title: Employment and disability for work in patients with COPD: a cross-sectional study among Dutch patients.
abstract: OBJECTIVE
  The aim was to gain insight into work experiences and problems of subjects with chronic obstructive pulmonary disease (COPD) to develop more effective guidelines for preventing work disability and work loss.
  
  
  METHODS
  A total of 617 patients aged 45-60, recruited from pulmonary outpatient clinics and general practices, completed a questionnaire on (respiratory) health and work history.
  
  
  RESULTS
  Of the patients 43% were female, 52% were employed and more than half were less educated. Comorbidity was present in 52% of the study group. Of those who stopped working (N=260), 36% stopped before the onset of COPD, 39% stopped because of COPD and 25%, although having COPD, had other reasons to stop. Of the patients with a work history 39% had an invalidity benefit: 21% of the working and 60% of the non-working patients. For one-third of these patients COPD was not the reason for having an invalidity benefit. For 56% of those who had a benefit because of COPD, comorbidity contributed to work disability. No difference in current smoking habit was seen between working patients and non-working patients. Yet, non-working patients were more often smokers at the moment they stopped working. Furthermore, former smokers who still worked stopped smoking at a younger age than former smokers who stopped working. Compared with workers and independent of smoking habit, former workers were more exposed to dust/irritants, had their work(place) less frequently modified and had more unfavourable (social) work experiences.
  
  
  CONCLUSIONS
  For employees with COPD, work loss is often multi-factorial. Comorbidity is often present and an important cause for work loss. Therefore occupational health guidance has to take other interfering (health) factors than COPD into consideration as well. In preventing work disability, work(place) adjustment merits more attention.
authors.affiliation: TNO Work and Employment, P.O. Box 718, 2130 AS, Hoofddorp, The Netherlands. a.kremer@arbeid.tno.nl
authors.forename: A M
authors.initials: AM
authors.lastname: Kremer
authors.forename: T M
authors.initials: TM
authors.lastname: Pal
authors.forename: A R J
authors.initials: AR
authors.lastname: van Keimpema
mesh_terms: D015897:Comorbidity; D003430:Cross-Sectional Studies; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016273:Occupational Exposure / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000191:economics / Q000453:epidemiology*; D018582:Sick Leave / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014938:Work Capacity Evaluation