Edward H. Yelin

Correlates of fatigue in older adults with rheumatoid arthritis.

The purposes of this study were to describe the prevalence of fatigue, examine the association between fatigue and doctor visits, and identify correlates of fatigue in rheumatoid arthritis (RA). On average, a high degree of fatigue was reported to occur every day, to remain constant during the course of a week, and to most often affect walking and household chores. When controlling for disease severity and insurance coverage, respondents who reported more fatigue made more visits to the rheumatologist than those reporting less fatigue. A regression model with fatigue as the dependent variable revealed that the following variables explained a significant amount of variance: pain rating, functional status, sleep quality, female gender, comorbid conditions, and duration of disease.

Work Disability in Rheumatoid Arthritis: Effects of Disease, Social, and Work Factors

We explore here the relative contribution of selected disease, social, and work-related factors to disability status in a population of persons with rheumatoid arthritis. Our study differs from previous studies in that it is limited to one diagnostic entity, yet at the same time evaluates a broad range of social and work-related factors in disability. One hundred-eighty persons with rheumatoid arthritis sampled from 19 socially diverse practice settings were given a structured survey about their medical and work histories and social backgrounds. We found significant effects of stage and duration of illness on continued employment but no positive effect of selected therapies. Social and work factors combined had a far larger effect on work disability than all disease factors. Among work factors, control over the pace and activities of work and self-employment status had the greatest effect on continued employment, suggesting that time control issues are crucial to the maintenance of ones job after onset of this illness.

The occupational burden of chronic obstructive pulmonary disease

Although chronic obstructive pulmonary disease (COPD) is attributed predominantly to tobacco smoke, occupational exposures are also suspected risk factors for COPD. Estimating the proportion of COPD attributable to occupation is thus an important public health need. A randomly selected sample of 2,061 US residents aged 55–75 yrs completed telephone interviews covering respiratory health, general health status and occupational history. Occupational exposure during the longest-held job was determined by self-reported exposure to vapours, gas, dust or fumes and through a job exposure matrix. COPD was defined by self-reported physicians diagnosis. After adjusting for smoking status and demography, the odds ratio for COPD related to self-reported occupational exposure was 2.0 (95% confidence interval (CI) 1.6–2.5), resulting in an adjusted population attributable risk (PAR) of 20% (95% CI 13–27%). The adjusted odds ratio based on the job exposure matrix was 1.6 (95% CI 1.1–2.5) for high and 1.4 (95% CI 1.1–1.9) for intermediate probability of occupational dust exposure; the associated PAR was 9% (95% CI 3–15%). A narrower definition of COPD, excluding chronic bronchitis, was associated with a PAR based on reported occupational exposure of 31% (95% CI 19–41%). Past occupational exposures significantly increased the likelihood of chronic obstructive pulmonary disease, independent of the effects of smoking. Given that one in five cases of chronic obstructive pulmonary disease may be attributable to occupational exposures, clinicians and health policy-makers should address this potential avenue of chronic obstructive pulmonary disease causation and its prevention.

An assessment of the annual and long‐term direct costs of rheumatoid arthritis: The impact of poor function and functional decline

OBJECTIVE To describe the distribution of direct medical care costs of rheumatoid arthritis (RA) over 1-year and 11-year periods, and to evaluate the impact of poor function and functional decline on direct costs. METHODS The present study uses data from the University of California, San Francisco, RA Panel Study in which 1,156 persons with RA have been followed up for as long as 15 years through annual structured interviews and periodic updates on severity from rheumatologists. We present annual direct medical care cost data for the years 1995 and 1996 and estimates of cumulative costs for the period 1986-1996 for the 272 persons followed up continuously for this period. RESULTS Medical care costs for RA averaged

Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary disease.

5,919 a year from a societal perspective; persons with RA incur another

The work impact of asthma and rhinitis: Findings from a population-based survey

2,582 in medical care costs for non-RA reasons. Of the RA total costs, hospital admissions account for more than half. Costs are highly skewed, with the costs in the 90th, 95th, and 100th percentiles totaling

Effects of Asthma Education on Children's Use of Acute Care Services: A Meta-analysis

8,209,

Influence of anxiety on health outcomes in COPD

31,059, and

COPD as a systemic disease: impact on physical functional limitations.

85,469 a year, respectively. Cumulative costs for the period 1986-1996 averaged

Cancer risk in systemic lupus: An updated international multi-centre cohort study

57,201, with cumulative costs in the 90th, 95th, and 100th percentiles totaling