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Association of Specific Organ Damage and Work Loss in a Population Based Cohort of Systemic Lupus Erythematosus Patients

Agan, Matthew Charles (2013)
Master's Thesis (55 pages)
Committee Chair / Thesis Adviser: Lim, S Sam
Committee Members:
Research Fields: Health Sciences, Public Health; Health Sciences, Epidemiology
Partnering Agencies: Emory University schools, faculty or affiliated programs
Keywords: Lupus; Work Disability; Systemic Lupus Erythematosus; Unemployment; Organ Damage
Program: Rollins School of Public Health, Epidemiology (Epidemiology)
Permanent url: http://pid.emory.edu/ark:/25593/d6298

Abstract

Background: Systemic lupus erythematosus (SLE) predominantly develops in younger age groups, when many are establishing themselves in the workforce. The development of a chronic, autoimmune condition during this period can have a devastating impact on employment. The objective of this study was to evaluate the association of specific types of organ system damage with work loss in population-based cohort of SLE patients. Research Design and Methods: The source of data was from the 2011 to 2012 annual patient reported survey of the Georgians Organized Against Lupus (GOAL) Study, an ongoing population-based cohort of patients with validated SLE in Atlanta, GA assembled primarily from the Georgia Lupus Registry (GLR). The GLR was supported by the Centers for Disease Control and Prevention and designed to more accurately estimate the incidence and prevalence of SLE. GOAL Study participants were surveyed regarding employment status at the time of survey completion along with other demographic information. Organ damage was measured using the Brief Index of Lupus Damage. Disease activity was measured using the SLE Activity Questionnaire (SLAQ). Logistic regression analysis was used to measure the association between categories of organ damage and employment/disability. Results: Multivariable logistic regression showed significant associations between work loss and three organ systems: cardiovascular (Adjusted POR 8.71, 95% CI 3.41-22.21), renal (Adjusted POR 6.29, 95% CI 2.09-18.93), and for those with low SLE disease activity, neuropsychiatric (Adjusted POR 9.96, 95% CI 2.72-36.49 for multiple imputation). A total of 463 SLE patients were surveyed with a mean age of 46.6 (SD 10.0), 13.5 (SD 8.6) years of disease, and 14.2 (SD 2.8) years of education; 93.2% were female, 79.5% were black and 14.4% white. 200 (42.9%) were working and 263 (57.1%) were unemployed or disabled and thus had experienced work loss. Conclusions: In total, 56.8% of SLE patients were unemployed or disabled at the time of the survey. Organ damage from SLE has a profound association with work loss. In the multivariable model, cardiovascular and renal damage were independently associated with work loss, which is in agreement with prior studies. Disease activity (SLAQ) acted as a mediator for neuropsychiatric damage; in those with low disease activity, neuropsychiatric damage was independently associated with work loss.

Table of Contents

TABLE OF CONTENTS -- -- Background.....................................1 -- Hypothesis....................................11 -- Methods........................................11 -- Results.........................................19 -- Discussion.....................................22 -- Conclusion.....................................27 -- References.....................................28 -- Figure...........................................36 -- Tables...........................................37

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