Due to shorter life expectancy, patients with kidney failure had shorter employment
Patients on maintenance dialysis in Taiwan were employed for fewer years during their lifetime than individuals from the general population without kidney failure.
Yu-Tzu Chang, MD, PhD, of National Cheng Kung University, and colleagues, attribute the lower employment duration to loss of life expectancy, noting that patients with kidney failure are, overall, as productive as those without the disease.
“Employment is associated with improved quality of life and relief of financial difficulties in the dialysis population,” the researchers wrote. “Nevertheless, patients undergoing dialysis who are seeking employment face tremendous challenges, including adverse effects from medical procedures, high incidence of cardiovascular diseases and disability, transportation issues, cognitive impairment, scheduling conflicts with dialysis appointments, and employer concerns about absenteeism and dependability. This inevitably leads to low employment rates in the dialysis population. Encouraging patients on dialysis to remain in or return to the workforce could potentially mitigate the financial burden these patients impose on society, at least through contributions to income taxes. Although quite a few studies have focused on this issue, no previous studies have comprehensively quantified lifetime loss of employment among patients undergoing dialysis.”
For the study, researchers considered the employment patterns of 83,358 patients undergoing dialysis between 2000 and 2017 (age ranged from 25-64 years). These patients were matched by age, sex and calendar year to individuals from the general population who served as referents, which allowed researchers to examine the difference between groups in lifetime employment duration.
Researchers noted men had a higher rate of employment than women in each age strata, with results showing the expected loss of lifetime employment duration for men with kidney failure was 11.8, 7.6, 5.7, 3.8, 2.3, 1 and 0.2 years for those aged 25 to 34 years, 35 to 40 years, 41 to 45 years, 46 to 50 years, 51 to 55 years, 56 to 60 years and 61 to 64 years, respectively; for women, expected loss of lifetime employment duration was 10.5, 10.1, 7.9, 5.6, 3.3, 1.5 and 0.3 years, respectively.
“Because the absolute differences in loss of life expectancy and loss of lifetime employment duration were generally [less than] 1 year between the patients undergoing dialysis and their corresponding referents, it appears that the loss of lifetime employment duration in patients undergoing dialysis in Taiwan mainly resulted from a loss of life expectancy,” Chang and colleagues suggested.
According to the researchers, this study illuminates the impact of employment (and loss of employment) on society as a whole, using the loss of employment duration as a “proxy” for productivity loss.
Researchers emphasized that although kidney failure was shown to result in loss of lifetime employment duration, it is significant that this was primarily due to loss of life expectancy.
“This highlights the phenomenon that many patients with kidney failure in Taiwan remain as productive as those without kidney failure, and their contributions should not be ignored from a societal perspective,” they wrote. “In our clinical experience, most patients with kidney failure who are employed typically suffer from emotional distress because of fear of losing their jobs when they initiated maintenance dialysis therapy. Therefore, our results strongly corroborate the assertion that dialysis not only saves lives, but also increases lifetime employment duration, which hopefully contributes to patient trust and self-confidence when initiating dialysis.
... Furthermore, our study results highlight the importance of the timely integration of a CKD educational plan and modern medical therapies to ameliorate kidney function decline in young patients with CKD. The slower the decline to kidney failure, the longer the life expectancy, which would reciprocally contribute to longer employment duration, reduced financial burden of those with CKD, and increased funding to the health care system through tax or insurance payments.”
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