# The association between unemployment and treatment among adults with hemophilia

## TL;DR

This study finds that prophylactic treatment for hemophilia reduces the risk of unemployment due to disability, improving quality of life.

## Contribution

The study identifies prophylactic treatment as a key factor in reducing unemployment among adults with hemophilia.

## Key findings

- Prophylactic treatment was associated with decreased odds of unemployment due to disability.
- Severe hemophilia, age, smoking, and psychiatric disorders increased the risk of unemployment.
- Maintaining factor levels above 3%-5% through prophylaxis could help avoid disability-related unemployment.

## Abstract

People with hemophilia often experience pain and suffer from comorbidities related to their bleeding disorder. Consequently, unemployment due to disability is prevalent among people with hemophilia.

To explore associations between unemployment due to disability and treatment while adjusting for known risk factors for unemployment.

Collecting data from 20 hemophilia centers from 15 European countries, the Age-related DeVelopments ANd ComorbiditiEs in hemophilia study recruited 785 participants aged 40 years and over with hemophilia A or B. A comprehensive electronic case report form included items related to patient characteristics, demographic information, past and current treatment regimens, and medical history, including a lifelong history of comorbidities. Baseline data from the Age-related DeVelopments ANd ComorbiditiEs in hemophilia study was analyzed using descriptive statistics and logistic regression models.

Employment status was available for 756 of 785 participants aged 40 to 88 years (median, 53 years). We used regression analysis to compare people with hemophilia who were fully employed with those who were unemployed due to disability. This analysis included 424 participants. Using multivariable logistic regression, we found that age (odds ratio [OR], 1.07; P < .01), severe hemophilia (OR, 10.81; P < .01), current smoker (OR, 2.53; P < .01), and psychiatric disorder (OR, 4.18; P = .02) were associated with increased odds of unemployment due to disability. In contrast, prophylactic treatment (OR, 0.44; P = .01) was associated with decreased odds.

Our analysis suggests that by maintaining factor levels above a critical threshold (3%-5%), prophylactic treatment for people with hemophilia could help avoid unemployment due to disability. While prophylaxis is more costly and can be burdensome, the benefits to material well-being and quality of life could be substantial.

•Unemployment is more prevalent for adults with hemophilia than for adults without disabilities.•The study recruited 785 people with hemophilia A or B from 15 European countries.•Prophylactic replacement therapy was negatively associated with unemployment due to disability.•We recommend prophylactic rather than on-demand treatment to always ensure adequate factor levels.

Unemployment is more prevalent for adults with hemophilia than for adults without disabilities.

The study recruited 785 people with hemophilia A or B from 15 European countries.

Prophylactic replacement therapy was negatively associated with unemployment due to disability.

We recommend prophylactic rather than on-demand treatment to always ensure adequate factor levels.