Job loss, 'dose of poverty' worsen disability, mortality outcomes in rheumatic diseases
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Unemployment and poverty can be significant drivers of poor outcomes in conditions like rheumatoid arthritis and systemic lupus erythematosus, according to a keynote lecture at ACR Convergence 2021.
“Are you poor because you’re sick or sick because you’re poor?” Edward Yelin, PhD, professor in the Institute for Health Policy Studies at the University of California, San Francisco Medical School, asked attendees during the ARP Distinguished Lecture. “Like most social scientists, because I can’t make a decision, I answered yes to both.”
Yelin has conducted extensive research exploring associations between health care outcomes and factors such as employment, broader labor issues and poverty. Some of that research has revealed two key points: one is that reduced health status is still one of the most common routes to poverty; the other is that musculoskeletal conditions are the most common cause of work loss.
Yelin explained why work loss is so critical. “Outcomes of RA and lupus are contingent upon interaction with a job, and not necessarily contingent upon severity of disease,” he said.
In both RA and SLE, after a decade with the disease, some 35% to 40% of patients have left their employment, according to Yelin. This is of particular concern in SLE, where patients are frequently diagnosed in their 20s and 30s. “People are leaving work in the prime of their career,” he said. “It makes it difficult to save for the future.”
Other data have shown that patients with SLE who did continue to work saw a reduction of less than 1% in the number of hours they spent at their jobs. “That is sad, because laccommodating them with lower hours would be a great way to help them retain employment,” Yelin said.
Looking at broader trends in labor, Yelin suggested that over the last several decades, women have taken up a larger share of the workforce while men have seen decreases.
However, for men with the kinds of limitations that accompany diseases like RA and SLE, the drop-off in employment has been “continuous and substantial,” according to Yelin. “Among men with musculoskeletal conditions, their employment declined by 20% over this time,” he said.
A similar pattern is seen among women with those limitations. “For women with musculoskeletal diseases, they are not sharing in the gains [in employment] experienced by all women over this time period,” he said. “That is very troubling.”
A lack of employment can naturally lead to poverty, which carries its own associations with poor outcomes in autoimmune and rheumatic diseases, according to Yelin. “‘Dose’ of poverty in terms of number of years in poverty affects levels of damage accrual,” he said. “Disability and mortality are higher for the poor. Patients with musculoskeletal disease are an example of this phenomenon."
In closing, Yelin showed a slide depicting an old cemetery in which those with the tallest gravestones had been the wealthiest in life. A study of this cemetery showed that the individuals with the tallest gravestones also lived longer than their counterparts with shorter monuments. “The relationship between wealth and health seems to be timeless,” Yelin said. “It should be troubling to us that it persists into the current time.”
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Yelin E. Abstract 7S402. Presented at: ACR Convergence 2021; November 5-9, 2021 (virtual meeting).
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