Effect of Early-Onset Dementia on Job Loss in Japan: A Matched Cohort Database Study Using Health Insurance Claims Data

Abstract

Objective: To assess the rate of job loss amongst primary insured participants diagnosed with early-onset dementia (EOD) and to investigate the association between patients' background factors and job loss. Additionally, we evaluated the job loss rates amongst primary insured participants whose spouses were diagnosed with EOD. Methods: We analysed health insurance claims data from the Japan Medical Data Centre, covering the period from 1 April 2013, to 30 November 2023. Participants were categorised into two groups: EOD Group 1, comprising primary insured individuals with EOD; EOD Group 2, comprising primary insured individuals' spouses with EOD. Each group was compared with its respective control group. The control group comprised participants without dementia matched in a ratio of 1:5 to cases in EOD group based on sex, age and major comorbidities. Results: The rate of job loss in EOD Group 1 was higher than that in Control Group 1 (hazard ratio [HR] = 1.59, 95% confidence interval [CI]:1.39–1.82, p < 0.05). In contrast, EOD Group 2 had a lower rate of job loss than Control Group 2 (HR = 0.75, 95% CI: 0.57–0.996, p = 0.046). In EOD Group 1, patient background factors influencing job loss within 2 years included sex (female) (adjusted HR = 2.18, 95% CI:1.60–2.96, p < 0.05), age (adjusted HR = 1.07, 95% CI: 1.04–1.10, p < 0.05) and hypertension (adjusted HR = 1.35, 95% CI: 1.02–1.77, p < 0.05). Conclusion: This study identified participant background factors that influence job loss amongst participants with EOD, suggesting that addressing comorbidities at EOD onset and promoting lifestyle modifications may be beneficial. Examining the time to job loss following EOD onset is crucial for predicting its economic impact and developing effective support strategies. Therefore, this study's findings may be valuable in reducing the rate of job loss by enforcing workplace health promotions for employees with EOD.