Impact of mRNA vaccines in curtailing SARS-CoV-2 infection and disability leave utilisation among healthcare workers during the COVID-19 pandemic: cross-sectional analysis from a tertiary healthcare system in the Greater Houston metropolitan area

ObjectivesWe provide an account of real-world effectiveness of COVID-19 vaccines among healthcare workers (HCWs) at a tertiary healthcare system and report trends in SARS-CoV-2 infections and subsequent utilisation of COVID-19-specific short-term disability leave (STDL).DesignCross-sectional study.Setting and participantsSummary data on 27 291 employees at a tertiary healthcare system in the Greater Houston metropolitan area between 15 December 2020 and 5 June 2021. The initial 12-week vaccination programme period (15 December 2020 to 6 March 2021) was defined as a rapid roll-out phase.Main outcomes and measuresAt the pandemic onset, HCW testing and surveillance was conducted where SARS-CoV-2-positive HCWs were offered STDL. Deidentified summary data of SARS-CoV-2 infections and STDL utilisation among HCWs were analysed. Prevaccination and postvaccination trends in SARS-CoV-2 positivity and STDL utilisation rates were evaluated.ResultsUpdated for 5 June 2021, 98.2% (n=26 791) of employees received a full or partial dose of one of the approved mRNA COVID-19 vaccines. The vaccination rate during the rapid roll-out phase was approximately 3700 doses/7 days. The overall mean weekly SARS-CoV-2 positivity rates among HCWs were significantly lower following vaccine roll-out (2.4%), compared with prevaccination period (11.8%, p<0.001). An accompanying 69.8% decline in STDL utilisation was also observed (315 to 95 weekly leaves). During the rapid roll-out phase, SARS-CoV-2 positivity rate among Houston Methodist HCWs declined by 84.3% (8.9% to 1.4% positivity rate), compared with a 54.7% (12.8% to 5.8% positivity rate) decline in the Houston metropolitan area.ConclusionDespite limited generalisability of regional hospital-based studies—where factors such as the emergence of viral variants and population-level vaccine penetrance may differ—accounts of robust HCW vaccination programmes provide important guidance for sustaining a critical resource to provide safe and effective care for patients with and without COVID-19 across healthcare systems.

Relationship of Cisplatin-Related Adverse Health Outcomes With Disability and Unemployment Among Testicular Cancer Survivors

Background Few data exist on the relationship of cisplatin-related adverse health outcomes (AHOs) with disability, unemployment, and self-reported health (SRH) among testicular cancer survivors (TCS). Methods A total of 1815 TCS at least 1 year postchemotherapy underwent clinical examination and completed questionnaires. Treatment data were abstracted from medical records. A cumulative burden of morbidity score (CBMPt) encompassed the number and severity of platinum-related AHOs (peripheral sensory neuropathy [PSN], hearing loss, tinnitus, renal disease). Multivariable regression assessed the association of AHOs and CBMPt with employment status and SRH, adjusting for sociodemographic and clinical characteristics. Unemployment was compared with a male normative population of similar age, race, and ethnicity. Results Almost 1 in 10 TCS was out of work (2.4%, disability leave; 6.8%, unemployed) at a median age of 37 years (median follow-up = 4 years). PSN (odds ratio [OR] = 2.89, 95% confidence interval [CI] = 1.01 to 8.26, grade 3 vs 0, P = .048), renal dysfunction defined by estimated glomerular filtration rate (OR = 12.1, 95% CI = 2.06 to 70.8, grade 2 vs 0, P = .01), pain (OR = 10.6, 95% CI = 4.40 to 25.40, grade 2 or 3 vs 0, P &lt; .001), and CBMPt (OR = 1.46, 95% CI = 1.03 to 2.08, P = .03) were associated with disability leave; pain strongly correlated with PSN (r2 = 0.40, P &lt; .001). Statistically significantly higher percentages of TCS were unemployed vs population norms (age-adjusted OR = 2.67, 95% CI = 2.49 to 3.02, P &lt; .001). PSN (OR = 2.44, 95% CI = 1.28 to 4.62, grade 3 vs 0, P = .006), patient-reported hearing loss (OR = 1.82, 95% CI = 1.04 to 3.17, grade 2 or 3 vs 0, P = .04), and pain (OR = 3.75, 95% CI = 2.06 to 6.81, grade 2 or 3 vs 0, P &lt; .001) were associated with unemployment. Increasing severity of most cisplatin-related AHOs and pain were associated with statistically significantly worse SRH. Conclusions Our findings have important implications regarding treatment-associated productivity losses and socioeconomic costs in this young population. Survivorship care strategies should include inquiries about disability and unemployment status, with efforts made to assist affected TCS in returning to the workforce.

Predictors of Duration of Injury-Related Disability Leave

Background: Medical leave due to workplace injury is common in the US workforce and creates significant financial drain on the economy. Although there are abundant data relating the duration of medical leave to specific injuries, there is a paucity of research correlating the duration of medical leave with a patient’s attributes or occupation. The primary objective of this study is to examine the influence of specific occupational and patient characteristics on the medical leave taken by employees. Methods: Using records accessed from a major academic institution of 2449 patients reporting medical leave, 547 patients met the inclusion criteria. Worker occupations were divided into three groups based on level of physical activity required for the job. Patient characteristics available for analysis included age, education level, sex, type of injury, and type of medical claim. The association between these factors and duration of disability leave was analyzed using bivariate and multivariable analysis as well Kaplan-Meier survival analysis.Results: Bivariate regression analysis showed that days off work were significantly correlated to physical requirement group (p= 0.0002), age (p=0.00357), injury type (p=0.002), insurance claim type (p=0.0001), injured body part (p=0.001), and level of education (p= 0.0005). On multivariable analysis, physical group, level of education, body part injured, and claim type remained statistically significant. Patient sex did not show significant correlation to days off work.Conclusions: Age, claim type, level of physical requirement, body part injured, and educational requirement are independent predictors of days lost from work following injury. Physicians should be aware of these factors when estimating length of disability leave to patients and their employers.

Impact of Myeloproliferative Neoplasms (MPNs) on Patient Employment and Income: Findings From the Living with MPNs Survey

Background The objective of this analysis was to evaluate income loss resulting from disease-related employment changes among patients with myeloproliferative neoplasms (MPNs). Methods Patients aged 18 to 70 years diagnosed with an MPN were eligible to participate in the online Living with MPNs survey (April–November, 2016). Respondents employed at the time of diagnosis were asked questions about changes in employment status related to their MPN and their salaries before and after those changes. Cumulative income loss resulting from disease-related employment changes up to the time of the survey was calculated based on the timing of changes in employment and salary, which was reported in inflation-adjusted 2018 US dollars. Results Among 904 patients with an MPN who responded to the survey, 299 were employed at the time of MPN diagnosis and reported ≥1 disease-related employment change. For nearly half (144/299 [48.2%]) of employed patients who reported a change in employment status, the first change occurred within 1 year of diagnosis, and most (229/299 [76.6%]) had ≥1 change within 2 years. Employment status changes and the associated impact on income were greatest among patients who took early retirement ($517,866 lost income), followed by those who took medical disability leave ($289,910) or left a job because of their disease ($257,178). Conclusions Disease-related employment changes contributed to considerable income loss among patients with MPNs. Similar to other chronic conditions, potential exists for disease-related employment changes and income loss among patients with MPNs that should be considered during disease management.