Disclosures: The authors report no relevant financial disclosures.
July 09, 2020
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Rural patients with axSpA report greater disease impact on work productivity

Disclosures: The authors report no relevant financial disclosures.
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The patient-reported impact of axial spondyloarthritis on work productivity is greater rural areas than in cities, according to data published in the Annals of the Rheumatic Diseases.

“According to one estimate, work disability affects up to 30% of patients with axial spondyloarthritis (axSpA),” Rosemary J. Hollick, PhD, MBChB, BSc, FRCP, of the University of Aberdeen, in the United Kingdom, and colleagues wrote. “Compared with the general population, individuals with axSpA are three times more likely to withdraw from work, especially from physically demanding jobs.”

The patient-reported impact of axial spondyloarthritis on work productivity is greater rural areas than in cities. Source: Adobe Stock

“With the aging, multimorbid population increasing faster in rural areas, and people working to older ages, understanding the relationship between rurality, health and work outcomes is important to ensure that individuals with rheumatic disease are supported to live and work well,” they added. “A number of studies have highlighted inadequate access to specialist health care services for those with rheumatic and musculoskeletal disease (RMD) living in rural and remote locations. However, in a recent systematic review of the literature, we found very limited evidence as to whether outcomes are poorer for individuals with rheumatic disease living in rural settings.”

To examine the differences in clinical and patient-reported outcomes among patients with axial SpA living in rural and urban locations, Hollick and colleagues started with data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS). According to the researchers, the registry is a prospective cohort study of biologic-naïve adults with axial SpA from 83 centers across Great Britain from 2012 to 2017. For their study, Hollick and colleagues analyzed data from 2,390 participants from the BSRBR-AS, of whom 24% lived in a rural area.

The researchers collected clinical data, including age, gender, disease manifestations and medications, as well patient-reported measures documented in the registry, such as education level, smoking status, alcohol consumption, employment status and job type. Quality of life was assessed using the Ankylosing Spondylitis Quality of Life Index and the Short Form-12 Physical and Mental Component Scores. Later, Hollick and colleagues conducted 30 semi-structured telephone interviews with a subset of patients drawn from the BSRBR-AS registry.

Among the interviewees, 77% were of working age across a variety of occupations, 80% were male, 60% had a disease duration of more than 11 years and 60% lived in a rural location.

According to the researchers, patients in rural areas were older and more likely to work in a physically intensive job, as opposed to one that was sedentary or at a desk. Among patients who received biologics, there were initially no differences in response. However, after adjusting for age, sex and local area deprivation, patients in rural locations reported more presenteeism and overall work impairment.

The researchers wrote that the effect on work could be explained by accounting for individual differences in disease activity, fatigue, physical function and job type. Interviews with patients suggested a complex relationship between clinical factors, contextual factors — including work environment and job demands — and work disability. The ability to work, and flexibility in terms of what, when and how tasks are undertaken, were important to participants. In addition, participants reported that support from employers was variable, and health care professionals were often perceived as unsupportive.

“Our findings have important implications for practice, policy and research,” Hollick and colleagues wrote. “Health care professionals could do much more to support their patients to work well, and resources are becoming available to support this. Most employers will have very few employees with rheumatic disease, and do not understand the often-unpredictable disease course, and relapsing and remitting trajectory. Education and support for employers to enable flexibility at work could be transformative, particularly if ‘best practice’ examples from other employers were made available.”