The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2016
High local unemployment rates limit work after lung transplantation.
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Nau Michael, Shrider Emily A, Tobias Joseph D, Hayes Don, Tumin Dmitry
Аннотация
BACKGROUND: Most lung transplant (LTx) recipients recover sufficient functional status to resume working, yet unemployment is common after LTx. Weak local labor markets may limit employment opportunities for LTx recipients.
METHODS: United Network for Organ Sharing data on first-time LTx recipients 18-60 years old who underwent transplant between 2010 and 2014 were linked to American Community Survey data on unemployment rates at the ZIP Code level. Multivariable competing-risks regression modeled the influence of dichotomous (≥8%) and continuous local unemployment rates on employment after LTx, accounting for the competing risk of mortality. For comparison, analyses were duplicated in a cohort of heart transplant (HTx) recipients who underwent transplant during the same period.
RESULTS: The analysis included 3,897 LTx and 5,577 HTx recipients. Work after LTx was reported by 300 (16.3%) residents of low-unemployment areas and 244 (11.9%) residents of high-unemployment areas (p < 0.001). Multivariable analysis of 3,626 LTx recipients with complete covariate data found that high local unemployment rates limited employment after LTx (sub-hazard ratio = 0.605; 95% confidence interval = 0.477, 0.768; p < 0.001), conditional on not working before transplant. Employment after HTx was higher compared with employment after LTx, and not associated with local unemployment rates in multivariable analyses.
CONCLUSIONS: LTx recipients of working age exhibit exceptionally low employment rates. High local unemployment rates exacerbate low work participation after LTx, and may discourage job search in this population.
METHODS: United Network for Organ Sharing data on first-time LTx recipients 18-60 years old who underwent transplant between 2010 and 2014 were linked to American Community Survey data on unemployment rates at the ZIP Code level. Multivariable competing-risks regression modeled the influence of dichotomous (≥8%) and continuous local unemployment rates on employment after LTx, accounting for the competing risk of mortality. For comparison, analyses were duplicated in a cohort of heart transplant (HTx) recipients who underwent transplant during the same period.
RESULTS: The analysis included 3,897 LTx and 5,577 HTx recipients. Work after LTx was reported by 300 (16.3%) residents of low-unemployment areas and 244 (11.9%) residents of high-unemployment areas (p < 0.001). Multivariable analysis of 3,626 LTx recipients with complete covariate data found that high local unemployment rates limited employment after LTx (sub-hazard ratio = 0.605; 95% confidence interval = 0.477, 0.768; p < 0.001), conditional on not working before transplant. Employment after HTx was higher compared with employment after LTx, and not associated with local unemployment rates in multivariable analyses.
CONCLUSIONS: LTx recipients of working age exhibit exceptionally low employment rates. High local unemployment rates exacerbate low work participation after LTx, and may discourage job search in this population.