#ECTRIMS2022 – Job Prospects Can Slowly Take a Hit After CIS Diagnosis

In the years after a diagnosis of clinically isolated syndrome (CIS) — a first episode of neurological symptoms suggestive of multiple sclerosis (MS) — the odds of maintaining employment progressively decrease, according to a recent study.

The risk of decreasing or losing employment was particularly high among individuals who later transitioned to a clinical diagnosis of MS, and among women and people who experienced more relapses or greater disability.

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These findings were presented at the 38th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held Oct. 26–28 in Amsterdam and virtually.

The talk, titled “Longitudinal transitions of employment status after a first episode of CNS demyelination,” was presented by Amin Zarghami, MD, a PhD student at the Menzies Institute for Medical Research at the University of Tasmania, in Australia.

The symptoms of MS, which may progressively worsen over time, can lead to substantial disability for patients. Coupled with a relatively early age at MS diagnosis, the chronic nature of the disease means that the socioeconomic status of patients is significantly affected, Zarghami noted in his presentation.

the probability of moving to unemployment increased with increasing disease duration

MS patients at higher risk of unemployment

Overall, MS patients are at a higher risk of work absences, may log fewer work hours, and have higher unemployment rates than the general population.

To help patients to retain employment, a better understanding of the long-term transitions in employment status among MS patients, starting early in their disease course, is needed.

To address that need, researchers examined the employment status of 237 adults, ages 18–59, who were followed for over a decade at four Australian centers after their initial CIS diagnosis.

About 78% of the participants were women, and the mean age at CIS diagnosis was 37.8. At that point, 23.6% of individuals were unemployed, 28.3% worked part-time, and 48.1% had a full-time job.

Results showed that a participant with full-time employment at CIS diagnosis had an 89% chance of retaining it over the next year, which decreased to 59.8% over the next five years and to 42.4% at the 10-year follow-up.

Consistently, while the likelihood of being unemployed after a year was 3.4% for people who started off with full-time employment, this likelihood progressively increased, reaching 14.6% after five years and 23.9% after 10.

For those working part-time, the probability of transitioning to full-time or being unemployed after a year was similar, about 6% each. After five years, this probability increased to about 20% for either outcome, reaching around 27% at 10 years.

Statistical analyses revealed that women were at about a 2.7 times higher risk of reaching a decreased employment status than men. Likewise, the risk of decreasing or losing employment was increased by 10% with each additional relapse, and by 45% for each point gained on the Expanded Disability Status Scale, reflecting that more relapses and greater disability contribute to the deterioration in employment status.

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Progression to MS raises odds of decreased employment by four times

Progression to a clinical MS diagnosis was the strongest predictor of decreased employment status, raising that risk by nearly four times.

The team also found that having clinically significant fatigue reduced the likelihood of gaining full-time employment from an unemployed state. On the other hand, re-entrance into the workforce (part-time or full-time) from unemployment was significantly more likely in people with a university education.

Based on the data, the researchers developed a model of employment transitions for a person diagnosed with CIS at about age 38.

Overall, “the probability of moving to unemployment increased with increasing disease duration,” Zarghami said. “In contrast, the probability of gaining full-time employment only increased in the first couple of years following [a CIS diagnosis] and then gradually decreased.”

“Understanding the multidimensional patterns of early predictors of employment transitions is important to optimally target work retention programs among people with MS,” he concluded.

Note: The Multiple Sclerosis News Today team is providing in-depth coverage of the ECTRIMS Forum 2022 Oct. 26-28. Go here to see the latest stories from the conference.