Employment Status and Work Ability in Adults with Cystic Fibrosis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants and Study Design
2.2. Data Collection
2.3. Health-Related Quality of Life
2.4. Work Ability Assessment
2.5. Statistical Methods
3. Results
3.1. Characteristics of Study Participants
3.2. Employment Status and Predictive Factors
3.3. Job Characteristics
3.4. Work Ability and Predictive Factors
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
- Stephenson, A.L.; Tom, M.; Berthiaume, Y.; Singer, L.G.; Aaron, S.D.; Whitmore, G.A.; Stanojevic, S.A. Contemporary survival analysis of individuals with cystic fibrosis: A cohort study. Eur. Respir. J. 2015, 45, 670–679. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Paranjape, S.M.; Mogayzel, P.J., Jr. Cystic fibrosis. Pediatr. Rev. 2014, 35, 194–205. [Google Scholar] [CrossRef] [PubMed]
- Naehrlich, L. The Changing Face of Cystic Fibrosis and Its Implications for Screening. Int. J. Neonatal. Screen. 2020, 6, 54. [Google Scholar] [CrossRef] [PubMed]
- Plant, B.J.; Goss, C.H.; Plant, W.D.; Bell, S.C. Management of comorbidities in older patients with cystic fibrosis. Lancet Respir. Med. 2013, 1, 164–174. [Google Scholar] [CrossRef]
- Elborn, J.S. Cystic fibrosis. Lancet 2016, 388, 2519–2531. [Google Scholar] [CrossRef]
- Scotet, V.; L’Hostis, C.; Férec, C. The Changing Epidemiology of Cystic Fibrosis: Incidence, Survival and Impact of the CFTR Gene Discovery. Genes 2020, 11, 589. [Google Scholar] [CrossRef] [PubMed]
- Coyne, I.; Sheehan, A.M.; Heery, E.; While, A.E. Improving transition to adult healthcare for young people with cystic fibrosis: A systematic review. J. Child Health Care 2017, 21, 312–330. [Google Scholar] [CrossRef] [PubMed]
- Leso, V.; Romano, R.; Santocono, C.; Caruso, M.; Iacotucci, P.; Carnovale, V.; Iavicoli, I. The impact of cystic fibrosis on the working life of patients: A systematic review. J. Cyst. Fibros. 2021, 29, S1569–S1993. [Google Scholar] [CrossRef]
- ISIC, International Standard Industrial Classification of All Economic Activities, Rev. 4. Available online: https://unstats.un.org/unsd/publication/seriesm/seriesm_4rev4e.pdf (accessed on 4 September 2021).
- ISCO, International Standard Classification of Occupations Structure, Group Definitions and Correspondence Tables. ISCO 2008. Volume 1. Available online: https://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/---publ/documents/publication/wcms_172572.pdf (accessed on 4 September 2021).
- Quittner, A.L.; Buu, A.; Messer, M.A.; Modi, A.C.; Watrous, M. Development and validation of The Cystic Fibrosis Questionnaire in the United States: A health-related quality-of-life measure for cystic fibrosis. Chest 2005, 128, 2347–2354. [Google Scholar] [CrossRef]
- Modi, A.C.; Quittner, A.L. Validation of a disease-specific measure of health-related quality of life for children with cystic fibrosis. J. Pediatr. Psychol. 2003, 28, 535–545. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Quittner, A.L.; Sawicki, G.S.; McMullen, A.; Rasouliyan, L.; Pasta, D.J.; Yegin, A.; Konstan, M.W. Psychometric evaluation of the Cystic Fibrosis Questionnaire-Revised in a national sample. Qual. Life Res. 2012, 21, 1267–1278. [Google Scholar] [CrossRef] [PubMed]
- Ilmarinen, J. The Work Ability Index (WAI). Occup. Med. 2007, 57, 160. [Google Scholar] [CrossRef] [Green Version]
- Martus, P.; Jakob, O.; Rose, U.; Seibt, R.; Freude, G. A comparative analysis of the Work Ability Index. Occup. Med. 2010, 60, 517–524. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Adel, M.; Akbar, R.; Ehsan, G. Validity and reliability of work ability index (WAI) questionnaire among Iranian workers; a study in petrochemical and car manufacturing industries. J. Occup. Health 2019, 61, 165–174. [Google Scholar] [CrossRef] [PubMed]
- R Core Team. R: A language and Environment for Statistical Computing; R Foundation for Statistical Computing: Vienna, Austria, 2021; Available online: https://www.R-project.org/ (accessed on 9 November 2021).
- ISTAT, Istituto Nazionale di Statistica. Tasso di Occupazione- Dati nazionali e Regionali 2020. Available online: http://dati.istat.it/index.aspx?queryid=25400# (accessed on 4 September 2021).
- Harness-Brumley, C.L.; Elliott, A.C.; Rosenbluth, D.B.; Raghavan, D.; Jain, R. Gender differences in outcomes of patients with cystic fibrosis. J. Womens Health 2014, 23, 1012–1020. [Google Scholar] [CrossRef] [PubMed]
- Cerrato, J.; Cifre, E. Gender Inequality in Household Chores and Work-Family Conflict. Front. Psychol. 2018, 9, 1330. [Google Scholar] [CrossRef] [PubMed]
- Bell, S.C.; Mainz, J.G.; MacGregor, G.; Madge, S.; Macey, J.; Fridman, M.; Suthoff, E.D.; Narayanan, S.; Kinnman, N. Patient-reported outcomes in patients with cystic fibrosis with a G551D mutation on ivacaftor treatment: Results from a cross-sectional study. BMC Pulm. Med. 2019, 19, 146. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Study Population (N = 196) | Non-Workers N(%) N = 98 | Workers N(%) N = 98 | p-Value | |
---|---|---|---|---|
Age (Mean ± SD) | 33.4 ± 10.6 | 30 ± 10 | 37 ± 10 | <0.001 |
Sex N (%) | <0.001 | |||
Female | 92 (47%) | 58 (59%) | 34 (35%) | |
Male | 104 (53%) | 40 (41%) | 64 (65%) | |
BMI (Mean ± SD) | 24.2 ± 4.2 | 24.1 ± 4.5 | 24.3 ± 3.9 | 0.736 |
Age at CF diagnosis (Mean ± SD) | 12.7 ± 16.2 | 9 ± 13 | 17 ± 18 | <0.001 |
Sport N (%) | 0.070 | |||
Yes | 121 (62%) | 67 (68%) | 54 (55%) | |
No | 43 (22%) | 15 (15%) | 28 (29%) | |
In the past | 32 (16%) | 16 (16%) | 16 (16%) | |
Smoker N (%) | <0.001 | |||
Yes | 20 (10%) | 3 (3.1%) | 17 (17%) | |
No | 160 (82%) | 90 (92%) | 70 (71%) | |
In the past | 16 (8%) | 5 (5.1%) | 11 (11%) | |
Educational level N (%) | 0.039 | |||
Primary/Secondary school | 38 (19%) | 21 (21%) | 17 (17%) | |
High school diploma/Enrolled in university | 113 (58%) | 62 (63%) | 51 (52%) | |
Degree/Post-graduate degree | 45 (23%) | 15 (15%) | 30 (31%) | |
Marital status N(%) | 0.005 | |||
Single | 113 (58%) | 67 (69%) | 46 (47%) | |
In a relationship | 77 (39%) | 29 (29%) | 48 (49%) | |
Separated/Divorced | 6 (3%) | 2 (2%) | 4 (4%) | |
Children N (%) | 0.215 | |||
Yes | 40 (20%) | 16 (16%) | 24 (24%) | |
No | 156 (80%) | 82 (84%) | 74 (76%) | |
Lung transplant recipient N (%) | - | |||
Yes | - | - | - | |
No | 196 (100%) | 98 (100%) | 98 (100%) | |
Spirometric parameters (Mean ±DS) | ||||
FEV1 L | 2.6 ± 1.2 | 2.45 ± 1.05 | 2.78 ± 1.27 | 0.051 |
FEV1 % | 76 ± 30 | 74 ± 29 | 78 ± 30 | 0.283 |
FVC L | 3.5 ± 1.3 | 3.26 ± 1.13 | 3.75 ± 1.33 | 0.006 |
FVC % | 86 ± 23 | 84 ± 22 | 89 ± 24 | 0.124 |
FEV1/FVC | 72 ± 13 | 73 ± 13 | 72 ± 13 | 0.323 |
Hospital admission in the last year N (%) | 0.805 | |||
Yes | 18 (9%) | 10 (10%) | 8 (8.2%) | |
No | 178 (91%) | 88 (90%) | 90 (92%) | |
Oxygen therapy in the last year N (%) | 0.282 | |||
Yes | 15 (8%) | 10 (10%) | 5 (5.1%) | |
No | 181 (92%) | 88 (90%) | 93 (95%) | |
IV antibiotic courses in the last year N (%) | 0.552 | |||
Yes | 30 (15%) | 17 (17%) | 13 (13%) | |
No | 166 (85%) | 81 (83%) | 85 (87%) | |
Cough in the previous 15 days N (%) | 0.064 | |||
Yes | 45 (23%) | 24 (24%) | 21 (21%) | |
No | 151 (77%) | 74 (76%) | 77 (79%) | |
Cystic Fibrosis Questionnaire—Revised (CFQ-R) subdomains | ||||
Physical functioning | 65 ± 25 | 62 ± 25 | 69 ± 26 | 0.036 |
Vitality | 65 ± 20 | 64 ± 21 | 66 ± 18 | 0.430 |
Emotional functioning | 75 ± 19 | 72 ± 20 | 77 ± 18 | 0.068 |
Eating problems | 92 ± 17 | 90 ± 20 | 94 ± 14 | 0.092 |
Treatment Burden | 58 ± 21 | 54 ± 17 | 62 ± 23 | 0.009 |
Health Perceptions | 68 ± 19 | 67 ± 20 | 69 ± 19 | 0.622 |
Social functioning | 69 ± 15 | 70 ± 16 | 69 ± 15 | 0.505 |
Body image | 79 ± 20 | 75 ± 20 | 83 ± 19 | 0.009 |
Role functioning | 80 ± 21 | 76 ± 23 | 83 ± 18 | 0.018 |
Weight | 82 ± 29 | 82 ± 29 | 83 ± 28 | 0.803 |
Respiratory symptoms | 78 ± 18 | 76 ± 19 | 80 ± 17 | 0.144 |
Digestive symptoms | 75 ± 20 | 74 ± 20 | 76 ± 21 | 0.505 |
Work ability index score | 39 ± 5.1 | - | 39 ± 5.1 | - |
Part-Time N = 33 | Full-Time N = 65 | p-Value | |
---|---|---|---|
Age (Mean ± SD) | 34 ± 11 | 39 ± 10 | 0.057 |
Sex N (%) | 0.007 | ||
Female | 18 (55%) | 16 (25%) | |
Male | 15 (45%) | 49 (75%) | |
BMI (Mean ± SD) | 23.9 ± 4.3 | 24.5 ± 3.7 | 0.499 |
Age at CF diagnosis (Mean ± SD) | 13 ± 19 | 19 ± 17 | 0.193 |
Sport N (%) | 0.019 | ||
Yes | 17 (52%) | 37 (57%) | |
No | 6 (18%) | 22 (34%) | |
In the past | 10 (30%) | 6 (9.2%) | |
Smoker N (%) | 0.519 | ||
Yes | 4 (12%) | 13 (20%) | |
No | 24 (73%) | 46 (71%) | |
In the past | 5 (15%) | 6 (9.2%) | |
Educational level N (%) | 0.435 | ||
Primary/Secondary school | 8 (24%) | 9 (14%) | |
High school diploma/Enrolled in university | 16 (48%) | 35 (54%) | |
Degree/Post-graduate degree | 9 (27%) | 21 (32%) | |
Marital status N(%) | 0.565 | ||
Single | 17 (52%) | 29 (45%) | |
In a relationship | 14 (42%) | 34 (52%) | |
Separated/Divorced | 2 (6.1%) | 2 (3.1%) | |
Children N (%) | >0.999 | ||
Yes | 8 (24%) | 16 (25%) | |
No | 25 (76%) | 49 (75%) | |
Lung transplant recipient N (%) | - | ||
Yes | 0 (0%) | 0 (0%) | |
No | 33 (100%) | 65 (100%) | |
Spirometric parameters (Mean ±DS) | |||
FEV1 L | 2.58 ± 1.23 | 2.87 ± 1.29 | 0.284 |
FEV1 % | 76 ± 31 | 79 ± 30 | 0.643 |
FVC L | 3.53 ± 1.41 | 3.86 ± 1.29 | 0.265 |
FVC % | 88 ± 27 | 89 ± 22 | 0.861 |
FEV1/FVC | 71 ± 12 | 72 ± 14 | 0.843 |
Hospital admission in the last year N (%) | 0.436 | ||
Yes | 29 (88%) | 61 (94%) | |
No | 4 (12%) | 4 (6.2%) | |
Oxygen therapy in the last year N (%) | 0.331 | ||
Yes | 30 (91%) | 63 (97%) | |
No | 3 (9.1%) | 2 (3.1%) | |
IV antibiotic courses in the last year N (%) | 0.352 | ||
Yes | 27 (82%) | 58 (89%) | |
No | 6 (18%) | 7 (11%) | |
Cough in the previous 15 days N (%) | 0.859 | ||
Yes | 6 (18%) | 15 (23%) | |
No | 27 (82%) | 50 (77%) | |
Cystic Fibrosis Questionnaire-Revised (CFQ-R) subdomains | |||
Physical functioning | 67 ± 24 | 70 ± 27 | 0.500 |
Vitality | 67 ± 17 | 65 ± 19 | 0.562 |
Emotional functioning | 77 ± 18 | 77 ± 18 | 0.949 |
Eating problems | 92 ± 17 | 95 ± 11 | 0.382 |
Treatment Burden | 58 ± 20 | 63 ± 25 | 0.282 |
Health Perceptions | 71 ± 16 | 68 ± 20 | 0.422 |
Social functioning | 70 ± 13 | 68 ± 16 | 0.459 |
Body image | 79 ± 20 | 84 ± 19 | 0.213 |
Role functioning | 82 ± 16 | 84 ± 19 | 0.703 |
Weight | 77 ± 34 | 86 ± 24 | 0.186 |
Respiratory symptoms | 77 ± 17 | 82 ± 17 | 0.208 |
Digestive symptoms | 69 ± 21 | 80 ± 20 | 0.019 |
Work ability Index score | 38.9 ± 4.1 | 39.0 ± 5.6 | 0.976 |
Industrial Classification (ISIC) | N (%) |
---|---|
A. Agriculture, forestry and fishing | 1 (1) |
B. Mining and quarrying | - |
C. Manufacturing | 7 (7) |
D. Electricity, gas, steam and air conditioning supply | 3 (3) |
E. Water supply, sewerage, waste management and remediation activities | - |
F. Construction | 6 (6) |
G. Wholesale and retail trade; repair of motor vehicles and motorcycles | 16 (16) |
H. Transportation and storage | 5 (5) |
I. Accommodation and food service activities | 7 (7) |
J. Information and communication | 2 (2) |
K. Financial and insurance activities | 4 (4) |
L. Real estate activities | - |
M. Professional, scientific and technical activities | 1 (1) |
N. Administrative and support service activities | 9 (9) |
O. Public administration and defence; compulsory social security | 8 (8) |
P. Education | 3 (3) |
Q. Human health and social work activities | 13 (13) |
R. Arts, entertainment and recreation | 4 (4) |
S. Other service activities | 9 (9) |
T. Activities of households as employers; undifferentiated good- and service-producing activities of households for own use | - |
U. Activities of extraterritorial organizations and bodies | - |
Occupation Classification (ISCO-08) | n (%) |
1—Managers | 8 (8) |
2—Professionals | 14(14) |
3—Technicians and associate professionals | 15 (15) |
4—Clerical support workers | 21 (21) |
5—Service and sales workers | 23 (23) |
6—Skilled agricultural, forestry and fishery workers | 1 (1) |
7—Craft and related trades workers | 10 (10) |
8—Plant and machine operators, and assemblers | 4 (4) |
9—Elementary occupations | 1 (1) |
10—Armed forces occupations | 1 (1) |
All Workers’ WAI Score | ||||
---|---|---|---|---|
Variable | N | β | (95% CI) | p-Value |
Age | 98 | −0.15 | −0.25, −0.05 | 0.002 |
BMI | 98 | −0.16 | −0.42, 0.10 | 0.225 |
Sex | 98 | 0.971 | ||
Female | — | — | ||
Male | −0.04 | −2.2, 2.1 | ||
Age at CF diagnosis | 98 | −0.06 | −0.11, 0.00 | 0.051 |
Sport | 0.073 | |||
Yes | 0.84 | −2.0, 3.7 | ||
No | −1.9 | −5.0, 1.3 | ||
In the past | — | — | ||
Smoker | 98 | 0.392 | ||
Yes | 1.8 | −5.7, 2.2 | ||
No | 98 | 0.12 | −3.2, 3.4 | |
In the past | — | — | ||
Marital status | 98 | 0.018 | ||
Single | — | — | ||
In a relationship | −2.5 | −4.6, −0.52 | ||
Separated/Divorced | −5.0 | −10, 0.08 | ||
Children | 98 | 0.410 | ||
No | — | — | ||
Yes | −1.0 | −3.4, 1.4 | ||
Type of contract | 76 | 0.407 | ||
Permanent contract | — | — | ||
Fixed term contract | −0.42 | −3.4, 2.6 | ||
Not known | −2.4 | −5.9, 1.1 | ||
Educational level | 98 | 0.071 | ||
Primary/Secondary school | — | — | ||
High school diploma/Enrolled in university | 2.8 | 0.04, 5.6 | ||
Degree/Post-graduate degree | 3.4 | 0.38, 6.4 | ||
Employment duration (years) | 98 | 0.027 | ||
<1 | — | — | ||
1–5 | 1.3 | −1.4, 4.0 | ||
6–10 | 0.72 | −2.5, 3.9 | ||
11–15 | 1.7 | −2.2, 5.7 | ||
>15 | −3.4 | −6.7, −0.13 | ||
Hospital admission last year | 98 | 0.443 | ||
No | — | — | ||
Yes | −1.5 | −5.2, 2.3 | ||
Oxygen therapy last year | 98 | 0.217 | ||
No | — | — | ||
Yes | −2.9 | −7.5, 1.7 | ||
IV antibiotic courses last year | 98 | 0.624 | ||
No | — | — | ||
Yes | −0.75 | −3.8, 2.3 | ||
Cough in the previous 15 days | 98 | 0.009 | ||
No | — | — | ||
Yes | −3.3 | −5.7, −0.83 | ||
Lung function parameters | ||||
FEV1 L | 98 | 0.67 | −0.13, 1.5 | 0.100 |
FEV1 % | 98 | 0.02 | −0.01, 0.06 | 0.171 |
FVC L | 98 | 0.70 | −0.06, 1.5 | 0.070 |
FVC % | 98 | 0.04 | 0.00, 0.08 | 0.063 |
FEV1/FVC | 98 | 0.01 | −0.07, 0.09 | 0.741 |
Cystic Fibrosis Questionnaire—Revised (CFQ-R) subdomains | ||||
Physical functioning | 98 | 0.11 | 0.08, 0.15 | <0.001 |
Vitality | 98 | 0.10 | 0.05, 0.15 | <0.001 |
Emotional functioning | 98 | 0.09 | 0.03, 0.14 | 0.003 |
Eating problems | 98 | 0.03 | −0.05, 0.10 | 0.464 |
Treatment Burden | 98 | 0.08 | 0.03, 0.12 | <0.001 |
Health Perceptions | 98 | 0.11 | 0.06, 0.16 | <0.001 |
Social functioning | 98 | 0.11 | 0.04, 0.17 | 0.001 |
Body image | 98 | 0.08 | 0.03, 0.13 | 0.003 |
Role functioning | 98 | 0.14 | 0.09, 0.19 | <0.001 |
Weight | 98 | 0.01 | −0.02, 0.05 | 0.511 |
Respiratory symptoms | 98 | 0.13 | 0.08, 0.19 | <0.001 |
Digestive symptoms | 98 | 0.05 | 0.00, 0.10 | 0.059 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Leso, V.; Carnovale, V.; Iacotucci, P.; Pacella, D.; Romano, R.; Della Volpe, I.; Iavicoli, I. Employment Status and Work Ability in Adults with Cystic Fibrosis. Int. J. Environ. Res. Public Health 2021, 18, 11776. https://doi.org/10.3390/ijerph182211776
Leso V, Carnovale V, Iacotucci P, Pacella D, Romano R, Della Volpe I, Iavicoli I. Employment Status and Work Ability in Adults with Cystic Fibrosis. International Journal of Environmental Research and Public Health. 2021; 18(22):11776. https://doi.org/10.3390/ijerph182211776
Chicago/Turabian StyleLeso, Veruscka, Vincenzo Carnovale, Paola Iacotucci, Daniela Pacella, Rosaria Romano, Ilaria Della Volpe, and Ivo Iavicoli. 2021. "Employment Status and Work Ability in Adults with Cystic Fibrosis" International Journal of Environmental Research and Public Health 18, no. 22: 11776. https://doi.org/10.3390/ijerph182211776