Birmingham COPD Cohort: a cross-sectional analysis of the factors associated with the likelihood of being in paid employment among people with COPD

Abstract

Background

Employment rates among those with chronic obstructive pulmonary disease (COPD) are lower than those without COPD, but little is known about the factors that affect COPD patients’ ability to work.

Methods

Multivariable analysis of the Birmingham COPD Cohort Study baseline data was used to assess the associations between lifestyle, clinical, and occupational characteristics and likelihood of being in paid employment among working-age COPD patients.

Results

In total, 608 of 1,889 COPD participants were of working age, of whom 248 (40.8%) were in work. Older age (60–64 years vs 30–49 years: odds ratio [OR] =0.28; 95% confidence interval [CI] =0.12–0.65), lower educational level (no formal qualification vs degree/higher level: OR =0.43; 95% CI =0.19–0.97), poorer prognostic score (highest vs lowest quartile of modified body mass index, airflow obstruction, dyspnea, and exercise (BODE) score: OR =0.10; 95% CI =0.03–0.33), and history of high occupational exposure to vapors, gases, dusts, or fumes (VGDF; high VGDF vs no VGDF exposure: OR =0.32; 95% CI =0.12–0.85) were associated with a lower probability of being employed. Only the degree of breathlessness of BODE was significantly associated with employment.

Conclusion

This is the first study to comprehensively assess the characteristics associated with employment in a community sample of people with COPD. Future interventions should focus on managing breathlessness and reducing occupational exposures to VGDF to improve the work capability among those with COPD.

Keywords:

• chronic obstructive pulmonary disease
• work
• employed
• breathlessness
• severity
• VGDF
• UK

Acknowledgments

The BLISS program was conceived in consultation with the other program coinvestigators KK Cheng, Brendan G Cooper, Amanda Daley, Sheila Greenfield, Kate Jolly, Sue Jowett, Jen Marsh, Martin R Miller, Richard Riley, Robert Stockley, and Alice M Turner and developed and executed in collaboration with Alexandra Enocson (BLISS program manager) and Andy P Dickens (research fellow of the cohort). The authors would like to thank all the patients that participated in the present study, as well as the support of their general practices. They would also like to thank all the BLISS team members for facilitating the study and conducting the assessment visits.

This paper summarizes independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0109-10061). The views expressed are those of the authors and not necessarily those of the national health service, the NIHR, or the Department of Health. Details of the funded NIHR proposal can be found on the institutional website.⁴⁰

Author contributions

PA and DAF are co-principal investigators for the BLISS program. REJ and PA supervised KKR directly for this analysis. KKR oversaw the occupational measures for the cohort, conducted the data analysis, and initially drafted the manuscript. SSS developed the JEM. AJS advised on the statistics. All authors contributed towards data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.