title: Pain exacerbation as a major source of lost productive time in US workers with arthritis.
abstract: OBJECTIVE
  To estimate the prevalence of arthritis and arthritis pain exacerbations in US workers including impact on functioning and lost productive work time (LPT).
  
  
  METHODS
  The research was conducted as a nested case-control study of participants in the Caremark American Productivity Audit, a US national random-digit-dial survey of US workers. The sample included 329 workers ages 40-65 years meeting the First National Health and Nutrition Examination Survey criteria for arthritis, and 91 workers not meeting arthritis inclusion criteria. Participants completed a telephone interview to measure the prevalence of arthritis and pain exacerbations, LPT (in hours and dollars), functional disability using the Western Ontario and McMaster Universities Knee and Hip Osteoarthritis Index (WOMAC) and the Australian/Canadian Osteoarthritis Hand Index, and demographics.
  
  
  RESULTS
  The prevalence of arthritis in US workers ages 40-65 years was 14.7% during the 2-week period. Pain exacerbation occurred among 38% of participants with arthritis. Workers with pain exacerbations were significantly more likely to have higher WOMAC scores (38.6 versus 29.6; P = 0.0041) and report arthritis-related LPT (24.4% versus 13.3%; P = 0.0118) than workers without exacerbations. Among those with LPT, average LPT did not differ (4.1 hours per week) between persons with and without exacerbations. The estimated annual LPT cost from arthritis in the US workforce was $7.11 billion, with 65.7% of this cost attributed to the 38% of workers with pain exacerbations.
  
  
  CONCLUSIONS
  Workers with arthritis pain exacerbation account for a disproportionate share of the arthritis-related LPT cost. Stratifying workers for appropriate treatment management based on pain exacerbation status could significantly decrease arthritis-related LPT and offer employees and employers an effective return on health care use.
authors.affiliation: Caremark, Hunt Valley, MD 21031, USA. judi.ricci@caremark.com
authors.forename: Judith A
authors.initials: JA
authors.lastname: Ricci
authors.forename: Walter F
authors.initials: WF
authors.lastname: Stewart
authors.forename: Elsbeth
authors.initials: E
authors.lastname: Chee
authors.forename: Carol
authors.initials: C
authors.lastname: Leotta
authors.forename: Kathleen
authors.initials: K
authors.lastname: Foley
authors.forename: Marc C
authors.initials: MC
authors.lastname: Hochberg
mesh_terms: D000041:Absenteeism; D000328:Adult; D000368:Aged; D001168:Arthritis / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D016022:Case-Control Studies; D017281:Cost of Illness; D003625:Data Collection; D004526:Efficiency; D004651:Employment / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D015995:Prevalence; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D014938:Work Capacity Evaluation