Highlights
- •The retirement rate due to multiple sclerosis in Finland has decreased since 1995.
- •Male sex and age were statistically significant risk factors for retirement due to disability pension in relapsing-remitting multiple sclerosis, but only age in progressive multiple sclerosis.
- •Not using disease modifying therapies was a statistically significant risk factor for retirement due to disability pension in relapsing-remitting multiple sclerosis.
Abstract
Background
Multiple sclerosis (MS) is the most common cause of non-traumatic neurological disability
affecting young adults during their best working years. Previous studies have shown
that approximately two-thirds of patients with MS (PwMS) are unable to retain employment
in the long term, and many retire soon after the diagnosis. However, it is not known,
how the rate of retirement has changed over the decades, especially after the introduction
of disease modifying therapies (DMTs). The year 1995 was selected as a division point
because DMTs have been increasingly available ever since.
Objective
To evaluate the change in retirement rate due to MS and to present risk factors for
early retirement.
Methods
A retrospective survey of all PwMS treated at the Department of Neurology, Kanta-Häme
Central Hospital, Finland between 1978 and 2015, was conducted. The population was
divided into two groups: those diagnosed before year 1995 and those diagnosed thereafter.
A Kaplan-Meier analysis was performed to evaluate the time from diagnosis to beginning
of a pension in both groups. Crude incidence rates, incidence rate differences as
well as age and multivariable adjusted Cox proportional hazard regression analysis
were calculated for all pension predictors collected.
Results
A total of 484 PwMS were identified, 140 of whom were diagnosed before the year 1995
and 344 after. Actual retirement rates were 88 (63%) before the year the year 1995
and 111 (32%) after, respectively. The hazard for disability pension diminished in
PwMS diagnosed after the year 1995 compared to those diagnosed before, HR 0.41 (95%
confidence interval 0.31-0.55). The median time from diagnosis to retirement was 8.3
years in the group diagnosed before year 1995 and 11.1 years in the group diagnosed
later. Male sex and age were statistically significant risk factors in relapsing-remitting
MS, HR for male sex 1.8 (95% confidence interval 1.18-2.75) and for age 1.1 (95% confidence
interval 1.07-1.12). Only age was a risk factor in progressive MS with HR 1.09 (95%
confidence interval 1.07-1.11). In subgroup of relapsing-remitting MS, not using disease
modifying therapies was a statistically significant risk factor, HR 1.89 (95% confidence
interval 1.19-3.01).
Conclusion
The rate of retirement due to MS in Finland has decreased significantly since 1995
and the median time from diagnosis to retirement has become longer. Not using disease
modifying therapies for relapsing remitting MS was identified as one risk factor for
losing ability to work prematurely.
Keywords
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Article info
Publication history
Published online: July 03, 2020
Accepted:
July 2,
2020
Received in revised form:
June 30,
2020
Received:
March 2,
2020
Identification
Copyright
© 2020 Published by Elsevier B.V.
