Labor market affiliation of patients with myeloproliferative neoplasms: a population-based matched cohort study

Patients with myeloproliferative neoplasms (MPNs) suffer from substantial symptoms and risk of debilitating complications, yet observational data on their labor market affiliation are scarce. We conducted a descriptive cohort study using data from Danish nationwide registries, including patients diagnosed with MPN in 2010-2016. Each patient was matched with up to ten comparators without MPN on age, sex, level of education, and region of residence. We assessed pre- and post-diagnosis labor market affiliation, defined as working, unemployed, or receiving sickness benefit, disability pension, retirement pension, or other health-related benefits. Labor market affiliation was assessed weekly from two years pre-diagnosis until death, emigration, or 31 December 2018. For patients and comparators, we reported percentage point (pp) changes in labor market affiliation cross-sectionally from week −104 pre-diagnosis to week 104 post-diagnosis. The study included 3,342 patients with MPN and 32,737 comparators. From two years pre-diagnosis until two years post-diagnosis, a larger reduction in the proportion working was observed among patients than comparators (essential thrombocythemia: 10.2 [95% CI: 6.3–14.1] vs. 6.8 [95% CI: 5.5–8.0] pp; polycythemia vera: 9.6 [95% CI: 5.9–13.2] vs. 7.4 [95% CI: 6.2–8.7] pp; myelofibrosis: 8.1 [95% CI: 3.0–13.2] vs. 5.8 [95% CI: 4.2–7.5] pp; and unclassifiable MPN: 8.0 [95% CI: 3.0–13.0] vs. 7.4 [95% CI: 5.7–9.1] pp). Correspondingly, an increase in the proportion of patients receiving sickness benefits including other health-related benefits was evident around the time of diagnosis. Overall, we found that Danish patients with essential thrombocythemia, polycythemia vera, myelofibrosis, and unclassifiable MPN had slightly impaired labor market affiliation compared with a population of the same age and sex. From two years pre-diagnosis to two years post-diagnosis, we observed a larger reduction in the proportion of patients with MPN working and a greater proportion receiving sickness benefits compared with matched individuals.

骨髓增殖性肿瘤（myeloproliferative neoplasms, MPNs）患者会承受显著症状，并面临致残性并发症风险，但目前关于其劳动力市场归属的观察性数据仍较为匮乏。
本研究依托丹麦全国登记数据库开展描述性队列研究，纳入2010-2016年确诊的MPNs患者。将每位患者与最多10名无MPN的对照者进行匹配，匹配维度包括年龄、性别、受教育程度及居住区域。
本研究评估了诊断前后的劳动力市场归属状态，定义为就业、失业、领取疾病津贴、伤残抚恤金、退休养老金或其他与健康相关的福利。劳动力市场归属状态以周为单位进行追踪，时间范围为诊断前2年至患者死亡、移民或2018年12月31日。
针对患者与对照者，本研究报告了从诊断前第104周至诊断后第104周的劳动力市场归属状态横断面百分点（percentage point, pp）变化。
本研究共纳入3342例MPNs患者与32737名对照者。在诊断前2年至诊断后2年期间，患者群体的就业比例降幅显著大于对照者：原发性血小板增多症（essential thrombocythemia）组为10.2[95%置信区间（Confidence Interval, CI）:6.3~14.1]百分点 vs 6.8[95%置信区间（CI）:5.5~8.0]百分点；真性红细胞增多症（polycythemia vera）组为9.6[95%CI:5.9~13.2] vs 7.4[95%CI:6.2~8.7]百分点；骨髓纤维化（myelofibrosis）组为8.1[95%CI:3.0~13.2] vs 5.8[95%CI:4.2~7.5]百分点；未分类MPNs组为8.0[95%CI:3.0~13.0] vs 7.4[95%CI:5.7~9.1]百分点。
相应地，诊断前后患者领取疾病津贴（含其他健康相关福利）的比例显著升高。
总体而言，相较于同年龄同性别人群，丹麦原发性血小板增多症、真性红细胞增多症、骨髓纤维化及未分类MPNs患者的劳动力市场归属状态存在轻度受损。
在诊断前2年至诊断后2年期间，MPNs患者的就业比例降幅及领取疾病津贴的比例增幅均显著高于匹配对照个体。