Unemployment in chronic airflow obstruction around the world: Results from the BOLD study
File(s)
Accepted version
Published version
Author(s)
Type
Journal Article
Abstract
Objectives: We aimed to examine associations between chronic airflow obstruction (CAO) and unemployment across the world.
Methods: Cross-sectional data from 26 sites in the Burden of Obstructive Lung Disease (BOLD) Study were used to analyze effects of CAO on unemployment. Odds ratios (OR) for unemployment in subjects 40-65 years old were estimated with multilevel mixed-effects generalized linear model with study site as random effect. Site-by-site heterogeneity was assessed using individual participant data meta-analyses.
Results: Of 18710 participants, 11.3% had CAO. Ratio of unemployed subjects with CAO divided by subjects without CAO showed large site discrepancies, though these were no longer significant after adjusting for age, sex, smoking and education. Site-adjusted OR for unemployment (95%CI) was 1.79 (1.41, 2.27) for CAO cases, decreasing to 1.43 (1.14, 1.79) after adjusting for sociodemographic factors, comorbidities and forced vital capacity. Of other covariates that were associated with unemployment, age and education were important risk factors in high-income sites (OR (95%CI) 4.02 (3.53, 4.57) and 3.86 (2.80, 5.30) respectively), while female gender was important in low-to-middle-income sites (OR 3.23 (2.66, 3.91)).
Conclusions: In the global BOLD study, CAO was associated with increased levels of unemployment, even after adjusting for sociodemographic factors, comorbidities and lung function.
Methods: Cross-sectional data from 26 sites in the Burden of Obstructive Lung Disease (BOLD) Study were used to analyze effects of CAO on unemployment. Odds ratios (OR) for unemployment in subjects 40-65 years old were estimated with multilevel mixed-effects generalized linear model with study site as random effect. Site-by-site heterogeneity was assessed using individual participant data meta-analyses.
Results: Of 18710 participants, 11.3% had CAO. Ratio of unemployed subjects with CAO divided by subjects without CAO showed large site discrepancies, though these were no longer significant after adjusting for age, sex, smoking and education. Site-adjusted OR for unemployment (95%CI) was 1.79 (1.41, 2.27) for CAO cases, decreasing to 1.43 (1.14, 1.79) after adjusting for sociodemographic factors, comorbidities and forced vital capacity. Of other covariates that were associated with unemployment, age and education were important risk factors in high-income sites (OR (95%CI) 4.02 (3.53, 4.57) and 3.86 (2.80, 5.30) respectively), while female gender was important in low-to-middle-income sites (OR 3.23 (2.66, 3.91)).
Conclusions: In the global BOLD study, CAO was associated with increased levels of unemployment, even after adjusting for sociodemographic factors, comorbidities and lung function.
Date Issued
2017-09-20
Date Acceptance
2017-06-20
Citation
European Respiratory Journal, 2017, 50 (3)
ISSN
1399-3003
Publisher
European Respiratory Society: ERJ
Journal / Book Title
European Respiratory Journal
Volume
50
Issue
3
Copyright Statement
Copyright ©ERS 2017
This ERJ Open article is open access and distributed under the terms of the Creative Commons Attribution Licence 4.0.
This ERJ Open article is open access and distributed under the terms of the Creative Commons Attribution Licence 4.0.
Sponsor
Kaiser Foundation Hospitals,Center for Health Research
Sociedade Portuguesa de Pneumologia
Tartu University Hospital
Wellcome Trust
Wellcome Trust
Ciro Horn
Grant Number
DHTBX_P19127
DHTBX_P18236
DHTBX_P19125
085790/Z/08/Z
089405/Z/09/Z
DHTBX_P19121
Subjects
11 Medical And Health Sciences
Respiratory System
Publication Status
Published
Article Number
1700499