The effects of chronic medical conditions on work loss and work cutback
The effects of chronic medical conditions on work loss and work cutback
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DOI：
10.1097/00043764-200103000-00009
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发表时间：
2001-03-01
影响因子：
3.2
通讯作者：
Wang, PS
中科院分区：
文献类型：
--
作者：
Kessler, RC;Greenberg, PE;Wang, PS
虽然工作表现已成为疾病成本研究的一个重要成果，但人们对普通人群样本中不同常见慢性疾病对工作障碍的比较影响知之甚少。这些数据来自一项具有全国代表性的大规模人口普查。这些数据来自麦克阿瑟基金会的美国中年发展调查（MIDUS），这是一项全国性的电话-邮件调查，共有3032名年龄在25至74岁之间的受访者。年龄在25至54岁之间的2074名调查受访者是本报告的重点。数据收集包括一个慢性病检查表，以及在过去的30天里，每个受访者有多少天因为健康问题而完全无法工作或进行正常活动（工作损失日），或者因为健康问题而不得不减少这些活动（工作减少日）。回归分析被用来估计工作障碍的条件的影响，控制社会人口。22.4%的受访者报告在过去30天内至少有一天因疾病而失去工作或减少工作，在有任何工作障碍的人中，每月平均有6.7天这样的日子。这相当于在抽样年龄段内每年超过25亿个工作受损日的全国估计数。癌症与迄今为止报告的任何损害的患病率最高（66.2%）和过去30年中最高的条件性损害天数（16.4天）相关。与任何损害的高几率相关的其他病症包括溃疡、重度抑郁症和恐慌症，而与大量有条件损害天数相关的其他病症包括心脏病和高血压。涉及关节炎、溃疡、精神障碍和物质依赖组合的合并症与比基于加性模型的预期更高的损伤相关。在根据年龄、性别、教育或就业状况定义的子样本中，条件的影响没有系统性差异。在雇主计算扩大医疗保险覆盖面的成本效益时，应考虑到与慢性病相关的工作损害的巨大程度以及对患病工人进行干预以减少工作损害的经济优势。考虑到与癌症相关的巨大工作障碍，以及绝大多数被诊断患有癌症的就业人员至少在部分治疗过程中留在劳动力市场，旨在减少这种疾病的工作场所成本的干预措施应该是优先事项。
Although work performance has become an important outcome in cost-of-illness studies, little is known about the comparative effects of different commonly occurring chronic conditions on work impairment in general population samples. Such data are presented here from a large-scale nationally representative general population survey. The data are from the MacArthur Foundation Midlife Development in the United States (MIDUS) survey, a nationally representative telephone-mail survey of 3032 respondents in the age range of 25 to 74 years. The 2074 survey respondents in the age range of 25 to 54 years are the focus of the current report. The data collection included a chronic-conditions checklist and questions about how many days out of the past 30 each respondent was either totally unable to work or perform normal activities because of health problems (work-loss days) ol had to cut back on these activities because of health problems (work-cutback days). Regression analysis was used to estimate the effects of conditions on work impairments, controlling for sociodemographics. At least one illness-related work-loss or work-cutback day in the past 30 days was reported by 22.4% of respondents, with a monthly average of 6.7 such days among those with any work impairment. This is equivalent to an annualized national estimate of over 2.5 billion work-impairment days in the age range of the sample. Cancer is associated with by far the highest reported prevalence of any impairment (66.2%) and the highest conditional number of impairment days in the past 30 (16.4 days). Other conditions associated with high odds of any impairment include ulcers, major depression, and panic disorder, whereas other conditions associated with a large conditional number of impairment days include heart disease and high blood pressure. Comorbidities involving combinations of arthritis, ulcers, mental disorders, and substance dependence are associated with higher impairments than expected on the basis of an additive model. The effects of conditions do not differ systematically across subsamples defined on the basis of age, sex, education, or employment status. The enormous magnitude of the work impairment associated with chronic conditions and the economic advantages of interventions for ill workers that reduce work impairments should be factored into employer cost-benefit calculations of expanding health insurance coverage. Given the enormous work impairment associated with cancer and the fact that the vast majority of employed people who are diagnosed with cancer stay in the workforce through at least part of their course of treatment, interventions aimed at reducing the workplace costs of this illness should be a priority.