BACKGROUND No studies have assessed changes in employment survival in multiple sclerosis (MS) populations over recent decades, including the introduction of disease-modifying therapies (DMTs). OBJECTIVES To evaluate factors associated with leaving employment due to MS; to assess whether the risk of leaving employment has changed over recent decades in Australia, stratified by MS phenotype. METHODS We included 1240 participants who were working before MS diagnosis. Information on employment status, reasons for leaving employment and year of leaving were collected. Data were analysed using competing risk survival analysis. RESULTS Males, progressive MS, lower education level and older age at diagnosis were associated with a higher sub-distribution hazard of leaving employment. Compared to the period before 2010, the sub-distribution hazard during 2010-2016 for relapsing-remitting multiple sclerosis (RRMS) was reduced by 43% (sub-distribution hazard ratio (sHR) 0.67, 95% confidence interval (CI): 0.50 to 0.90), while no significant reduction was seen for primary-progressive multiple sclerosis (PPMS) (sHR 1.25, 95% CI: 0.72 to 2.16) or secondary-progressive multiple sclerosis (SPMS) (sHR 1.37, 95% CI: 0.84 to 2.25). CONCLUSION Males, people with progressive MS and those of lower education level were at higher risk of leaving employment. The differential changed risk of leaving employment between people with different MS phenotype after 2010 coincides with the increased usage of high-efficacy DMTs for RRMS.

中文翻译：

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由于多发性硬化症和过去几十年风险变化而离职的风险因素：使用竞争风险生存分析

背景 近几十年来，没有研究评估多发性硬化症 (MS) 人群就业生存率的变化，包括疾病缓解疗法 (DMT) 的引入。目标 评估与因多发性硬化症而离职的相关因素；评估澳大利亚近几十年来离职风险是否发生变化，按 MS 表型分层。方法 我们纳入了 1240 名在 MS 诊断前工作的参与者。收集了有关就业状况、离职原因和离职年份的信息。使用竞争风险生存分析来分析数据。结果 男性、进展性 MS、受教育程度较低和诊断时年龄较大与离职的子分布风险较高相关。与2010年前相比，2010-2016 年复发缓解型多发性硬化症 (RRMS) 的亚分布风险降低了 43%（亚分布风险比 (sHR) 0.67，95% 置信区间 (CI)：0.50 至 0.90），但无显着性原发性进行性多发性硬化 (PPMS) (sHR 1.25, 95% CI: 0.72 to 2.16) 或继发性进行性多发性硬化 (SPMS) (sHR 1.37, 95% CI: 0.84 to 2.25) 降低。结论 男性、进展性 MS 患者和受教育程度较低的人离职的风险较高。2010 年后具有不同 MS 表型的人之间离职风险的差异变化与 RRMS 使用高效 DMT 的增加相吻合。50 至 0.90），而原发性进行性多发性硬化症 (PPMS)（sHR 1.25，95% CI：0.72 至 2.16）或继发性进行性多发性硬化症（SPMS）（sHR 1.37，95% CI：0.84）未见显着降低到 2.25）。结论 男性、进展性 MS 患者和受教育程度较低的人离职的风险较高。2010 年后具有不同 MS 表型的人之间离职风险的差异变化与 RRMS 使用高效 DMT 的增加相吻合。50 至 0.90），而原发性进行性多发性硬化症 (PPMS)（sHR 1.25，95% CI：0.72 至 2.16）或继发性进行性多发性硬化症（SPMS）（sHR 1.37，95% CI：0.84）未见显着降低到 2.25）。结论 男性、进展性 MS 患者和受教育程度较低的人离职的风险较高。2010 年后具有不同 MS 表型的人之间离职风险的差异变化与 RRMS 使用高效 DMT 的增加相吻合。