Objective: To evaluate work status and its determinants among ankylosing spondylitis (AS) patients in our country.
Materials and methods: We carried out a case-control study, including AS patients older than 16-year-old. Demographic, socioeconomic, and employment data were collected. Individuals from the general population matched by age, sex, and socioeconomic level served as the control group. Functional capacity was evaluated by bath ankylosing spondylitis functional index (BASFI) and health assessment questionnaire (HAQ-S) and disease activity by bath ankylosing spondylitis disease activity index (BASDAI). All patients completed quality of life (ASQol), depression (CES-D), and fatigue (FSS)-validated questionnaires.
Results: Sixty-four patients with AS (57 men) and 93 controls (83 men) were included. The frequency of retirement due to age was comparable in both groups, however, a significantly larger number of patients with AS were retired due to disability: 6 (9.4%) versus 0 (P = 0.004). Patients with AS had a significantly greater number of comorbidities than controls (78.7% vs. 31.5%, P = 1 x 10(-8)). Sixteen patients (26.2%) were unemployed compared with 4 controls (4.5%) (P = 0.001). Permanence at work was significantly lower in patients (median age 58, SD 54-61 years) versus controls (median age 66, SD 63-68 years) (log Rank P = 0.001). There were less full-time workers (71% vs. 87%, P = 0.03) and higher number of sick leave days (6.56 +/- 13 vs. 2.13 +/- 4.5, P = 0.01) in AS patients than controls. Unemployed patients had significantly worst quality of life, disease activity, and depression scores than employed patients. In the multivariate analysis, the primary variable associated to unemployment was depression [Odds Ratio (OR): 20, 95% confidence interval (CI), 1.69-258, P = 0.001] followed by disease activity (OR: 1.05, 95% CI, 1-1.1, P = 0.04) and age (OR: 1.1, 95% CI, 1.02-1.21, P = 0.01) as secondary variables.
Conclusions: The frequency of work disability among our patients with AS was significantly higher than in age, sex, and socioeconomic matched population. The main variable associated with work disability and unemployment was depression. Whether this factor is contributing to or is a result of disability is not known.