Objective: To examine whether associations between socioeconomic factors and work outcomes in spondyloarthritis (SpA) differ across axial (axSpA), peripheral SpA (pSpA) and psoriatic arthritis (PsA... Show moreObjective: To examine whether associations between socioeconomic factors and work outcomes in spondyloarthritis (SpA) differ across axial (axSpA), peripheral SpA (pSpA) and psoriatic arthritis (PsA), and whether associations for individual-level socioeconomic factors are modified by country-level factors. Methods: Patients with a physician diagnosis of SpA within working age (18-65 years) were included. Associations between individual-(age, gender, education, marital status) and country-level factors (Human Development Index, Health Care Expenditure (HCE), Gross Domestic Product, percentage unemployed) with work outcomes (employment status, absenteeism, presenteeism) were assessed using multivariable mixed-effects models. Associations between individual factors and outcomes were compared according to SpA phenotypes and country-level factors using interaction terms. Results: A total of 3835 patients (mean age 42 years, 61% males) from 23 countries worldwide were included (66% axSpA, 10% pSpA, 23% PsA). Being employed was associated with gender (male vs. female OR 2.5; 95%CI 1.9-3.2), education (university vs. primary OR 3.7; 2.9-4.7), marital status (married vs. single OR 1.3; 1.04-1.6), and age in a non-linear manner. University (vs primary) education was associated with lower odds of absenteeism (OR 0.7; 0.5-0.96) and presenteeism (OR 0.5; 0.3-0.7). Associations were similar across SpA phenotypes. Higher HCE was associated with more favourable work outcomes, e.g., higher odds of employment (OR 2.5; 1.5-4.1). Gender discrepancy in odds of employment was greater in countries with lower socioeconomic development. Conclusion: Higher educational attainment and higher HCE were associated with more favourable work outcomes, independently of SpA phenotype. The disadvantageous effect of female gender on employment is particularly strong in countries with lower socioeconomic development. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) Show less
Population ageing affects health care expenditure (HCE) through a myriad of dynamics which can be categorized in three major components: rising life expectancy a higher share of older people, and... Show morePopulation ageing affects health care expenditure (HCE) through a myriad of dynamics which can be categorized in three major components: rising life expectancy a higher share of older people, and increasing mortality rates in combination with high "costs of dying". By disentangling these dynamics, and relating the insights presented in this thesis on the determinants of old age mortality, HCE, and the costs of dying, we have shown that the effect of population ageing on HCE may be curtailed by different trends. Specific insights from this thesis are summarized below: - Counter-intuitively, the mortality risk of older people increases during times of economic growth. - The mortality risk and level of HCE of older people is markedly higher in the autumn and winter than in the spring and summer. - A transitional care programme improved the health outcomes of frail older people. - After the death of the spouse, HCE of older people increases with around 50%. This is probably mainly related to the loss of an informal care-giver, and not bereavement. - There is not much variation in the "costs of dying" amongst older people. Variation that exists can be mostly explained by age and preceding level of HCE. Show less
