.cat (6) Pamir Atagunduz, MD, Division of Rheumatology, Marmara University, Faculty of Medicine, Istanbul, Turkey. (7) Pauline Bakker, MD, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. P.A.C.Bakker@lumc.nl (8) Juan C. Barreira, MD, jbarreira@hbritanico.com.ar, Hospital Británico de Buenos Aires, Argentina. (9) Leila Benbrahim, MD, Mohamed Vth University, URAC 30, Department of Rheumatology, El Ayachi Hospital, Salé, Faculty of Medicine and Pharmacy, Rabat, Morocco. l.benbrahim@yahoo.fr (10) Bahia Benchekroun, MD, Mohamed Vth University, URAC 30, Department of Rheumatology, El Ayachi Hospital, Salé, Faculty of Medicine and Pharmacy, Rabat, Morocco. benchk_1@yahoo.fr (11) Alberto Berman, MD. Albertoberman1@yahoo.com.ar, Centro Médico Privado, Tucumán, Argentina. (12) Juergen Braun, MD, Rheumazentrum Ruhrgebiet, Herne, Germany. juergen.braun@elisabethgruppe.de (13) Alain Cantagrel, MD, PhD, Centre de Rhumatologie, CHU Purpan, Toulouse, France. (14) Roberto Caporali, MD, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. (15) Pedro Carvalho, MD, Clínica Universitária de Reumatologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal. (16) Gustavo Casado, MD. guscasado@hotmail.com. Hospital Militar Central, Buenos Aires, Argentina. (17) James Cheng-Chung Wei, MD, PhD, Chung Shan Medical University Hospital, Taichung, Taiwan. e-mail: jccwei@gmail.com (18) Francisco Colombres, MD. colombresfrancisco@yahoo.com.ar. Centro Médico Privado, Tucumán, Argentina. (19) Eugenio del Miguel Mendieta, MD, PhD, Hospital Universitario La Paz, Madrid, Spain. eugenio.demiguel@gmail.com (20) Juan D. Diaz-Garcia, MD, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico. (21) Michel De Bandt, MD, PhD, Rheumatology Unit, University Hospital of Martinique, Fort de France, France. (22) Vanesa Duarte, MD. vanu.duarte24@gmail.com. Hospital Rivadavia, Buenos Aires, Argentina. (23) Cristina Fernandez Carballido, MD, Hospital General Universitario de Elda, Elda, Spain. soficarballido@hotmail.com (24) Mari Cruz Fernandez Espartero, MD, Hospital de Mostoles, Madrid, Spain. mcruzespartero@yahoo.es (25) Manuel Fernandez-Prada, MD, Hospital de Guadalajara, Guadalajara, Spain. (26) Rene-Marc Flipo, MD, PhD, Rheumatology Department, CHRU Lille, France. (27) Pilar Font Ugalde, MD, PhD, Hospital Universitario Reina Sofia, IMIBIC, Córdoba, Spain. fougp@hotmail.com (28) Philippe Gaudin, MD, PhD, Clinique Universitaire de Rhumatologie, Hôpital Sud, Echirolles, and Université Joseph Fournier, Grenoble, France. (29) Philippe Goupille, MD, Rheumatology Department, Tours University, Tours, France. (30) Dolors Grados Cánovas, MD, Hospital San Rafael, Barcelona, Spain. dgrados23@hotmail.com (31) Jordi Gratacós Masmitjá, MD, PhD. Hospital Universitario Parc Taulí, Badalona, Spain. jgratacosmas@gmail.com (32) Vittorio Grosso, MD, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. (33) Naomi Ichikawa, MD, Institute of Hematology, Tokyo Women’s Medical University, Japan. Naomu@twmu.ac.jp 34. Hisashi Inoue, MD, Juntendo University School of Medicine, Japan. fwif1005@mb.infoweb.ne.jp (35) Yuko Kaneko, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan. ykaneko@z6.keio.jp (36) Taku Kawasaki, MD, PhD, Department of Orthopaedic Surgery, Shiga University of Medical Science, Japan. tka@belle.shiga-med.ac.jp (37) Shigeto Kobayashi, MD, Juntendo University School of Medicine, Japan. shigeto@juntendo.ac.jp (38) Manjari Lahiri, MD, Division of Rheumatology, National University Hospital, Singapore. Manjari_lahiri@nuhs.edu.sg. (39) Hernán Maldonado-Ficco, MD. nanmaldonado@msn.com. Clinica Regional del Sud, Rio Cuarto (Córdoba), Argentina. (40) Marhadour, MD, Rheumatology Department, CHRU Cavale Blanche, Brest, France. (41) Alejandro Martínez, MD. ale_mmzgonc@yahoo.com.ar. Hospital Tornú, Buenos Aires, Argentina. (42) Kazuo Matsui, MD, Department of Rheumatology, Kameda Medical Center, Japan. PXU17054@nifty.com (43) Ramón Mazzuchelli Esteban, MD, Hospital Fundación Alcorcón, Madrid, Spain. rmazzucchelli@fhalcorcon.es (44) Corinne Micelli, MD, PhD, Rheumatology Department, Kremlin-Bicêtre Hospital, Paris VII University, Paris, France. (45) Chisun Min, MD, Immuno-Rheumatology Center, St Luke’s International Hospital, Japan. sinrai7055@gmail.com (46) Mitsuhiro Morita, MD, PhD, Department of Orthopaedic Surgery, Fujita Health University, Japan. mimorita@fujita-hu.ac.jp (47) Juan Mulero Mendoza, MD, PhD, Hospital Universitario ‘Puerta de Hierro’, Madrid, Spain. juan.mulero@arrakis.es (48) Jose Raul Noguera Pons, MD, Hospital de Elche, Elche, Spain. noguera_jos@gva.es (49) Masato Okada, MD, Immuno-Rheumatology Center, St Luke’s International Hospital, Japan. okadama@luke.ac.jp (50) Alberto Ortiz, MD. albertoortiz_4@hotmail.com Hospital Provincial Dr. José Cullen, Santa Fe, Argentina. (51) Jon Packham, DM, FRCP, Keele University. Jon.Packham@uhns.nhs.uk (52) Gisela Pendón, MD. giselapendon@yahoo.com.ar. Hospital Ricardo Gutierrez, La Plata, Argentina. (53) Dora Pereira, MD. dorapereira@fibertel.com.ar. Hospital Ricardo Gutiérrez, La Plata, Argentina. (54) José A Pereira da Silva, MD, Clínica Universitária de Reumatologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal. (55) Fernando Pimentel-Santos, MD, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal. (56) Hanan Rkain, MD, Mohamed Vth University, URAC 30, Department of Rheumatology, El Ayachi Hospital, Salé, Faculty of Medicine and Pharmacy, Rabat, Morocco. hananrkain@yahoo.fr (57) Oscar Rillo, MD. rillo.oscar@gmail.com. Hospital Pirovano, Buenos Aires, Argentina. (58) Carlos Rodriguez Lozano, MD, Hospital Universitario Negrin, Tenerife, Spain. crlormar@gmail.com (59) Adeline Ruyssen-Witrand, MD, PhD, Centre de Rhumatologie, CHU Purpan, Toulouse, France. (60) Adrián Salas, MD. adrianpsalas@yahoo.com.ar. Hospital General San Martín, La Plata. Argentina. (61) Carlos Salinas-Ramos, MD, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico. (62) Amelia Santosa, MD, Division of Rheumatology, National University Hospital, Singapore. amelia_santosa@nuhs.edu.sg (63) Alain Saraux, MD, PhD, Rheumatology Department, CHRU Cavale Blanche, Brest, France. (64) Raj Sengupta, FRCP, PGCME, Royal Bath Hospital for Rheumatic Diseases, Bath, UK. rajsen99@gmail.com (65) Stefan Siebert, PhD, University of Glasgow, UK. stefan.siebert@glasgow.ac.uk (66) Martin Soubrier, MD, PhD, CHU Clermont-Ferrand, Dpt of Rheumatology, UMR 1019 INRA/Clermont 1 University, Clermont-Ferrand, France. (67) Caroline Spiegel, Rheumazentrum Ruhrgebiet, Herne, Germany. carolinspiegel@gmx.de (68) Carmen Stolwijk, MD, Maastricht University Medical Center, Maastricht, The Netherlands. (69) Kurisu Tada, MD, Juntendo University School of Medicine, Japan. chris@juntendo.ac.jp (70) Naoho Takizawa, MD, Department of Rheumatology, Kameda Medical Center, Japan. ttkkzzww5959@gmail.com (71) Yoshinori Taniguchi, MD, PhD, Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi University, Japan. taniguchiy@kochi-u.ac.jp (72) Atsuo Taniguchi, MD, PhD, Institute of Rheumatology, Tokyo Women’s Medical University, Japan. amtanigu@ior.twmu.ac.jp (73) Chung Tei Chou, MD, Veterans General Hospital, Taipei, Taiwan. ctchou1007@gmail.com (74) Lay-Keng Teoh, Division of Rheumatology, National University Hospital, Singapore. lay_keng_teoh@nuhs.edu.sg (75) Tetsuya Tomita, MD, PhD, Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Japan. tomita@ort.med.osaka-u.ac.jp (76) Wen-Chan Tsai, MD, PhD, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; email: d10153@ms14. hinet.net (77) Shigeyoshi Tsuji, MD, PhD, Department of Orthopedic surgery, Osaka Minami Medical Center, Japan. hige.t1970@gmail.com (78) Olga Tsyplenkova, Rheumazentrum Ruhrgebiet, Herne, Germany. carolinspiegel@gmx.de (79) Astrid van Tubergen, MD, PhD, Maastricht University Medical Center, Maastricht, The Netherlands. (80) Kiana Vakil-Gilani, BS, MPH, Oregon Health & Science University, Portland, USA. (81) Rafael Valle-Oñate, MD, Rheumatology Department, Faculty of Medicine, HMC/UMNG, Bogota, Colombia. (82) Gaelle Varkas, MD, Department of Rheumatology, Ghent University Hospital, Ghent, Belgium. (83) Virginia Villaverde, MD, Hospital de Mostoles, Madrid, Spain. virginia.villaverde@yahoo.es (84) Ai Yap, Division of Rheumatology, National University Hospital, Singapore. B.Sc ai_yap@nuhs.edu.sg (85) Pedro Zarco Montejo, MD, PhD. Hospital Fundación Alcorcón, Madrid, Spain. pzarco@fhalcorcon.es.