Background Delayed return to work is common after acute respiratory distress syndrome (ARDS), but has undergone little detailed evaluation. We examined factors associated with the timing of return to work after ARDS, along with lost earnings and shifts in healthcare coverage.
Methods Five-year, multisite prospective, longitudinal cohort study of 138 2-year ARDS survivors hospitalised between 2004 and 2007. Employment and healthcare coverage were collected via structured interview. Predictors of time to return to work were evaluated using Fine and Grey regression analysis. Lost earnings were estimated using Bureau of Labor Statistics data.
Results Sixty-seven (49%) of the 138 2-year survivors were employed prior to ARDS. Among 64 5-year survivors, 20 (31%) never returned to work across 5-year follow-up. Predictors of delayed return to work (HR (95% CI)) included baseline Charlson Comorbidity Index (0.77 (0.59 to 0.99) per point; p=0.04), mechanical ventilation duration (0.67 (0.55 to 0.82) per day up to 5 days; p<0.001) and discharge to a healthcare facility (0.49 (0.26 to 0.93); p=0.03). Forty-nine of 64 (77%) 5-year survivors incurred lost earnings, with average (SD) losses ranging from US$38 354 (21,533) to US$43 510 (25,753) per person per year. Jobless, non-retired survivors experienced a 33% decrease in private health insurance and concomitant 37% rise in government-funded coverage.
Conclusions Across 5-year follow-up, nearly one-third of previously employed ARDS survivors never returned to work. Delayed return to work was associated with patient-related and intensive care unit/hospital-related factors, substantial lost earnings and a marked rise in government-funded healthcare coverage. These important consequences emphasise the need to design and evaluate vocation-based interventions to assist ARDS survivors return to work.
- return to work
- acute respiratory distress syndrome
- critical illness
- intensive care unit
- health insurance
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Contributors DMN and BBK: contributed to conception and design of the manuscript; are responsible for the overall content as guarantors; and affirm that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned have been explained. BBK, KAS, RKL, VDD, EC, TMvW and DMN: contributed to analysis and interpretation of data. BBK: drafted the manuscript and all other authors critically revised it for important intellectual content. All authors: gave final approval of the manuscript version to be published.
Funding BBK is supported by a grant through the UCLA Clinical Translational Research Institute (CTSI) and the National Institutes of Health/National Center for Advancing Translational Sciences (UL1TR000124&UL1TR001881). This research was supported by the National Institutes of Health (P050HL73994, R01HL088045, and K24HL088551), along with the Johns Hopkins Institute for Clinical and Translational Research (ICTR) (UL1 TR 000424)06).
Competing interests None declared.
Ethics approval The University’s Institutional Review Boards of all participating sites approved this study.
Provenance and peer review Not commissioned; externally peer reviewed.
Correction notice This article has been corrected since it was published Online First. The ’Trial registration number' has been removed from the abstract. This is an observational study and not linked to a clinical trial.
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