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Long-term trajectories of employment status, workhours and disability support pension status, after a first episode of CNS demyelination


Zarghami, A and van der Mei, I and Hussain, MA and Claflin, S and Bessing, B and Simpson-Yap, S and Ponsonby, A-L and Lechner-Scott, J and Broadley, S and Blizzard, L and Taylor, BV, AusLong Investigator Group, Long-term trajectories of employment status, workhours and disability support pension status, after a first episode of CNS demyelination, Multiple Sclerosis, 28, (11) pp. 1793-1807. ISSN 1352-4585 (2022) [Refereed Article]

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DOI: doi:10.1177/13524585221089900


Background: People with multiple sclerosis face significant employment-related challenges, with little known of the drivers of these outcomes.

Objective: We examined prospective trajectories of employment-related outcomes up to 11 years following a first episode of central nervous system (CNS) demyelination (FCD).

Methods: Participants were aged 18-59 years, at FCD, with at least two observations and were employed at study entry or anytime during follow-up (n = 207). Outcomes were employment status (full-time, part-time and unemployed), average workhours per week and disability support pension (DSP; receiving/not receiving). We used group-based trajectory modelling to identify groups with common trajectories. Factors associated with trajectory membership were explored using log-multinomial regression.

Results: Distinct trajectories were identified for employment (4), workhours (4) and DSP (2). Compared with stable full-time, female sex was strongly associated with being in the stable part-time trajectory (risk ratio (RR): 5.35; 95% confidence interval (CI) = 2.56-11.20; p < 0.001). A greater level of disability at 5-year review (RR: 1.35; 95% CI = 1.19-1.53) and having more than two comorbidities at baseline (RR: 2.77; 95% CI = 1.37-5.64) were associated with being in early and late deteriorated employment trajectories, respectively. Compared with the increased part-time trajectory, every additional relapse during the 5 years post-FCD was associated with a 10% increased risk of being in the reduced part-time trajectory (RR = 1.10; 95%CI = 1.00-1.22). For every additional EDSS point at 5-year review, the risk of being in the DSP trajectory increased (RR = 1.21; 95% CI = 1.05-1.41).

Conclusion: These trajectories indicate substantial heterogeneity and the complex impact of MS on employment from its earliest timepoints. Understanding these trends could enable better targeting of interventions to facilitate workforce retention, particularly for females, those with a higher number of comorbidities, more frequent relapses and greater rate of disability accrual.

Item Details

Item Type:Refereed Article
Keywords:multiple sclerosis, employment, longitudinal studies, risk factors, disease progression, disability pension
Research Division:Biomedical and Clinical Sciences
Research Group:Neurosciences
Research Field:Central nervous system
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Zarghami, A (Mr Amin Zarghami)
UTAS Author:van der Mei, I (Professor Ingrid van der Mei)
UTAS Author:Hussain, MA (Dr Akhtar Hussain)
UTAS Author:Claflin, S (Dr Suzi Claflin)
UTAS Author:Bessing, B (Mr Barnabas Bessing)
UTAS Author:Simpson-Yap, S (Dr Steve Simpson JR)
UTAS Author:Blizzard, L (Professor Leigh Blizzard)
UTAS Author:Taylor, BV (Professor Bruce Taylor)
ID Code:155202
Year Published:2022
Deposited By:Menzies Institute for Medical Research
Deposited On:2023-02-02
Last Modified:2023-02-09

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