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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) • • • • • • 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: • • 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 ?