Supplementary Material for: Real-world data on switches of the employment status in people with multiple sclerosis: a longitudinal observational study of the German MS Register

Introduction: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system affecting 2.9 million people worldwide. MS symptom variety can have a significant impact on the economic and occupational participation of people with MS (pwMS). The objective of this study was to investigate the trends in the employment (EMP) status change of pwMS over a two-year period and to identify the associated sociodemographic, clinical and symptom-specific factors. Methods: The present longitudinal observational study analysed real-world registry data from pwMS characterised by ≥1 documented data set during 2014–2023, an age of 18–60 years, ≥2 data sets during a two-year period (±2 months) and a documented EMP status change. The transition from EMP to non-employment (NEMP) or vice versa within a two-year period was investigated during two visits: baseline (pre-transition) and follow-up (post-transition). Univariable and multivariable logistic regression models were utilised to identify associated variables. Results: The study population (N=940) was classified into NEMP-to-EMP patients (n=269) and EMP-to-NEMP patients (n=671). EMP-to-NEMP patients were found to be older in median (45.6 vs. 39.3 years) and more likely to have chronic progressive MS at baseline (14.2% vs. 4.8%) than NEMP-to-EMP patients. Moderate/severe disability level emerged as the most robust predictor of EMP-to-NEMP switches (odds ratio [OR]=1.89, p=0.005). Pain (baseline: OR=1.96, p=0.017; follow-up: OR=5.57, p=0.025) and cognitive impairment (baseline: OR=1.78, p=0.048; follow-up: OR=10.47, p=0.005) were significant symptomatic predictors of EMP-to-NEMP transitions. Conclusion: The results emphasise the particular importance of pain and cognitive impairment as independent symptomatic predictors, whose impact on work ability may be underestimated.

引言：多发性硬化症（Multiple Sclerosis, MS）是一种中枢神经系统慢性自身免疫性疾病，全球范围内共有290万患者。该疾病的症状多样性可对多发性硬化症患者（people with MS, pwMS）的经济状况与职业参与度造成显著影响。本研究旨在探究pwMS在两年周期内的就业（Employment, EMP）状态变化趋势，并明确与之相关的社会人口学、临床及症状特异性影响因素。
方法：本项纵向观察性研究分析了2014至2023年间符合以下条件的pwMS的真实世界登记数据：至少存在1份可追溯的记录数据、年龄介于18至60岁之间、在两年周期（±2个月）内拥有至少2份记录数据，且存在可追溯的EMP状态变化。研究针对两次就诊阶段（基线期即转归前、随访期即转归后）的两年周期内，患者从EMP转向非就业（Non-Employment, NEMP）或反之的转归情况展开分析。本研究采用单变量及多变量逻辑回归模型以识别相关影响变量。
结果：本研究的受试人群（总例数N=940）被分为两类：从NEMP转向EMP的患者（n=269），以及从EMP转向NEMP的患者（n=671）。相较于从NEMP转向EMP的患者，从EMP转向NEMP的患者中位年龄更高（45.6岁 vs 39.3岁），且基线期慢性进展型MS的患病率更高（14.2% vs 4.8%）。中/重度残疾水平是EMP转向NEMP转归最显著的预测因素（优势比[Odds Ratio, OR]=1.89，p=0.005）。疼痛（基线期：OR=1.96，p=0.017；随访期：OR=5.57，p=0.025）与认知障碍（基线期：OR=1.78，p=0.048；随访期：OR=10.47，p=0.005）是EMP转向NEMP转归的重要症状学预测因素。
结论：本研究结果凸显了疼痛与认知障碍作为独立症状学预测因素的特殊重要性，二者对工作能力的影响或被低估。