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Understanding the Impact of Arthritis Across the Working Life Course: A Canadian Context Arif Jetha 1, Elizabeth M. Badley 2,3, Dorcas Beaton 4,5, Monique.

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Presentation on theme: "Understanding the Impact of Arthritis Across the Working Life Course: A Canadian Context Arif Jetha 1, Elizabeth M. Badley 2,3, Dorcas Beaton 4,5, Monique."— Presentation transcript:

1 Understanding the Impact of Arthritis Across the Working Life Course: A Canadian Context Arif Jetha 1, Elizabeth M. Badley 2,3, Dorcas Beaton 4,5, Monique A.M. Gignac 2,3,5 1 Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA 2 Dalla Lana School of Public Health, University of Toronto 3 Toronto Western Research Institute, University Health Network 4 Mobility Program, Clinical Research Unit, St. Michaels Hospital, Toronto 5 Institute for Work and Health, Toronto, Canada

2 Arthritis Group of 100 autoimmune conditions Rheumatoid arthritis, osteoarthritis, juvenile arthritis, lupus, gout Inflammation joints, connective tissues Affect all parts of the body Range of symptoms Pain, fatigue, rash, failure to organs Episodic and invisible Contributes to activity limitations and disability in all areas of life No cure (The Arthritis Society, 2013)

3 Not Your Grandmother’s Arthritis Canadians live with one or more chronic conditions 4.6 Million 55% Canadians with arthritis 2 nd and 3 rd most common chronic disease in women and men, respectively Expected to double in the next decade 58% Canadians with arthritis are under 65 years of age ½ Million People ages 15 to 44 years living with arthritis (The Arthritis Society, 2013; Public Health Agency of Canada, 2010)

4 Economic Implications of Arthritis in Canada 2/3 Indirect costs Work loss Underemployment Long and short-term disability costs Productivity loss Total costs of arthritis in Canada Direct medical costs Indirect costs $ 33 Billion Arthritis & MSKs most costly condition in Canada (The Arthritis Society, 2013; Public Health Agency of Canada, 2010)

5 Arthritis and Employment: A Reciprocal Relationship Employment Employment related to greater physical and mental health An important social determinant of health Arthritis limits working Arthritis Arthritis more likely to affect people living with low socioeconomic status (Allaire et al., 2005; Badley & Wang, 2001; Jin, Shah & Svaboda, 1995; Lacaille et al., 2007; Public Health Agency of Canada, 2010 )

6 Arthritis and Employment at a Glance 2/3 More likely to report permanently being unable to work compared to people with other chronic conditions >1/4 Canadians with arthritis are not in the labour force Compared to 12% of healthy Canadians 3x Go to work even though they feel unwell 14.2 hours * Work productivity loss reported over a two-week period $285 * Cost of work productivity loss over a two week period Based on estimates from a study of a general adult sample with arthritis (Zhang et al., 2010; The Arthritis Society, 2013; Public Health Agency of Canada, 2010)

7 Arthritis and Employment: Potential Mechanisms Workplace activity limitations Difficulties sitting or standing, reaching and mobility, travel, pace of work Health-related job disruptions Interruptions to work day, lost time Self-management, fatigue, attending doctors appointment Unpredictability of arthritis Taking on commitments in the workplace Invisibility Disclosing their condition Limits access to job accommodation (Backman et al., 2004; Badly & Wang, 2001; Gignac et al., 2011; Gignac et al., 2005)

8 Life Course Perspective Number / Perceived important of social roles Young adulthood Middle age Older age Age (Gignac et al., 2013; Hendrick, 2012)

9 Young Adulthood: 18 to 30 years Understudied in arthritis and employment research Transitional life phase, increased participation in social roles Work, post-secondary education, social relationship Period of high optimism, exploration and stress Learning to manage their health condition while working and participating in different roles Independence Failure in early labour market can have long-lasting effects Future risk of unemployment, reduced long-term earnings, deterioration of skills

10 Life Course Perspective to Arthritis and Employment Number / Perceived important of social roles Young adulthood Middle age Older age Age

11 Middle ages: 30 to 59 years More experience working with arthritis Inform a range of coping strategies Fully involved in a range of social roles that are highly valued or necessary Parenting, marriage, community life, recreation Role conflict/stress Conflicting time demands or pressures from different personal roles Stressful to maintain employment, manage health and participate in different roles Report experiencing more job disruptions or interruptions Related to choosing to leave the labour force (Gignac et al., 2013; Gignac, Sutton & Badley, 2006)

12 Life Course Perspective to Arthritis and Employment Number / Perceived important of social roles Young adulthood Middle age Older age Age

13 Growing subset of the population Re-prioritizing or disengaging from social roles Decision to stay employed, reduce hours, modify work or retire Arthritis often coupled with co-morbidities Diabetes, osteoporosis, heart disease Learning to work with more co-morbidities Risk of pre-mature work cessations if workplace adaptations don’t exist Significant financial and health implications Less time to contribute to retirement income or plan for financial burden Older Workers with Arthritis: 59+ years (Allaire et al., 2005; Gignac et al., 2013; Gignac, Sutton & Badley, 2006)

14 Different Life Phase. Similar interventions? Universal Interventions Promote modifiable work environment Adapt physical and psychosocial job demands to health and life phase Flexible Scheduling Balance changing role participation - work, personal and health For people with arthritis Encourage early disclosure Gain access to accommodations Continue pharmacologic and non-pharmacologic therapy to manage arthritis Minimize disease severity and disability Summary Young: Career establishment; learning to balance work and health Middle: Maintaining participation in a greater range of roles Old: Comorbidities and minimizing participation

15 Future Research Directions Comparative research between young, middle, and older adults Determine effectiveness and delivery of job accommodations/modifications at different life phases Understand best ways to measure work productivity loss in different age groups

16 Take Home Points Arthritis affects Canadians of all ages and limits involvement in different roles. Arthritis is associated with significant societal and personal costs related to employment and productivity loss. People with arthritis face unique challenges to finding and maintaining employment at different stages of the working life course. Universal interventions should be designed to promote employment at across life phases.

17 References Allaire S, Wolfe F, Niu J, LaValley MP, Zhang B, Reisine S. Current risk factors for work disability associated with rheumatoid arthritis: Recent data from a US national cohort. Arthritis Care & Research. 2009;61(3): Allaire S, Wolfe F, Niu J, Lavalley M, Michaud K. Work disability and its economic effect on 55–64 ‐ year ‐ old adults with rheumatoid arthritis. Arthritis Care & Research. 2005;53(4): Arnett JJ. Emerging adulthood: The winding road from late teens through the twenties. New York, NY.: Oxford University Press; Backman CL, Kennedy SM, Chalmers A, Singer J. Participation in paid and unpaid work by adults with rheumatoid arthritis. The Journal of Rheumatology. 2004;31(1): Badley EM, Wang PP. The contribution of arthritis and arthritis disability to nonparticipation in the labor force: a Canadian example. The Journal of Rheumatology. 2001;28(5): Beaton D, Bombardier C, Escorpizo R, Zhang W, Lacaille D, Boonen A, et al. Measuring Worker Productivity: Frameworks and Measures. The Journal of Rheumatology. 2009;36(9): Gignac MAM, Backman CL, Davis AM, Lacaille D, Cao X, Badley EM. Social role participation and the life course in healthy adults and individuals with osteoarthritis: Are we overlooking the impact on the middle-aged? Social Science & Medicine. 2013;81: Gignac MAM, Cao X, Lacaille D, Anis AH, Badley EM. Arthritis-related work transitions: A prospective analysis of reported productivity losses, work changes, and leaving the labor force. Arthritis Care & Research. 2008;59(12): Gignac MAM, Cao X, Tang K, Beaton DE. Examination of arthritis-related work place activity limitations and intermittent disability over four-and-a-half years and its relationship to job modifications and outcomes. Arthritis Care & Research. 2011;63(7): Gignac MAM, Sutton D, Badley EM. Reexamining the arthritis-employment interface: perceptions of arthritis-work spillover among employed adults. Arthritis & Rheumatism. 2006;55: Hendricks J. Considering life course concepts. Journals of Gerontology Series B-Psychological Sciences & Social Sciences (2): Jin RL, Shah CP, Svoboda TJ. The impact of unemployment on health: a review of the evidence. Canadian Medical Association Journal. 1995;153(5): Lacaille D, White MA, Backman CL, Gignac MAM. Problems faced at work due to inflammatory arthritis: New Insights Gaines from Understanding Patients Perspective. Arthritis & Rheumatology. 2007;57(7): Public Health Agency of Canada. Life with Arthritis in Canada: A personal and public health challenge. Ottawa, ON: Chronic Disease Surveillance and Monitoring Division: Centre for Chronic Disease Prevention and Control; The Arthritis Society. Arthritis Facts & Figures [cited 2014 May 5]; Available from: Zhang W, Gignac MA, Beaton D, Tang K, Anis AH. Productivity Loss Due to Presenteeism Among Patients with Arthritis: Estimates from 4 Instruments. The Journal of Rheumatology. 2010;37(9):

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