Unemployment in chronic airflow obstruction around the world: Results from the BOLD study

Objectives: We aimed to examine associations between chronic airflow obstruction (CAO) and unemployment across the world. Methods: Cross-sectional data from 26 sites in the Burden of Obstructive Lung Disease (BOLD) Study were used to analyze effects of CAO on unemployment. Odds ratios (OR) for unemployment in subjects 40-65 years old were estimated with multilevel mixed-effects generalized linear model with study site as random effect. Site-by-site heterogeneity was assessed using individual participant data meta-analyses. Results: Of 18710 participants, 11.3% had CAO. Ratio of unemployed subjects with CAO divided by subjects without CAO showed large site discrepancies, though these were no longer significant after adjusting for age, sex, smoking and education. Site-adjusted OR for unemployment (95%CI) was 1.79 (1.41, 2.27) for CAO cases, decreasing to 1.43 (1.14, 1.79) after adjusting for sociodemographic factors, comorbidities and forced vital capacity. Of other covariates that were associated with unemployment, age and education were important risk factors in high-income sites (OR (95%CI) 4.02 (3.53, 4.57) and 3.86 (2.80, 5.30) respectively), while female gender was important in low-to-middle-income sites (OR 3.23 (2.66, 3.91)). Conclusions: In the global BOLD study, CAO was associated with increased levels of unemployment, even after adjusting for sociodemographic factors, comorbidities and lung function.