ARP lecturer describes link between employment, poverty, and rheumatic diseases

Musculoskeletal conditions, particularly rheumatic diseases like rheumatoid arthritis and lupus, are among the most common causes of employment problems, according to health services researcher Edward H. Yelin, PhD, who delivered this year’s ARP Distinguished Lecture on Sunday, Nov. 7.

Dr. Yelin’s lecture, Keeping What You Have and Gaining What You Have Lost: Employment, Poverty and the Rheumatic Diseases, can be viewed by registered meeting participants through March 11, 2022.

“A lot of my research and career has been devoted to the question, ‘Are you poor because you are sick or sick because you are poor?’ Like most social scientists, I can’t make a good choice and answer ‘yes’ to both,” said Dr. Yelin, the Edward A. Dickson Professor Emeritus of Medicine and Health Policy at the University of California, San Francisco.

For most Americans, maintaining employment is the best — but not a certain — way of avoiding poverty, he said. And among chronic diseases, musculoskeletal conditions are some of the most common causes of work loss.

In one study that analyzed the effect of rheumatic conditions on employment, 40% of people diagnosed with rheumatoid arthritis were out of the workforce within 10 years of their diagnosis, and two-thirds were no longer employed 15 years after diagnosis. The results were similar for lupus patients, said Dr. Yelin, noting that the onset of lupus usually occurs when patients are in their 20s and 30s, the prime of their careers.

Dr. Yelin also discussed the effect of poverty on health outcomes. It’s well established that rates of morbidity, disability, and mortality are higher among the poor, he said. In his own research, Dr. Yelin has found that healthcare access and utilization, doctor-patient communication, quality of care, and health outcomes are affected by patient traits. Health outcomes are also affected by where that patient lives (areas of high poverty vs. low poverty), he said.

“Public policy to ensure access to employment through macroeconomic policy and workplace accommodation, and to alleviate poverty, are essential to the welfare of persons with rheumatic diseases,” Dr. Yelin said.