Employment, income drop steadily over 2 decades after onset of MS

For people who develop multiple sclerosis (MS), the disease can exact a toll on their ability to work and on how much they earn in the private sector, according to a study by researchers in France, who said policies need to be enacted to replace lost income.

“The effects of MS on the employed population in the private sector occur early in the disease course and are cumulative,” the researchers wrote in “Impact of multiple sclerosis on employment and income: Insights from a random sample representative of private sector employees in France using longitudinal administrative data,” which was published in Revue Neurologique. “Replacement income helps to reduce the loss of resources thanks to the French health and social system.”

In MS, the immune system mistakenly mounts an inflammatory attack against the brain and spinal cord, causing nerve cell damage. This results in blurred or poor vision, fatigue, and difficulty walking, among other symptoms that are likely to affect daily activities, including work.

To measure its impact on paid work, researchers in France drew on the HYGIE database, which contains data from a random sample of more than 920,000 people in the country in the private sector to compare the work trajectories of people with MS with those of matched controls.

The study included 946 adults with a diagnosis of MS registered between 1987 and 2013. It followed their work trajectories from the year before their diagnosis to up to 20 years later. More than half (51.9%) were 38 or younger, and 68.3% were women. In the year before their diagnosis, most (88.1%) were employed. The rest were either unemployed (4.5%) or inactive (7.4%).

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Employment, income rates after MS diagnosis

A year after their diagnosis, the employment rate dropped by 6.6% and continued to drop over the years. It was 46.2% lower after 20 years than in the year before a diagnosis.

This drop in employment translated into an increase in inactivity, defined as not being employed or unemployed in any quarter of the year. In the year after the onset of disease, the proportion of inactive people increased by 6.9%. After 20 years, it had increased by 48.9%.

Similarly, the proportion of patients who received a disability pension for at least a quarter of the year also increased, from 7.3% in the year before diagnosis to 50.5% at 10 years after diagnosis and 68.3% after 20 years.

The changes in employment also affected wages and income, which markedly dropped over the years. Before the onset of their disease, people with MS earned a salary above the median of all workers in the HYGIE database, but fell steadily to well below the median after 20 years.

“This sharp downgrading was consistent with the decline in the ability to work,” wrote the researchers, who noted the composition of income changed radically and became mainly composed (75%) of replacement income — daily allowances for sickness leaves, unemployment benefits, and disability pensions — after 20 years.

The changes in employment was similar for men and women. But women, who started with a lower income than men, fell below the median income in the first year after diagnosis, while men were still above it after 10 years.

As it happens in the general population, “men have higher wages than women, and men were in a more favorable situation than the average French population of private-sector employees before MS,” the researchers wrote.

There were also some differences in employment based on the age at diagnosis or the presence of other co-occurring conditions. Patients older than 38 or who had other conditions were less likely to be employed in the year before diagnosis and their employment and incomes saw a more pronounced drop than other subgroups.

The researchers said their study shows MS “has strongly negative and lasting effects on work in a large sample of private sector employees in France.”