title: Work outcome in persons with musculoskeletal diseases: comparison with other chronic diseases & the role of musculoskeletal diseases in multimorbidity.
abstract: Chronic diseases and multimorbidity are increasingly common among persons in working age. This study explores the impact of type, number and combinations of chronic diseases with focus on the role of MSKD on (1) adverse work status (i.e. work disability (WD), economic unemployment (UE) or receiving a living allowance (LA)) and on (2) the occurrence of sick leave.
  
  
  
  Subjects participating in a Dutch household survey, who were ≤65 years and could have paid work, provided data on socio-demographics and nine physician diagnosed chronic diseases. To explore the independent association of each chronic disease, of multimorbidity and of MSKD in context of multimorbidity with 1) work status (employed, WD, LA, UE) and 2) sick leave (SL) in those employed, multinomial logistic regressions and logistic regressions were used, respectively.
  
  
  
  Among 5396 subjects, MSKD was the most common morbidity (17%), multimorbidity occurred in 755/5396 (14%), 436/755 (61%) of subjects with multimorbidity had an MSKD. For MSKD the odds of WD, LA and UE were 2.06 [95% CI 1.56;2.71], 2.15[1.18;3.91] and 1.35[0.94;1.96], respectively, compared to being employed and the odds of SL in MSKD were 2.29[1.92;2.73]. Mental diseases had a stronger impact on all these outcomes. The odds for adverse work outcomes increased strongly with an increasing number of diseases. When an MSKD was part of multimorbidity, an additional impact on the association with WD and SL was observed.
  
  
  
  Multimorbidity has a stronger impact on all work outcomes compared to single chronic diseases. The presence of the MSKD in the context of multimorbidity amplifies the chance of WD or SL.
authors.affiliation: Internal Medicine/Rheumatology, CAPHRI, Maastricht University Medical Centre, Maastricht University, NL-6202 AZ MAASTRICHT, P/O 5800, Maastricht, Netherlands. antje.vdzee@gmail.com.
authors.forename: Antje
authors.identifier: 0000-0002-7167-7524
authors.initials: A
authors.lastname: van der Zee-Neuen
authors.affiliation: Internal Medicine/Rheumatology, CAPHRI, Maastricht University Medical Centre, Maastricht University, NL-6202 AZ MAASTRICHT, P/O 5800, Maastricht, Netherlands.|Health Promotion, Maastricht University, Maastricht, Netherlands.
authors.forename: Polina
authors.initials: P
authors.lastname: Putrik
authors.affiliation: Rheumatology, Leiden University Medical Center, Leiden, Netherlands.|Rheumatology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Ramiro
authors.affiliation: Department of Medical Informatics Uniklinik RWTH, Aachen University, Aachen, Germany.
authors.forename: Andras
authors.initials: A
authors.lastname: Keszei
authors.affiliation: Internal Medicine/Rheumatology, CAPHRI, Maastricht University Medical Centre, Maastricht University, NL-6202 AZ MAASTRICHT, P/O 5800, Maastricht, Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: de Bie
authors.affiliation: Netherlands Organization for Applied Scientific Research, Lifestyle, Leiden, Netherlands.
authors.forename: Astrid
authors.initials: A
authors.lastname: Chorus
authors.affiliation: Internal Medicine/Rheumatology, CAPHRI, Maastricht University Medical Centre, Maastricht University, NL-6202 AZ MAASTRICHT, P/O 5800, Maastricht, Netherlands.
authors.forename: Annelies
authors.initials: A
authors.lastname: Boonen
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004651:Employment / Q000639:trends*; D016832:Employment, Supported / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000076322:Multimorbidity; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D018582:Sick Leave / Q000639:trends; D011795:Surveys and Questionnaires; D014478:Unemployment / Q000639:trends
keywords: Living allowance; Multimorbidity; Musculoskeletal diseases; Sick leave; Unemployment; Work disability; Work outcome