title: Determinants of unemployment amongst Australian systemic sclerosis patients: results from a multicentre cohort study.
abstract: OBJECTIVE
  We sought to assess employment status, risk factors for unemployment and the associations of unemployment with patients' health related quality of life (HRQoL).
  
  
  METHODS
  All patients enrolled in a systemic sclerosis (SSc) longitudinal cohort study, completed an employment questionnaire on enrolment. Clinical manifestations were defined based on presence at the time of enrolment. Summary statistics, chi-square tests, univariate and multivariable logistic regression were used to determine the associations of various risk factors with employment.
  
  
  RESULTS
  Among 1587 SSc patients, 160 (20%) were unemployed at the time of cohort enrolment excluding retired patients. Of these, 63% had limited disease subtype. Mean (±SD) age at enrollment was 51.9 (±10.4) years; 13 years below the average retirement age in Australia. Mean (±SD) disease duration at recruitment was 11.1 (±10.9) years. Multivariable regression analysis revealed the presence of digital amputation (OR 3.9, 95%CI 1.7-9.1, p=0.002), diffuse disease subtype (OR 2.2, 95%CI 1.3-3.5, p-value=0.002), sicca symptoms (OR 2.7, 95%CI 1.6-4.4, p<0.001), a physical job (OR 1.8, 95%CI 1.1-3.1, p=0.03) and pulmonary arterial hypertension (OR 2.2, 95%CI 1.1-4.5, p=0.02) to be associated with unemployment. Unemployed patients had consistently poorer HRQoL scores in all domains (physical, emotional and mental health) of the SF-36 form than those who were employed.
  
  
  CONCLUSIONS
  SSc is associated with substantial work disability and unemployment, which is in turn associated with poor quality of life. Raising awareness, identifying modifiable risk factors and implementing employment strategies and work place modifications are possible ways of reducing this burden.
authors.affiliation: Department of Medicine, The University of Melbourne at St Vincent's Hospital, and Department of Rheumatology, St. Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Morrisroe
authors.affiliation: Department of Medicine, The University of Melbourne at St Vincent's Hospital, and Department of Rheumatology, St. Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Molla
authors.initials: M
authors.lastname: Huq
authors.affiliation: Department of Rheumatology, St .Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Stevens
authors.affiliation: Department of Rheumatology, St .Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Candice
authors.initials: C
authors.lastname: Rabusa
authors.affiliation: Department of Rheumatology, Royal Adelaide Hospital, North Terrace; and Discipline of Medicine, University of Adelaide, Australia.
authors.forename: Susanna M
authors.initials: SM
authors.lastname: Proudman
authors.affiliation: Department of Medicine, The University of Melbourne at St Vincent's Hospital, and Department of Rheumatology, St. Vincent's Hospital, Melbourne, Victoria, Australia. m.nikpour@unimelb.edu.au.
authors.forename: Mandana
authors.initials: M
authors.lastname: Nikpour
mesh_terms: D000328:Adult; D000367:Age Factors; D000671:Amputation, Surgical; D001315:Australia / Q000453:epidemiology; D016009:Chi-Square Distribution; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007587:Job Description; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D045743:Scleroderma, Diffuse / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery; D011795:Surveys and Questionnaires; D013997:Time Factors; D014478:Unemployment / Q000523:psychology*; D014938:Work Capacity Evaluation