THE IMPACT of the COVID-19 PANDEMIC on WORK PRODUCTIVITY in PATIENTS with SPONDYLOARTHRITIS: RESULTS from the DUTCH SPA-NET REGISTRY

ABSTRACT

Background: Since early 2020, governments have initiated local and nationwide measures to contain the spread of the coronavirus disease 2019 (COVID-19). In the Netherlands, people were strongly recommended to work from home, and several work sectors were shut down. In addition, hospitals had to reduce regular care. These changes, together with the risk of contracting COVID-19 and becoming ill, could have affected people's employment perspectives and work productivity. It is unknown to what degree this affected persons with chronic disorders, such as spondyloarthritis (SpA). Objectives: To investigate whether work productivity in patients with SpA changed following the onset of the pandemic and the associated government-initiated containment measures in the Netherlands. Methods: Data from the Dutch eHealth monitoring system SpA-Net were used. Since 2016, patients in SpA-Net completed outcome measurements when they attended outpatient rheumatology visits. Employment and work productivity were assessed with the Work Productivity and Activity Impairment questionnaire (WPAI, work productivity loss range 0-100%), capturing both sick leave and reduced at-work productivity. Covariables of interest were age, gender, education (high vs. low) and disease activity (ASDAS, BASDAI, patient global). The proportions of patients employed and their work productivity losses were compared during a 1-year period before and after the onset of the pandemic (March 2020). Generalized Estimating Equations (GEE) analysis of all assessments over time explored if work productivity in employed patients had changed with the onset of the pandemic, adjusting for potential confounders. Similar analyses with disease activity as outcome were used to facilitate interpretation of work productivity results. Results: Of 238 patients, data were available during the 1-year period both before and after onset of the pandemic. Pre-pandemic, 128 (54%) patients were employed. These employed patients had a mean age of 49.0 (SD 10.2) years, 66 (54%) were male and the mean ASDAS was 2.1 (0.9). After the onset of the pandemic, 7 (5.5%) were no longer employed. In addition, 8 out of 110 (7.3%) originally unemployed patients had become employed by this time. Work productivity loss (0-100%) was worse after the onset of the pandemic (37.0) compared to the pre-pandemic year (27.0) (p<0.01). In multivariable GEEs with work productivity loss as outcome (and stratifed by education due to interaction), patients with low education had work productivity losses that were almost 10% (absolute) higher after onset of the pandemic compared to pre-pandemic (B = 9.57, 95%CI 5.63-13.51) (Table 1). This was independent of ASDAS and other confounders. In patients with high education, however, no such association between pandemic onset and work productivity was seen. Analyses adjusting for other measures of disease activity (BASDAI, patient global) showed similar results. In GEEs with disease activity as outcome, disease activity before and after pandemic onset did not differ (B =-0.05, 95%CI-0.15 to 0.06 for ASDAS, model not shown). Conclusion: Work productivity has worsened in patients with SpA since the onset of the pandemic, especially in patients with lower educational attainment, while disease activity remained stable. Care should be taken to support patients in their work role during the pandemic, and thereafter.