People with multiple sclerosis (MS) spend a significantly greater number of work days each year on sick leave or disability pay than do the general population — including in the years before they are formally diagnosed, a Swedish study found.
Though the number of missed work days rises in post-diagnosis years as the disease progresses, reasons given are not always directly related to MS, the researchers found. Other diagnosed illnesses also contributed to a lesser capacity for work.
The study, “Diagnosis-specific sickness absence and disability pension before and after multiple sclerosis diagnosis: An 8-year nationwide longitudinal cohort study with matched references,” was published in the journal Multiple Sclerosis and Related Disorders.
MS symptoms usually first appear in working-age adults, and patients go on to experience physical and cognitive decline that limits their daily activities, including those of the workplace.
People in Sweden have guaranteed access to sick leave when their ability to work is affected by disease or injury. They also are eligible for disability payments if a disease or injury leads to long-term or permanent reductions in their work capacity. Both can be given full-time (100%) or part-time (25%, 50%, or 75%) based on normal working hours, the study noted, and patients may be able to claim both a disability pension and sick leave.
Evidence suggested MS patients in Sweden have more disability pay and sickness leave claims than do the general public. It also suggested this greater need started before an official MS diagnosis, and continued to rise with advancing disease.
However, studies of disability pay and sickness leave have looked at any cause for claims, rather than being specific to MS. People with this disease are known to be at greater risk of other conditions, and these may contribute to missed days at work.
Researchers at the Karolinska Institutet set out to compare the number of missed work days by MS patients, before and after their diagnosis, with that of the working population in Sweden. They also aimed to understand how many of these days were directly related to MS.
They examined data from 2,567 MS working-age patients (25 to 59) diagnosed from 2009 to 2012, who had resided in Sweden for at least the two prior years. As a control group, 10,268 individuals were included, matched to patients in terms of sex, age, educational level, area of residence, and country of birth. For each patient, four controls were matched.
Data included sick leave and disability payments in the four years before a diagnosis, and in the four years after it.
In pre-diagnosis years, both leaves and payments were already more common among patients (13.7% and 8.9%, respectively) than among controls (11.2% and 7%, respectively), and this difference kept rising over post-diagnosis years, results showed.
When sick leaves and disability payments for all causes were examined together, MS patients on average had 10.3 more annual missed work days than controls at four years before their diagnosis. This reached a peak one year after diagnosis, with a difference of 70 missed days. These numbers remaining elevated over the following years, compared with controls.
Consistent with their diagnosis, patients experienced a rise in missed work days due to MS after a diagnosis. But missed days due to other causes were also high.
Of the 347 patients on sick leave at four years after diagnosis, 233 had MS listed as the cause. Claims by the other patients were due to other neurological problems, musculoskeletal disease, mental illness, cardiovascular problems, cancer, or injury.
Likewise, among the 318 patients on disability pay at four year post-diagnosis, 199 were due to MS symptoms.
Researchers also found that an MS diagnosis was associated with disability payments due to any cause, with patients being 23 times more likely of needing disability pay than controls. This association was significant across all age and sex groups, regardless of the disease to which the payment was attributed.
People with MS were 3.4 times more likely to be collecting disability due to diagnoses of other diseases, 2.6 times more likely due to musculoskeletal disease, and 19.2 times more likely for neurological disorders other than MS.
These findings show “higher levels of SA/DP [sickness absence/disability pension] among MS patients than among references, both before and after diagnosis with MS,” the researchers wrote.
They noted, however, that the high number of work disability claims among these patients was not entirely due to MS, and that other diagnosed diseases were also contributing to the greater number of missed work days.
“Further knowledge of how SA/DP diagnoses other than MS contribute to work incapacity among MS patients is needed to inform individualised care, including goal setting and planning strategies to maintain work participation,” the team concluded.
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