Joblessness and lost earnings after acute respiratory distress syndrome in a 1-year national multicenter study

Biren B. Kamdar, Minxuan Huang, Victor D. Dinglas, Elizabeth Colantuoni, Till M. Von Wachter, Ramona O. Hopkins, Dale M. Needham

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


Rationale: Following acute respiratory distress syndrome (ARDS), joblessness is common but poorly understood. Objectives: To evaluate the timing of return to work after ARDS, and associated risk factors, lost earnings, and changes in healthcare coverage Methods: Over 12-month longitudinal follow-up. ARDS survivors from 43 U.S. ARDSNet hospitals provided employment and healthcare coverage data via structured telephone interviews. Factors associated with the timing of return to work were assessed using Fine and Gray regression analysis. Lost earnings were estimated using Bureau of Labor Statistics data. Measurements and Main Results: Of 922 consenting survivors, 386 (42%) were employed before ARDS (56% male; mean6SD age, 45613 yr), with seven dying by 12-month follow-up. Of 379 previously employed 12-month survivors, 166 (44%) were jobless at 12-month follow-up. Accounting for competing risks of death and retirement, half of enrolled and previously employed survivors returned to work by 13 weeks after hospital discharge, with 68% ever returning by 12 months. Delays in return to work were associated with longer hospitalization and older age among nonwhite survivors. Over 12-month follow-up, 274 (71%) survivors accrued lost earnings, averaging $26,949±$22,447 (60% of pre-ARDS annual earnings). Jobless survivors experienced a 14% (95% confidence interval, 5-22%; P = 0.002) absolute decrease in private health insurance (from 44% pre-ARDS) and a 16% (95% confidence interval, 7-24%; P<0.001) absolute increase in Medicare and Medicaid (from 33%). Conclusions: At 12 months after ARDS, nearly one-half of previously employed survivors were jobless. Post-ARDS joblessness is associated with readily identifiable patient and hospital variables and accompanied by substantial lost earnings and a shift toward government-funded healthcare coverage.

Original languageEnglish (US)
Pages (from-to)1012-1020
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Issue number8
StatePublished - Oct 15 2017


  • Employment
  • Health insurance
  • Income
  • Intensive care unit

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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