Why was this study done?
As they transition into the working world, young adults with a rheumatic disease (such as juvenile arthritis, lupus or rheumatoid arthritis) experience more difficulty finding stable work than young adults without a health condition. What’s more, persistent symptoms such as pain and fatigue, which affect about one in three young adults with rheumatic disease, can lead to more job disruptions and impact the indirect pathways to better health (often referred to as the social determinants of health).
Past studies aimed at improving the work participation of young adults with rheumatic disease have focused on access to clinical care—not as much on adapting working conditions.
This study set out to better understand the association of two specific working conditions with rheumatic symptoms: work activity limitations and job insecurity.
Work activity limitations refer to long-standing limitations in performing usual work activities due to health problems or disabilities. These limitations have been found in other research to be linked to greater employment challenges for people with rheumatic diseases.
As for job insecurity, its association with physical and mental health outcomes has been examined in research of the general working population. No studies to date have been conducted on job insecurity in young adults with rheumatic disease.
How was the study done?
This longitudinal (or follow-up) study was based on an online survey, administered three times over 27 months, from December 2019 to March 2022.
The research team took a purposive recruitment approach as young adults with rheumatic disease are a challenging population to recruit for survey-based research. To address the challenges, the team worked with specialty clinics in British Columbia, Ontario and Quebec, a research firm and patient-led community organizations to recruit a nationally representative sample. In the end, the team recruited 124 young adults with rheumatic disease; their average age was 29 years.
To measure rheumatic disease symptoms, the survey asked participants to report pain, fatigue and disease activity.
To measure work activity limitations, the survey used the Workplace Activity Limitations Scale (WALS). Designed to capture aspects of the work environment that may create challenges for people living with rheumatic disease, WALS measures respondents’ difficulties with 12 workplace activities.
To measure job insecurity, the survey asked a single question from the Copenhagen Psychosocial Questionnaire: Are you worried about becoming unemployed or losing your job?
In the study, the researchers identified two groups of people, those with persistently high symptom scores (that is, they were present across all three surveys) and those with persistently low symptoms. They analyzed the extent to which job insecurity and work limitations were related to whether individuals were in the persistently high or low symptom group.
What did the researchers find?
Participants in the sample reported a high degree of work activity limitations. Over a third of participants also reported job insecurity (36 per cent). Participants also indicated, on average, moderate pain, fatigue and disease activity.
Each increase in work activity limitations was associated with an increase in the risk of persistently experiencing high pain and fatigue levels.
Job insecurity was associated with a 14 per cent increase in the risk of experiencing persistently high pain and a 11 per cent increase in experiencing persistently high disease activity. No statistically significant link was found between job insecurity and persistent fatigue.
The direction of the association could not be inferred with this study design. That is, while it may be possible that work activity limitations or job insecurity worsened rheumatic disease symptoms, it may also be possible that study participants experienced more work activity limitation or job insecurity due to their symptoms.
What are the implications of the study?
Rheumatic disease symptoms such as pain and disease activity are complex and interact with a constellation of biopsychosocial and contextual factors. This study of work activity limitations and job insecurity brings to light potentially important factors that may exacerbate, or be exacerbated by, rheumatic disease symptoms.
For young people with rheumatic disease, the workplace and labour market conditions in which they work as they enter the workforce can provide a foundation for longer-term employment engagement and health. Understanding how these conditions and rheumatic disease symptoms are linked can point the way to policies to better support their work and health outcomes.
What are some strengths and weaknesses of the study?
This research study is among the first to examine the relationship between working conditions and rheumatic disease symptoms, over time, in a cohort of young adults. Young adults with rheumatic disease are difficult to recruit in community-based studies of employment, and this study was one of the largest of its kind.
A strength was its use of a job insecurity measure that had been validated in the general working population. Another strength was the study’s sample, which reflected the female/male breakdown of young people with rheumatic disease in previous population-level research.
A weakness of the study was its sample size, which did not allow for a more detailed picture of disease symptom trajectories over time. More research is needed to expand on the personal, psychosocial, and contextual factors that can explain the relationship between working conditions and health in young adults with rheumatic disease.