Employment status in people with multiple sclerosis: Profile, dynamic changes and determinants over time

AIM: In a large UK multiple sclerosis (MS) cohort, we examined work status and how it changed over follow-up, identifying demographic, clinical and other factors associated with these transitions. METHODS: Participants of the Trajectories of Outcome in Neurological Conditions-MS study completed questionnaires on demographics, work instability, disability, fatigue, mood and quality of life at baseline and follow-up to explore work disability (stopping), discontinuity (retiring early) and drift (downgrading). Regression and Classification and Regression Tree (CART) analysis examined predictive factors. RESULTS: Among 1035 subjects aged 20-60 years in paid work at baseline with mean follow-up 22.7 months, net annual increases were 4.0 % for work disability, 3.1 % for discontinuity and 1.8 % for drift. Risk of work disability was increased by age, work instability and for part-time work, female sex. The risk of drift was 3.9 times higher for females; work instability increased drift for all subjects. Reverse work disability and drift were also observed, i.e. returning to employment or upgrading work. Discontinuity was influenced by secondary progressive subtype, impaired cognition, more comorbidities, and reduced by disease modifying therapy use. CART analysis showed that risk of job loss could be predicted using age, EDSS and sickness absence information, and of medical retirement using the above three factors and MS subtype. CONCLUSIONS: Screening for people with MS at greater risk of losing employment could be readily done in clinical practice, facilitating further discussion with the multidisciplinary team and referral to support services as appropriate.