Impact of chronic disease on premature medical disablement

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1 Impact of chronic disease on premature medical disablement Dr Ki DOUGLAS MBBS MPH MEL GDipOHS FAFOEM Adjunct Associate Professor QUT Consultant Occupational Physician

2 Chronic disease & premature medical disablement What are common chronic diseases? What effect do they have on Physical function Cognitive function Work capacity Case studies

3 Common chronic diseases Depression + anxiety Musculoskeletal disorders eg adhesive capsulitis, LBP Diabetes and its complications Other inflammatory bowel disease/arthritis heart disease multiple sclerosis

4 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

5 Diabetes Cognitive function with high BSL Slowed information processing Poor working memory Longer term risk of dementia Other complications affecting work

6 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

7 Frozen shoulder (adhesive capsulitis) Age 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

8 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://

9 Multiple sclerosis 0.1% of population (60/100,000) Relapsing/remitting: onset yrs Secondary progressive: onset yrs Fatigue/depression Cognitive dysfunction (recent memory, speed of processing, attention, abstract conceptualisation)

10 Estimated 10 most commonly diagnosed cancers, Australia, 2012

11 Estimated age-specific incidence rates for all cancers combined, Australia, 2012 AIHW h'p://

12 Cancer facts: yr age cohort Cancer Incidence (new cases diagnosed) Prevalence (people with condi7on) Breast 1.1% 4.7% Prostate 1.3% 4.6% Bowel 0.3% 1.1% Qld Cancer Stats Online - QCSOL

13 Risk score calculator Age: 51 years old Gleason Score: 9 Lead Time: 0 years (picked up on screening) Quartile of Health: Healthy (Middle 25-75%) Life Expectancy: 10.7years Death Risk of Prostate Cancer: 73.70%

14 Depression & mental health 20% of yr olds have mental health disorder (AIHW 2006) Newer drugs but still side effects affect cognition How much is due to perceived workplace stressors?

15 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.

16 Finnish Health 2000 study Sinokki et al JOEM 2010; 52 ( ) Odds ra7o Odds ra7o adjusted for health behaviour Low support High support Low social support from supervisors predicts subsequent disability pension

17 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

18 Comorbidities count: yrs cohort Health condi7ons In workforce Schofield at al 2013 PLOS Not working due to ill health 0 83% 0% 1 71% 6% 2 62% 10% 3 49% 19% % 31%

19 Case studies group work Inflammatory bowel disease Diabetes Degenerative disc disease

20 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?

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