Predictors of delayed return to work or job loss with respiratory ill-health: a systematic review

Every year approximately 17,000 people in the UK are off work through sickness for six or more weeks. Only fifty percent of those off for six months return to work. Methods: A systematic review was conducted to identify potential risk factors for non-return to work within six to 26 weeks or job loss in adult workers with respiratory ill-health. Twelve databases, citation and author lists and cited references were searched. All abstracts and papers were double read and quality assessed. Main outcome measures were return to work and employment status. Results: Five studies of variable methodological quality were identified, all focussing on asthma, occupationally induced or not, with two single studies also covering chronic obstructive pulmonary disease or rhinitis. In the single study of a general working population, blue collar workers having either asthma or chronic obstructive pulmonary disease, were from two to six times less likely to return to work quickly compared with office workers. Overall, unemployment was high with becoming unemployed three times higher in those with all forms of asthma compared with rhinitis. Also, in those with occupational asthma, job loss was more likely if working in smaller companies and being less well educated. Conclusions: Evidence on predictors for non-return to work or job loss with respiratory ill-health in a general working population is limited. Yet without an understanding of these, interventions to reduce the further step to long term disability cannot be designed and implemented