Permanent Disability Claims for RA May Rise in Years Following COVID-19 Crisis

The economic impacts caused by the COVID-19 pandemic may lead to a rise in permanent disability claims for patients with rheumatoid arthritis (RA) based on a recent study that found that rates of disability benefit enrollment spiked during periods of economic recessions.

“If similar associations hold for the current economic downturn and unemployment due to the COVID-19 pandemic, we might expect sharp increases in disability claims for RA in the near future,” wrote Michael M. Ward, MD, MPH, chief of clinical trials and outcomes breach at the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the National Institutes of Health.

The study, published in Arthritis Care and Research, is the first US population-based study evaluating the rates of permanent work disability for RA. Additionally, the findings showed that rates of permanent work disability among young and middle-aged workers with RA has remained stable between 1999 and 2015 despite advances in treatment options.

Studies from the 1980s and 1990s have shown that 30% to 50% of employed patients with RA have their conditions progress to require permanent work disability 10 years after receiving an RA diagnosis. Although tumor necrosis factor inhibitors are known to prevent short-term work loss, permanent work disability in RA may depend on severity of joint symptoms and impairment and how physically demanding a patient’s work environment is.

In the United States, Social Security Disability Insurance (SSDI) offers eligible workers with medical conditions deemed unlikely to improve permanent benefits. Recipients are eligible for Medicare insurance after receiving SSDI benefits for 2 years.

Ward collected data from 1999 to 2015 for 100% fee-for-service Medicare inpatient and outpatient administrative claims files. He included information on newly enrolled beneficiaries aged 20 to 59 who enrolled in a Medicare program through SSDI eligibility.

In total, 97,787 beneficiaries with RA enrolled in Medicare via SSDI eligibility, with women making up 75.5% of beneficiaries. The mean age of beneficiaries was 50.1(8.3) years.

In 1999, the rate of enrollment under SSDI was 26 per million people. The Medicare enrollment rate was comparable or higher during each subsequent year, peaking at 40 per million in 2011, which corresponded with the lag between SSDI enrollment and Medicare eligibility after the 2008-2009 recession.

Another yet smaller peak was observed for 2003 and 2004, which Ward suggested may be a consequence of the 2001 recession.

“Our results also highlight the association of disability claims with the national economy, and demonstrate the major role that macro level factors have on what has often been considered a personal decision,” wrote Ward.

After adjusting for rise in unemployment rates in 2009-2012, there was no linear trend in Medicare enrollment among beneficiaries with RA (relative risk [RR], 0.99 annually; 95% CI, 0.99-1.00; P = .69).

Risks of permanent work loss were greater among older patients with RA, with the RR reaching 1.75 (95% CI, 1.63-1.88) for patients aged 20 to 24 years, 20.85 (95% CI, 19.68-21.98) for patients aged 55 to 59 years, and 31.50 (95% CI, 29.66-33.11) for those aged 55 to 59 years.

In the sensitivity analyses, Ward examined a subgroup of beneficiaries with 3 or more claims with RA in their first year in Medicare (n = 75,930) and a subgroup of beneficiaries aged 20 to 39 years (n = 12,564), who potentially could have a greater benefit from novel therapies.

Although the absolute rates in these group were lower than in the overall study group, enrollments rates did not decrease over time, suggesting that stricter inclusion requirements and a large proportion of middle-aged beneficiaries did not impact enrollment decreases that could have been seen over time for young adults.

“These findings raise questions about access to newer treatments, particularly by low income, blue-collar workers who are most at risk for work disability related to RA,” wrote Ward.

Additionally, Ward said that it’s possible that physical health improved over time among workers with RA, but social or psychological influences persisted and led to work disability.

Population-based studies from Sweden and Finland have reported decreases in permanent work disability rates of more than 50% between 1990 and 2010. Ward noted that the differences in results from the United States and Nordic countries could be explained by differences in health care system organization and financing.

Ward identified the lack of availability of data after 2015 as a study limitation. The study also assumed that RA prevalence was stable during the study period.

Reference

Ward MM. Trends in permanent work disability associated with rheumatoid arthritis in the United States, 1999 – 2015. Published online February 5, 2021. Accessed February 26, 2021. doi:10.1002/acr.24575