The impact of biologic therapy on work capacity and workforce attachment in patients with severe asthma

Severe asthma impacts work capacity, but little is known about the effects of biologic therapy on patients’ ability to work. We aimed to assess the impact of biologic therapy for severe asthma on work capacity and workforce attachment. This cohort study used the Danish Severe Asthma Register, comprising all Danish patients with severe asthma initiating biologic therapy. Earned income, hours worked, and workforce attachment were tracked in national databases from one year prior to biologic therapy as well as during 2 years of biologic therapy. Outcomes were compared to age-, sex-, cohabitation- and residence-matched controls from the general population. Overall, 381 patients aged 20–62 years (52% females) were included. Annual weeks worked were lower among patients with severe asthma (adjusted incidence rate ratio (aIRR) 0.82 (0.80–0.84)), driven by increases in sick leave (aIRR 2.77 (2.58–2.98)), unemployment (aIRR 1.38 (1.30–1.46)) and disability pension (aIRR 1.85 (1.76–1.94)). After initiating biologic therapy, patients saw modest increases in annual hours worked during the second year of treatment (aIRR 1.03 (1.03–1.04)). However, patients remained at risk for temporary (OR 1.83 (1.15–2.93)) and permanent (OR 2.67 (1.16–6.16)) workforce withdrawal. Patients achieving on-treatment remission worked significantly more hours compared to non- and clinical responders and had lower unemployment-, sick-leave and disability pension rates both at baseline and after two years. Biologic therapy resulted in a modest increase in hours worked, yet patients remain at significant risk of early workforce withdrawal. Patients achieving remission had a stronger attachment to the workforce, also prior to biologic therapy.

重症哮喘会损害患者的劳动能力，但目前学界对生物制剂治疗对重症哮喘患者劳动能力的影响尚缺乏足够了解。本研究旨在评估生物制剂治疗对重症哮喘患者劳动能力与劳动力留存情况的影响。本队列研究依托丹麦重症哮喘登记库（Danish Severe Asthma Register），纳入所有首次启动生物制剂治疗的丹麦重症哮喘患者。研究通过国家数据库追踪了患者在生物制剂治疗前1年，以及治疗期间2年内的劳动收入、工作时长与劳动力留存情况。同时将患者与普通人群中按年龄、性别、同居状态及居住地匹配的对照人群进行对比。最终共纳入381例年龄介于20至62岁的患者，其中女性占比52%。总体而言，重症哮喘患者的年度工作周数更低，校正发病率比（adjusted incidence rate ratio, aIRR）为0.82（95%置信区间0.80–0.84），这一结果主要由病假（aIRR 2.77, 2.58–2.98）、失业（aIRR 1.38, 1.30–1.46）与伤残抚恤金（aIRR 1.85, 1.76–1.94）的发生率升高所驱动。启动生物制剂治疗后，患者在治疗第二年的年度工作时长出现小幅提升，校正发病率比为1.03（1.03–1.04）。但患者仍面临暂时性（比值比（odds ratio, OR）1.83, 1.15–2.93）与永久性（OR 2.67, 1.16–6.16）退出劳动力市场的风险。达到治疗期间临床缓解的患者，相较于无应答者与临床应答者，其年度工作时长显著更长，且在基线与治疗两年后，其失业、病假与伤残抚恤金发生率均更低。生物制剂治疗可小幅提升患者的工作时长，但患者仍面临较高的早期劳动力退出风险。达到临床缓解的患者，即便在接受生物制剂治疗前，其劳动力留存能力也更强。