Spinal cord injury (SCI) and multiple sclerosis (MS) are disabling conditions associated with low employment rates and loss of earnings.
OBJECTIVE:
Quantify the relationships of demographic, educational, and functional characteristics with gainful employment and earnings after SCI or MS.
METHODS:
Participants were adults under age 65 with SCI (n = 1275) or MS (n = 1107) identified through a specialty hospital or a state-based surveillance registry in the southeastern United States. An econometric model of cross-sectional data using a two-step data analytic model examined employment status and earnings. This included one model that was restricted to only those employed (conditional earnings) and another model that included all participants, using $0 earnings for those who were unemployed (unconditional earnings – earnings not conditional upon being employed).
RESULTS:
Diagnosis was not significantly related to employment status. Several functional characteristics were associated with lower odds of employment and higher unconditional earnings (cognition, walking, shopping independently). Higher conditional earnings were reported by those with MS ($16,405) and those without difficulty in cognition ($8,532) and bathing ($20,932). Higher educational attainment was related to probability of employment and greater earnings.
CONCLUSIONS:
Those with SCI and those with several types of functional limitations have lower quality of employment, as measured by earnings. Efforts should be made to enhance quality of employment for those at greatest risk for unemployment and underemployment.
Anderberg,D., Rainer,H., Wadsworth,J., & Wilson,T. (2015). Unemployment and domestic violence: Theory and evidence, The Economic Journal, 126(597), 1947–1979. 10.1111/ecoj.12246
2.
Berkowitz,M., O’Leary,P., Kruse,D. L., & Harvey,C. (1998). An Analysis of Medical and Social Costs. New York: Demos Medical Publishing, Inc.
3.
Cao,Y., Chen,Y., & DeVivo,M. (2011). Lifetime direct costs after spinal cord injury, Topics in Spinal Cord Injury Rehabilitation, 16(4), 10–16. doi: 10.1310/sci1604-10.
4.
Cao,Y., Krause,J. S., Saunders,L. L., & Bingham,W. (2014). Household income and subjective well-being after spinal cord injury: a longitudinal study, Topics in Spinal Cord Injury Rehabilitation, 20(1), 40–47. doi: 10.1310/sci2001-40.
5.
Centers for Medicare and Medicaid Services. (2014). Medicare Health Outcomes Survey (HOS). Retrieved from https://hosonline.org/en/.
6.
De Judicibus,M. A., & McCabe,M. P. (2007). The impact of the financial costs of multiple sclerosis on quality of life, International Journal of Behavioural Medicine, 14(1), 3–11. doi: 10.1080/10705500701316767.
7.
DeLuca,J., & Nocentini,U. (2011). Neuropsychological, medical and rehabilitative management of persons with multiple sclerosis, NeuroRehabilitation, 29(3), 197–219. doi: 10.3233/NRE-2011-0695.
8.
Falvo,D. R. (2014). Medical and psychosocial aspects of chronic illness and disability (5th ed.). Burlington, MA: Jones and Bartlett Publishers, LLC.
9.
Harding,K., Anderson,V., Williams,O., Willis,M., Butterworth,S., Tallantyre,E., & Robertson,N. (2018). A contemporary study of mortality in the multiple sclerosis population of south east Wales, Multiple Sclerosis Related Disorders, 25, 186–191. doi: 10.1016/j.msard.2018.08.001.
10.
Henkel,D. (2011). Unemployment and substance use: A review of the literature, Current Drug Abuse Reviews, 4(1), 4–27. doi: 10.2174/1874473711104010004.
11.
Julian,L. J., Vella,L., Vollmer,T., Hadjimichael,O., & Mohr,D. C. (2008). Employment in multiple sclerosis. Exiting and re-entering the work force, Journal of Neurology, 255(9), 1354–1360. doi: 10.1007/s00415-008-0910-y.
12.
Krause,J. S., Dismuke-Greer,C. E., Jarnecke,M., Li,C., Reed,K. S., & Rumrill,P., (2018a). Employment and gainful earnings among those with multiple sclerosis, Archives of Physical and Medical Rehabilitation. doi: 10.1016/j.apmr.2018.11.005.
13.
Krause,J. S., Dismuke-Greer,C. E., Jarnecke,M., & Reed,K. S. (2019). Differential odds of employment and estimation of earnings among those with spinal cord injury. Rehabilitation Counseling Bulletin, first published online 13 May 2019, doi: 10.1177/0034355219848493
14.
Krause,J. S., & Reed,K. S. (2009). Obtaining employment after spinal cord injury: Relationship with pre- and post-injury education, Rehabilitation Counseling Bulletin, 53, 27–33. doi: 10.1177/0034355208329443.
15.
Krause,J. S., Rumrill,P., Dismuke-Greer,C. E., & Jarnecke,M., (2018b). Quality employment outcomes after multiple sclerosis: A comparison of participants from a specialty hospital and the National MS Society, Journal of Vocational Rehabilitation, 48(2), 177–186. doi: 10.3233/JVR-180931.
16.
Krause,J. S., Saunders,L. L., & Acuna,J. (2012). Gainful employment and risk of mortality after spinal cord injury: effects beyond that of demographic, injury and socioeconomic factors, Spinal Cord, 50, 784–788. doi: 10.1038/sc.2012.49.
17.
Krause,J. S., Saunders,L. L., & DeVivo,M. J. (2011). Income and risk of mortality after spinal cord injury, Archives of Physical and Medical Rehabilitation, 92(3), 339–345. doi: 10.1016/j.apmr.2010.09.032.
18.
Krause,J. S., & Terza,J. V. (2006). Injury and demographic factors predictive of disparities in earnings after spinal cord injury, Archives of Physical and Medical Rehabilitation, 87(10), 1318–1326. doi: 10.1016/j.apmr.2006.07.254.
19.
Krause,J. S., Terza,J. V., & Dismuke,C. (2008). Earnings among people with spinal cord injury, Archives of Physical Medicine and Rehabilitation, 89(8), 1474–1481. doi: 10.1016/j.apmr.2007.12.040.
20.
Krause,J. S., Terza,J. V., Erten,M., Focht,K. L., & Dismuke,C. E. (2012). Prediction of postinjury employment and percentage of time worked after spinal cord injury, Archives of Physical Medicine and Rehabilitation, 93(2), 373–375. doi: 10.1016/j.apmr.2011.09.006.
21.
Krause,J. S., Terza,J. V., Saunders,L. L., & Dismuke,C. E. (2010). Delayed entry into employment after spinal cord injury: factors related to time to first job, Spinal Cord, 48(6), 487–491. doi: 10.1038/sc.2009.157.
22.
McClelland,A. (2000). Effects of unemployment on the family, The Economic and Labour Relations Review, 11(2), 198–212. doi: 10.1177/103530460001100204.
23.
Meade,M., Reed,K. S., Rumrill,P., Aust,R., & Krause,J. S. (2016). Perceptions of quality of employment outcomes after multiple sclerosis: A qualitative study, Journal of Rehabilitation, 82(2), 31–40.
24.
Meade,M. A., Reed,K. S., Saunders,L. L., & Krause,J. S. (2015). It’s all of the above: Benefits of working for individuals with spinal cord injury, Topics in Spinal Cord Injury Rehabilitation, 21(1), 1–9. doi: 10.1310/sci2101-1.
25.
Mood,C., & Jonsson,J. O. (2016). The social consequences of poverty: An empirical test on longitudinal data, Social Indicators Research, 127, 633–652. doi: 10.1007/s11205-015-0983-9.
26.
Moore,P., Harding,K. E., Clarkson,H., Pickersgill,T. P., Wardle,M., & Robertson,N. P. (2013). Demographic and clinical factors associated with changes in employment in multiple sclerosis, Multiple Sclerosis, 19(12), 1647–1654. doi: 10.1177/1352458513481396.
27.
Naci,H., Fleurence,R., Birt,J., & Duhig,A. (2010). Economic burden of multiple sclerosis: a systematic review of the literature, Pharmacoeconomics, 28(5), 363–379. doi: 10.2165/11532230-000000000-00000.
28.
Ottomanelli,L., & Lind,L. (2009). Review of critical factors related to employment after spinal cord injury: Implications for research and vocational services, Journal of Spinal Cord Medicine, 32(5), 503–531. doi: 10.1080/10790268.2009.11754553.
29.
Ramakrishnan,K., Loh,S. Y., & Omar,Z. (2011). Earnings among people with spinal cord injury, Spinal Cord, 49(9), 986–989. doi: 10.1038/sc.2011.47.
30.
Roessler,R. T., Rumrill,P. D., Li,J., & Leslie,M. J. (2015). Predictors of differential employment statuses of adults with multiple sclerosis, Journal of Vocational Rehabilitation, 42(2), 141–152. doi: 10.3233/JVR-150731.
31.
Schiavolin,S., Leonardi,M., Giovannetti,A. M., Antozzi,C., Brambilla,L., Confalonieri,P., ... & Raggi,A. (2013). Factors related to difficulties with employment in patients with multiple sclerosis: A review of 2002–2011 literature, International Journal of Rehabilitation Research, 36(2), 105–111. doi: 10.1097/MRR.0b013e32835c79ea.
Wang,R. Y., Yang,Y. R., Yen,L. L., & Lieu,F. K. (2002). Functional ability, perceived exertion and employment of the individuals with spinal cord lesion in Taiwan, Spinal Cord, 40, 69–76. doi: 10.1038/sj.sc.3101257.
Young,A. E., & Murphy,G. C. (2009). Employment status after spinal cord injury (1992–2005): A review with implications for interpretation, evaluation, further research, and clinical practice, International Journal of Rehabilitation Research, 32(1), 1–11. doi: 10.1097/MRR.0b013e32831c8b19.
