Increasing Disability Decreases Employment Levels in Patients with Multiple Sclerosis

Background: Multiple sclerosis (MS) is a chronic disease characterized by progressive disability. With peak onset at

age 30, MS affects prime productive years and is associated with high unemployment rates. The impacts

of disability on mobility, cognition and quality of life have been well-studied, yet the relationship

between disability and employment status (ES) has primarily been assessed in small local studies.

Objectives: The objective of this study is to characterize the relationship between increasing disability (measured by

the Expanded Disability Status Scale (EDSS)) on ES for MS patients.

Methods: We implemented a cross-sectional cohort analysis of United States patient-reported data surveyed by

the Adelphi MS Disease Specific Programme. Patients provided information on demographics, disease

characteristics, ES (under or unemployed, and whether due to MS), and others. Underemployment was

defined as self-assessed part-time work , unemployed, or retired. EDSS is rated from 0-10 (lower scores

indicate less disability). The relationship between EDSS and ES was modeled using logistic regression and

tested for significance using Wald Chi-Square tests. Patients identifying as homemakers or students

were excluded due to possible ES misidentification. To overcome small sample sizes at high EDSS levels,

we divided the EDSS scale into bins approximately equal in patient numbers .

Results: A total of 1,069 US patients provided both EDSS and ES and did not identify as homemaker or student.

Of these, 471 patients identified as working full-time and 171 as being employed part-time, unemployed

or retired, respectively, with a primary cause other than MS. 427 patients identified as working part-

time, unemployed or retired due to MS. Over half of the individuals had EDSS≤2. Compared to those

with EDSS≤1, those with EDSS 1.5-2.5 were more likely to be underemployed in general and due to MS

(p=0.0171 and p=0.0937, respectively), but equally likely to be unemployed. Relative to those with

EDSS≤1, patients with EDSS≥3 were significantly more likely to be under or unemployed in general and

due to MS (p<0.0001 for all), with 2.4 and 3.8 times the predicted likelihoods of general under and

unemployment, respectively, and 4.1 times the likelihood of both under and unemployment due to MS.

Conclusions: MS represents a significant burden on patient ability to work. Interventions that can delay disability

progression could have significant impacts on workplace productivity.