Impact of Pulmonary Arterial Hypertension on Employment, Work Productivity, and Quality of Life - Results of a Cross-Sectional Multi-Center Study

Jan Fuge; Da-Hee Park; Thomas von Lengerke; Manuel J Richter; Henning Gall; Hossein A Ghofrani; Jan C Kamp; Marius M Hoeper; Karen M Olsson

doi:10.3389/fpsyt.2021.781532

Impact of Pulmonary Arterial Hypertension on Employment, Work Productivity, and Quality of Life - Results of a Cross-Sectional Multi-Center Study

Front Psychiatry. 2022 Feb 8:12:781532. doi: 10.3389/fpsyt.2021.781532. eCollection 2021.

Authors

Jan Fuge^{1

2}, Da-Hee Park^{1

2}, Thomas von Lengerke³, Manuel J Richter^{4

5}, Henning Gall^{4

5}, Hossein A Ghofrani^{4

5}, Jan C Kamp^{1

2}, Marius M Hoeper^{1

2}, Karen M Olsson^{1

2}

Affiliations

¹ Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
² Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany.
³ Department of Medical Psychology, Centre for Public Health and Healthcare, Hannover Medical School, Hannover, Germany.
⁴ Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, Giessen, Germany.
⁵ The German Center for Lung Research, Giessen, Germany.

Abstract

Introduction: Data on burden of pulmonary arterial hypertension (PAH) are mostly limited to physical and clinical endpoints as well as quality of life. Research on employment, work productivity, and educational background is scarce. The aim of this study was to assess the impact of PAH on employment status and work productivity in Germany.

Materials and methods: In a multicenter cross-sectional survey, patients with PAH were surveyed in two large pulmonary hypertension referral centers in Germany. The survey contained questions on education, employment, work productivity and impairment (WPAI, also at the time of diagnosis), quality of life, and socioeconomic status. Additional data was assessed using clinical research database for 6-min walk distance (6MWD), WHO functional class, and N-terminal fragment of pro-brain natriuretic peptide. All patients provided written informed consent, and the institutional review board approved this study.

Results: In total, 212 patients were surveyed (72% female; median, 57 years) approximately 6 years after initial PAH diagnosis. A total of 76% had an idiopathic PAH followed by hereditary and associated PAH (10% each). Employment at the time of diagnosis was 48% (34% full-time, 14% part-time), with productivity measured by a WPAI score of 6 points and decreased to 29% (21% full-time, 8% part-time) at the time of the survey (with a WPAI score of 2 points, p < 0.001). Logistic regression showed education and 6MWD as predictors for employment. Patients in moderate or high educational category had a 3.6- or 5.6-fold chance, respectively, of being employed (p = 0.025 and p = 0.019), and per 50-m increase of 6MWD, the odds of being employed were 1.2, p = 0.042.

Conclusion: Patients with PAH had a reduced employment rate, which was influenced by education and 6MWD. There was a considerable loss of employment over the course of the disease. Employment should be one possible treatment goal in patients with PAH to provide social participation to this patient group.

Keywords: education; employment status; pulmonary arterial hypertension; quality of life; social participation; work productivity; work productivity activity impairment questionnaire.