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Biomedical subjects

E Yelin

Publications and source records attributed to E Yelin.

At least 19 recordsLinked to original sources
PubMed1999

Work dynamics of adults with asthma.

BACKGROUND: Asthma has been found to be among the most common conditions in the working age population and is among the most common causes of work limitation, but we could find no longitudinal studies of employment among persons with this condition. METHODS: A panel of 601 persons with a diagnosis of asthma from random samples of northern California pulmonologists and allergy-immunologists were interviewed as many as three times at 18-month intervals by a trained survey worker to report on the severity of disease, demographic characteristics, and the extent of their employment. Their employment was then compared to that of a matched sample from the U.S. Bureau of the Census Current Population Survey. RESULTS: Ninety-two percent of the persons with asthma had worked at some point prior to study enrollment. Among persons with onset during adulthood, only 29% of those who were not employed at disease onset were working at study enrollment, compared to 68% among those who were employed. Among the 420 persons interviewed three times, 75, 81, and 75%, respectively, were employed as of the three interviews. Among these 420, 66% were continuously employed and 15% were continuously not employed. The principal determinants of continuity of employment were demographic and employment characteristics, not medical ones. The employment rate and hours of work per week and per year of the persons with asthma were similar to the matched sample. CONCLUSIONS: Asthma has not substantially impeded the employment of the persons with asthma we studied, with the exception that those who were not employed at disease onset continued to have low employment rates.

Adolescent↗
PubMed1999

An assessment of the annual and long-term direct costs of rheumatoid arthritis: the impact of poor function and functional decline.

OBJECTIVE: To describe the distribution of direct medical care costs of rheumatoid arthritis (RA) over 1-year and 11-year periods, and to evaluate the impact of poor function and functional decline on direct costs. METHODS: The present study uses data from the University of California, San Francisco, RA Panel Study in which 1,156 persons with RA have been followed up for as long as 15 years through annual structured interviews and periodic updates on severity from rheumatologists. We present annual direct medical care cost data for the years 1995 and 1996 and estimates of cumulative costs for the period 1986-1996 for the 272 persons followed up continuously for this period. RESULTS: Medical care costs for RA averaged $5,919 a year from a societal perspective; persons with RA incur another $2,582 in medical care costs for non-RA reasons. Of the RA total costs, hospital admissions account for more than half. Costs are highly skewed, with the costs in the 90th, 95th, and 100th percentiles totaling $8,209, $31,059, and $85,469 a year, respectively. Cumulative costs for the period 1986-1996 averaged $57,201, with cumulative costs in the 90th, 95th, and 100th percentiles totaling $114,844, $142,563, and $191,540, respectively. Persons with RA in the worst quartile of function experienced total annual direct costs that were 2.55 times as high and total hospital costs that were 6.97 times as high as those in the best (e.g., the first) quartile. Poor baseline functional status and declining functional status had similar, large effects on cumulative medical care costs. CONCLUSION: Medical care costs for RA over 1 year and 1 decade are highly skewed. Persons with RA with poor and declining function experience much higher costs of care.

Arthritis, Rheumatoid↗
PubMed1998

Predictors of rate of return to work after surgery for carpal tunnel syndrome.

OBJECTIVE: To evaluate the impact of patient demographics, clinical features, and job-related factors on the time until return to work after carpal tunnel release surgery. METHODS: We employed a cross-sectional community-based study of 59 patients who had undergone carpal tunnel release surgery. Sociodemographic, clinical, and job-related characteristics and time to return to work were obtained by interview and from medical records. Exposure to ergonomic risk was derived from an independently validated job matrix. Time to return to work after surgery was analyzed by survival techniques. RESULTS: Median time to return to work was 5 weeks. After adjustment, the relative rate (RR) of return to work per week after surgery was most strongly decreased by the receipt of workers' compensation, RR 0.2 (95% confidence interval [CI] 0.1-0.5), and by the exposure to bending and twisting of the hand prior to surgery, RR 0.7 (95% CI 0.5-0.9) per hour. Female gender was another predictor of decreased return to work, RR 0.5 (95% CI 0.3-0.8). CONCLUSIONS: Patients receiving workers' compensation, those exposed to higher levels of bending and twisting of their hands and wrists, and women were slower to return to work after carpal tunnel release surgery.

Adult↗
PubMed1997

The earnings, income, and assets of persons aged 51-61 with and without musculoskeletal conditions.

OBJECTIVE: To describe the personal and family earnings, income, and assets of persons with musculoskeletal conditions. METHODS: This study uses the Health and Retirement Survey, a national, community based probability sample of persons 51-61 years of age and their spouses in 1992 to estimate earnings, income, and assets (by kind) in the years immediately prior to the normal age of retirement. RESULTS: Fifty-nine percent of persons 51-61 years of age (13.76 million) report one or more musculoskeletal condition; of these 38% (8.74 million) also report at least one comorbid condition and 21% (5.02 million) report no such comorbidity. Persons with musculoskeletal conditions and comorbidity report 18% lower family earnings, 15% lower family income, and 35% fewer assets than the average among all persons these ages. Persons with musculoskeletal conditions and no comorbidity have earnings, incomes, and assets closer to the average among their peers. CONCLUSION: Persons with musculoskeletal conditions and comorbidity have lower earnings and incomes now and fewer assets with which to face the future than the remainder of their peers.

Comorbidity↗
PubMed1996

Self-reported carpal tunnel syndrome: predictors of work disability from the National Health Interview Survey Occupational Health Supplement.

The objective of this study was to identify risk factors for work disability among persons with carpal tunnel syndrome (CTS). The study was designed to analyze data from the Occupational Health Supplement of the National Health Interview Survey, a nationwide, population-based survey. Subjects included 544 survey respondents with self-report of CTS and 32,688 survey respondents without CTS, all aged 18-64 years, and with a history of labor force participation. Measurements were as follows: Dependent variables were work disability, defined either as cessation of employment without attribution of cause or, alternatively, as cessation of employment or job change specifically attributed to CTS by the survey respondent. Independent variables were ergonomic risk of work disability, defined by minutes of workplace repetitive hand and wrist bending for the most recent job held. This measure was derived from responses categorized by an occupation and industry matrix independent of CTS status. Socio-demographic and health status risk factors for work disability were based on the respondent report. The main results were as follows: Among 544 persons with CTS, 58 (11%, CI 8-13%) reported work disability specifically attributed to CTS, representing an estimated national prevalence of 240,578 persons with this limitation. Workplace ergonomic risk, measured as repetitive hand or wrist bending in the occupation and industry of last employment, was a significant factor predictive of CTS-attributed work disability (per 120 min of daily exposure, OR 1.7, CI 1.1-2.6), even after taking into account socio-demographic factors and health status. The conclusions were that work disability among persons with CTS is common. For those with CTS, working conditions characterized by repetitive bending of the hand or wrist may increase the risk of work disability associated with this condition.

Adolescent↗
PubMed1996

The impact on unemployment of an intervention to increase recognition of previously untreated anxiety among primary care physicians.

Anxiety is a common, though often unrecognized, problem in primary care settings. This study examines the effect on employment of an intervention designed to attune primary care physicians to previously unrecognized and untreated anxiety. Primary care physicians in a mixed-model health maintenance organization (HMO) were randomized by practice site to groups with (intervention) and without (usual care) intensive one-on-one education about anxiety and periodic feedback about their patients with anxiety. All persons 21-65 years of age presenting to the offices of these primary care providers were screened for anxiety with the SCL-90-R on two occasions. Those meeting the SCL-90-R cutpoints for anxiety and whose medical records provided no evidence of recognition or treatment for a mental health condition within the last 6 months were eligible for the study (n = 637). Of these, 573 (90%) completed two follow-up assessments. The present study evaluates the impact of the intervention aimed at the primary care physicians on the labor force participation rate of the persons with anxiety after 5 months of follow-up. The study also evaluates the impact of the intervention on hours of work and the presence of days spent in bed among the persons with anxiety working at the baseline interview and after 5 months. At baseline, the patients of intervention and usual care physicians with previously unrecognized and untreated anxiety did not differ in labor force participation rates. At the conclusion of the study, the patients of the intervention group physicians had significantly lower rates of labor force participation than those of the usual care group physicians. Among those working both at the beginning and conclusion of the study, the intervention had no impact on hours of work or the presence of days spent in bed. We conclude that attuning physicians may reduce labor force participation rates.

Absenteeism↗
PubMed1996

The costs of rheumatoid arthritis: absolute, incremental, and marginal estimates.

We determined the average medical and indirect costs of rheumatoid arthritis (RA) from clinical and community based samples and compared those costs to those experienced by similar persons without RA. We reviewed the literature and analyzed the UCSF RA Panel Study and the National Health Interview Survey for the years 1989-91. The annual medical care costs of RA ranged from $4,300 to $5,700 in 1994 terms in the clinical samples, with hospital admissions accounting for half to two-thirds of the total. Indirect costs in the clinical samples exceeded direct costs and ranged from just under $10,000 to more than $16,000 a year. Medical care costs of RA are highly skewed, with persons in the 90th percentile experiencing costs more than 100 times as large as those in the 10th. In the national community based sample, the costs of RA amounted to $8.74 billion, of which more than half was due to medical care. In this sample, the increment of costs experienced by persons with RA compared to those without was $3.07 billion, with 80% of the excess the result of indirect costs due to wage losses.

Arthritis, Rheumatoid↗
PubMed1995

Access to medical care among persons with musculoskeletal conditions. A study using a random sample of households in San Mateo County, California.

OBJECTIVE: To study access to medical care services, including subspecialty care, among persons with musculoskeletal conditions. METHODS: In early 1993, a random sample of households in San Mateo County, California, was screened for the presence of household members with musculoskeletal conditions, and a member of each household so identified was administered a structured survey about access to medical care and other related subjects. RESULTS: Eighty-six percent of all persons with a musculoskeletal condition had ever seen at least one physician for the condition, but only 6.5% had ever seen a rheumatologist. Those without health insurance were only 82% as likely as those with health insurance to have ever seen a physician. CONCLUSION: Most persons with a musculoskeletal condition have seen a physician for the condition, but lack of health insurance significantly reduces the proportion who have done so.

Adult↗
PubMed1995

The economic cost and social and psychological impact of musculoskeletal conditions. National Arthritis Data Work Groups.

OBJECTIVE: To provide an indication of the economic, social, and psychological impact of musculoskeletal conditions in the United States. METHODS: Review of the literature combined with estimates of data concerning health care utilization and acute and chronic disability due to musculoskeletal conditions, from the 1990-1992 National Health Interview Survey. RESULTS: The cost of musculoskeletal conditions was $149.4 billion in 1992, of which 48% was due to direct medical care costs and the remainder was due to indirect costs resulting from wage losses. This amount translates to approximately 2.5% of the Gross National Product, a sharp rise since the prior studies, even if part of the increase is an artifact of improved accounting methods. Each year, persons with musculoskeletal conditions make 315 million physician visits, have more than 8 million hospital admissions, and experience approximately 1.5 billion days of restricted activity. Approximately 42% of persons with musculoskeletal conditions--more than 17 million in all--are limited in their activities. CONCLUSION: The economic and social costs of musculoskeletal conditions are substantial. These conditions are responsible for a sizable amount of health care use and disability, and they significantly affect the psychological status of the individuals with the conditions as well as their families.

Activities of Daily Living↗
PubMed1995

Work disability in adults with cystic fibrosis.

Greater numbers of persons with cystic fibrosis (CF) reach adulthood and, therefore, actively participate in the labor force. In this study, we estimated labor force participation rates and determined risk factors for work disability among persons with CF. We recruited 49 (73%) of 67 adults followed at one of two hospital-based CF centers. We ascertained employment history and CF-attributed work disability by structured questionnaire. Independently, we reviewed medical records for demographics and illness severity indicators. We analyzed potential risk factors for work disability by logistic regression analysis. All of those studied reported past or present labor force participation, consistent with high work motivation. Complete cessation of work attributed to CF was reported by 17 (35%; 95% CI, 21 to 49%). Although 23 (47%; 95% CI, 32 to 60%) of those surveyed stated that CF had affected career choice, only nine respondents had ever received career counselling and 16 had ever discussed job choice with their physicians. After adjusting for standard measures of disease severity by multiple logistic regression, age, adult diagnosis of CF, female gender, and single marital status, analyzed as a group, provided significant additional explanatory power to a predictive model of disability risk (model chi square [4 d.f.] = 11.5, p < 0.05). Health care professionals who design interventions targeted at work disability among persons with CF should address demographic factors as well as illness severity and should assess the vocational needs of persons with CF and the potential benefit of career counselling.

Adult↗
PubMed1994

Mortality risk among elderly workers.

We analyzed population-based data for respondents aged 70 and older from the Longitudinal Study on Aging. We compared mortality risk among 358 baseline-year working with 4,373 nonworking respondents. Including other demographic and health status predictors in a multiple logistic regression model, employment remained a significant predictor of survival (mortality odds ratio (OR) = 0.4). Diabetes mellitus was the only factor that displayed a mortality risk that was significantly interactive with work (OR = 3.5). These data suggest that a healthy worker effect persists in older age groups, but that within the working stratum, patterns of risk may differ as compared to those among the nonworking.

Aged↗
PubMed1993

Work disability among adults with asthma.

OBJECTIVE: To estimate the incidence of work disability among adults with asthma and to evaluate a clinically based illness severity score as a predictor of such disability. DESIGN: Baseline and follow-up telephone interviews and medical record review. SETTING: University-based outpatient pulmonary specialty practice. PATIENTS: Fifty-six patients interviewed at baseline; 42 reinterviewed 2 years later. MEASUREMENTS: Work disability ascertained by interview report and defined as change in job duties, reduction in pay, or change in job or employment status attributed to asthma. Severity of asthma score derived from medical records and based on respiratory symptom frequency, asthma history, and prescribed medications. Pulmonary function by routine testing. Logistic regression analysis of the 5-year incidence of work disability on severity score and forced expiratory volume in 1 s (FEV1). RESULTS: The 5-year work disability cumulative incidence was 19 percent for change in duties, 17 percent for reduction in pay, 20 percent for change in job or work status, and 36 percent for any of these measures. The median asthma score was 10 (range, 2 to 26). The mean FEV1 as a percent predicted (FEV1 percent) was 88 +/- 25 percent. Score and FEV1 percent were statistically correlated (r = -0.6, p < 0.0001). Severity of asthma score statistically predicted each measure of work disability (p < 0.01). Addition of FEV1 percent added little additional explanatory power to the logistic regression model (maximum chi 2 = 1.3, p > 0.2). CONCLUSIONS: Work disability is common among adults with asthma. A severity of asthma score based on clinical variables is statistically correlated with lung function but appears to be a stronger predictor of disability than airflow measured at one point in time.

Adolescent↗
PubMed1993

Impact of the American Health Security Act of 1993.

In the months to come, opponents of President Clinton's proposal will focus on issues of choice among physicians and health plans and on estimates of the economic impact of reform. Others will raise the issue of the efficiency of the administrative structures necessary to implement the Act. These important concerns notwithstanding, people with rheumatic diseases stand to gain much from the passage of the American Health Security Act of 1993, principally the knowledge that they always will have insurance, that their out-of-pocket costs will be limited, that they will have access to a standard set of benefits, and that these benefits are more comprehensive than the current Medicare and Medicaid programs and all but a small percentage of private health insurance plans.

Health Care Reform↗
PubMed1992

Health policy and musculoskeletal conditions.

This paper reviews two strains of research within rheumatology relevant to contemporary health policy debates. The first concerns studies of the effectiveness of medical care on outcomes among persons with musculoskeletal conditions; the second, studies of functional status and disability among such persons. The studies of the effectiveness of medical care, largely funded by the Agency for Health Care Policy and Research, are designed to assist in the development of practice guidelines concerning lower back pain, knee replacement, hip disease, and other conditions for use by physicians and other providers as well as third party payers. The studies of functional status and disability in arthritis, largely funded by the National Institute of Arthritis, Musculoskeletal, and Skin Diseases as part of its Multipurpose Arthritis Center Program, are designed to provide measures of outcome for use in studies of medical effectiveness and to assess the societal impacts of musculoskeletal conditions.

Disability Evaluation↗
PubMed1992

Arthritis. The cumulative impact of a common chronic condition.

OBJECTIVE: To document the extent of disability related to arthritis among working-age (18-64-year-old) and elderly (greater than or equal to 70-year-old) individuals. METHODS: Data from the 1970-1987 National Health Interview Surveys were used to determine the prevalence of arthritis-related disability among working-age adults. The Longitudinal Study on Aging was used to determine the prevalence of arthritis-related disability among the elderly. RESULTS: Among working-age persons, 3.734 million men and 5.649 million women reported having arthritis, of whom in excess of 2 million and 3 million, respectively, reported activity limitation (the definition of disability in the National Health Interview Survey). Labor force participation among men with arthritis was approximately 20% lower than among those without arthritis and approximately 25% lower among women with arthritis than among those without. Among elderly individuals, 55% reported having arthritis and, of these, more than three-quarters were limited in a physical activity and more than one-third were limited in an activity of daily living. Moreover, disability rates for persons with arthritis were found to be increasing, even on an age-adjusted basis. CONCLUSION: The impact of arthritis in terms of disability was shown to be high and was probably underestimated, given the high prevalence of the disease among women and elderly persons, and the limitations in the methods used in contemporary social surveys to establish the extent of disability, in these 2 population groups in particular.

Activities of Daily Living↗