Download Impact of chronic disease on premature medical disablement

Impact of chronic disease on
premature medical disablement
•  Dr Ki DOUGLAS MBBS MPH MEL GDipOHS FAFOEM
Adjunct Associate Professor QUT
Consultant Occupational Physician
Chronic disease & premature medical
disablement
•  What are common chronic diseases?
•  What effect do they have on
–  Physical function
–  Cognitive function
–  Work capacity
•  Case studies
Common chronic diseases
•  Depression + anxiety
•  Musculoskeletal disorders eg adhesive capsulitis, LBP
•  Diabetes and its complications
•  Other
–  inflammatory bowel disease/arthritis
–  heart disease
–  multiple sclerosis
Diabetes fast facts
•  Prevalence of Type 2 diabetes 3 – 10% in Qld
•  Lifetime risk: 40% men, 37% women
•  Risk with obesity/ age/ lower SES:
–  age 45 years - 7.1%
–  age 55 years -13.1%
–  Age 65 years – 19.2%
•  1 million Australian with diabetes by 2025
Magliano DJ et al Diabetologica 2008
Diabetes
•  Cognitive function with high BSL
–  Slowed information processing
–  Poor working memory
•  Longer term risk of dementia
•  Other complications affecting work
Metabolic syndrome
•  19% of people > 25 yrs old
•  Central adiposity
triglycerides, BP, BSL
Diabetes, heart disease, sleep apnoea
•  OSA
attention, vigilance, working memory,
planning, problem solving
Frozen shoulder (adhesive capsulitis)
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Age 40 – 70 years
2 – 5% of population (10-20% in diabetics)
Females > males
Pain, “freeze”, “thaw”
Most but NOT all get better within 18 months
Affects posture, reach, lifting, sustained upper arm
activities
Inflammatory bowel disease
•  Ulcerative colitis, Crohn’s disease
•  Complications
uveitis (eyes)
arthritis
bowel cancer risk
•  Fatigue secondary to disease, side effects Rx
AIHW h'p://www.aihw.gov.au/cancer/ Multiple sclerosis
•  0.1% of population (60/100,000)
•  Relapsing/remitting: onset 25 – 29 yrs
•  Secondary progressive: onset 40 – 44 yrs
•  Fatigue/depression
•  Cognitive dysfunction (recent memory, speed of
processing, attention, abstract conceptualisation)
Estimated 10 most commonly diagnosed
cancers, Australia, 2012
Estimated age-specific incidence rates for all cancers
combined, Australia, 2012
AIHW h'p://www.aihw.gov.au/cancer/ Cancer facts: 45 – 64 yr age cohort
Cancer Breast Prostate Bowel Incidence (new cases diagnosed) 1.1% 1.3% 0.3% Prevalence (people with condi7on) 4.7% 4.6% 1.1% Qld Cancer Stats Online -­‐ QCSOL Risk score calculator
www.roswellpark.org/apps/prostate_cancer_estimator/
•  Age:
•  Gleason Score:
51 years old
9
•  Lead Time: 0 years (picked up on screening)
•  Quartile of Health:
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•  Life Expectancy:
Healthy (Middle 25-75%)
10.7years
•  Death Risk of Prostate Cancer: 73.70%
Depression & mental health
•  20% of 16 – 85 yr olds have mental health disorder
(AIHW 2006)
•  Newer drugs – but still side effects affect cognition
•  How much is due to perceived workplace stressors?
Preventable job stress costs $730M a year –
Uni Melbourne VicHealth report
Job strain is related to
•  17 per cent of depression in working women
•  13 per cent of depression in working men.
Finnish Health 2000 study
Sinokki et al JOEM 2010; 52 (733 -739)
Odds ra7o Odds ra7o adjusted for health behaviour Low support 1.44 1.71 High support 1.0 1.0 Low social support from supervisors predicts subsequent disability pension Long term sick leave – Norway
Aagstedt et al JOEM 56(8) 2014
•  Risk factors:
–  >55 years age, female, high school only
Psychosocial risk factors increase the risk
–  High role conflict 5.8 x risk
–  High emotional demands 6.7 x risk
–  Low supportive leadership 7.3 x risk
–  High job strain 7.9 x risk
–  Low job control 7.7 x risk
Comorbidities count: 45 – 64 yrs cohort
Schofield at al 2013 PLOS
Health condi7ons In workforce 0 1 2 3 4 + 83% 71% 62% 49% 34% Not working due to ill health 0% 6% 10% 19% 31% Case studies – group work
•  Inflammatory bowel disease
•  Diabetes
•  Degenerative disc disease
Questions?
•  Discussion - what issues does the insurer need to
consider
–  At the time of risk assessing policy ?
–  At the time that the person becomes ill ?