PB1264 - The Association between Unemployment and Treatment Among Adults with Hemophilia

Background: People with hemophilia (PWH) often experience pain and suffer from comorbidities related to their bleeding disorder. Consequently, unemployment due to disability is more prevalent among people with hemophilia than among the rest of the population.

Aims: To explore associations between unemployment due to disability and treatment while adjusting for known risk factors for unemployment.

Methods: Collecting data from 20 hemophilia centers from 15 European countries, the ADVANCE study recruited 785 participants aged 40 years and over with hemophilia A or B. A comprehensive electronic case report form included items relating to patient characteristics, demographic information, past and current treatment regimens, and medical history, including a lifelong history of comorbidities. Baseline data from the ADVANCE study was analyzed using descriptive statistics and logistic regression models.

Results: Employment status was available for 757 of 785 participants aged 40-88 years (mean 54 years). The cohort included adults who predominantly had hemophilia A (85%) and severe hemophilia (56%). We used regression analysis to compare PWH who were fully employed to those who were unemployed due to disability. This analysis included 441 participants. Using multivariable logistic regression, we found that age (odds ratio [OR]=1.1, P< 0.001), severe hemophilia (OR=10.8, P< 0.001), current smoker (OR=2.5, P=0.003), and psychiatric disorder (OR=4.2, P=0.02) were associated with increased odds of unemployment due to disability. In contrast, prophylactic treatment (OR=0.4, P=0.01) was associated with decreased odds. Chronic liver disease and current target joint was associated with unemployment due to disability in univariable analysis, but not in multivariable logistic regressions after adjusting for severity.

Conclusion(s): Our analysis suggests that by maintaining factor levels above a critical threshold prophylactic treatment for PWH could help avoid unemployment due to disability. While prophylaxis is more costly and can be burdensome, the benefits to material well-being and quality of life could be substantial.