Central Data Catalog

Introduction: The geographic variation and correlates of unemployment in COPD is unknown. We set out to examine associations between employment status and COPD in the Burden of Obstructive Lung Disease (BOLD) study.

Methods: Spirometry and interviews were performed at 26 sites in 22 countries. Unemployment was defined as not having had a paid job the preceding year, and was the main outcome in Poisson regression analysis with sex, age, lung function, education, smoking habits, airway symptoms, study site and self-reported comorbidities as covariates. COPD was defined as post-bronchodilator FEV1/FVC < lower limit of normal (LLN)(NHANES III prediction equation for Caucasians).

Results: Altogether, 11.3% (2123 of 18710 subjects) had spirometric COPD. In total, 863 subjects with COPD (40.7%) and 9345 subjects without COPD (56.3%) had a paid job the preceding year. The prevalence of employment in COPD varied from 20% (Algeria) to 64% (India).

Spirometric COPD was associated with increased risk of unemployment in unadjusted analyses (relative risk (RR) 1.36, 95% CI 1.31-1.41). In multivariable analyses the effect of COPD was reduced to RR 1.09 (1.05-1.13). Stronger effects were found for hypertension, heart disease, diabetes and stroke. We observed increased prevalence of unemployment for (RR, 95% CI) ex-smokers (1.06, 1.02-1.10), 10 yrs increased age (1.47, 1.45-1.49), primary school educated vs university (1.65, 1.55 -1.76) and for women (1.63, 1.57-1.68). Site variation was considerable (RR from 1.78 (Iceland) to 5.38 (Morocco)).

Conclusion: There was substantial variation in employment of COPD-patients, but the overall effect of COPD on unemployment was modest when we adjusted for geography, demographic factors and comorbidities.