O20 The impact of axial spondyloarthritis on work productivity in individuals living in rural areas: results from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS)

Abstract

Background: Living in rural areas has been associated with reduced health service use and poorer health outcomes, including work. Individuals with axSpA are more likely to leave the workforce prematurely compared to the general population. This study aims to explore differences in work and disease outcomes between rural and urban dwellers. Methods or theme: The BSRBR:AS is a prospective UK cohort of axSpA patients. Differences in work productivity and activity impairment index, Bath Ankylosing Spondylitis disease activity and function indices (BASDAI/BASFI) between rural and urban dwellers were assessed using logistic/linear regression. Response to biologics was compared at baseline and first follow-up (three to nine months); results expressed as odds ratios (OR) or coefficients (-) with 95% confidence intervals. Results: Employed rural dwellers (n579) were more likely to work in a physical job (OR 2.0 (95% CI 1.5, 2.6)) and report higher levels of presenteeism (at-work productivity loss) (-5.0 (1.3, 8.7)). Adjustment for BASDAI, BASFI, fatigue and job type attenuated this relationship (-0.5 (-2.0, 3.1)). Rural patients prescribed biologic therapy (n111) were older (51 vs. 46 yrs) and more likely to have a physical job (67 vs. 45%). Baseline BASDAI, BASFI were similar between groups. At followup, ASAS 20/40 response was similar but rural-dwellers reported 8% more presenteeism (-8.4 (1.3, 15.6)) and work impairment (-8.4 (0.9, 16.1)), adjusted for age, gender, deprivation, job type and baseline score. Conclusions: This is the first study to demonstrate that axSpA patients living in rural areas report a greater impact on work productivity, and suggests a complex relationship between job type, work environment and work productivity.