In this study, we found a significant association between CKD and a higher likelihood of unemployment compared to that in individuals without CKD. This association was more prominent in patients with severe CKD.
Our findings are consistent with those of a previous study conducted in the United States, which identified a comparable association between renal dysfunction and labor force nonparticipation (OR, 7.94; CI, 1.60 to 39.43) [16]. The significance of our results is further emphasized by the fact that this association between CKD prevalence and unemployment was observed in Korea, a country known for its long working hours (with an average of 1993 hours annually, compared with the OECD average of 1734 hours in 2018) [38]. This indicates that CKD substantially hinders individuals from sustaining employment. Additionally, our study revealed that a higher proportion of patients with CKD were aged ≥ 70 years. This finding aligns with those of previous cohort studies, which have shown an age-related increase in the number of patients with CKD as the GFR declines, particularly among individuals aged ≥ 70 years [39]. This observation highlights the growing prevalence of CKD with an increasing life expectancy [1]. Considering the increasing global prevalence of CKD, these findings raise concerns regarding important social issues.
The results of the present study highlight the challenges faced by individuals with CKD in maintaining employment compared to those without CKD. However, our study had limitations in categorizing patients with CKD into specific subgroups, such as patients undergoing dialysis or kidney transplantation, due to the constraints of the questionnaire design. Despite this, we investigated the association between patients with CKD and their employment status by stratifying them based on the severity of CKD, which was determined by eGFR levels derived from serum creatinine levels. Our findings revealed a gradual increase in the risk of unemployment with an increase in CKD severity. Particularly, individuals with the most severe form of CKD experienced a substantial increase in the risk of unemployment, although the number of participants in this specific subgroup was limited. Moreover, our study is significant because in contrast with previous research, which primarily focused on comparing job retention difficulties between patients undergoing dialysis and kidney transplant [13–15], we examined the association between CKD and employment status between patients with CKD and individuals without CKD.
A previous study used data from the Third National Health and Nutrition Examination Survey conducted in the United States [16]. However, in addition to utilizing nationwide data, our study expanded the investigation by categorizing the occupational types of individuals with CKD. We discovered that the likelihood of precarious employment was higher among patients with CKD than that in individuals without CKD. Furthermore, patients with CKD displayed a notable inclination towards precarious job arrangements, self-employment, and unemployment in contrast to participants without CKD, who predominantly held permanent positions. Remarkably, this occupational pattern became more pronounced as severity of CKD, based on eGFR levels, increased. Consequently, several factors, including health-related issues, personal circumstances, and environmental factors contribute to the challenges experienced by patients with CKD in maintaining or obtaining stable employment. Patients with CKD encounter limitations in their working hours owing to regular hospital visits for dialysis treatment and heightened levels of fatigue, which adversely affects their work performance [12]. Moreover, the tendency for precarious employment among patients with CKD is supported by a significant number of individuals within this group being unemployed, which is evident from the elevated risk of unemployment observed in the subgroup with the greatest CKD severity. This outcome parallels previous findings indicating that patients in Stage 5, representing the most advanced stage of CKD, tend to quit the workforce [40]. These findings indicate that when the severity of CKD increases beyond a certain threshold, there is a tendency to quit employment.
Our study had several limitations. First, the cross-sectional design employed in this study implies that the data were collected at a single time point. This limited our ability to establish clear causal associations, which is why the present results indicate associations rather than definitive causal relationships. Reverse causality is a drawback of cross-sectional studies. However, it can be argued that the prevalence of CKD is more likely to be a causal factor influencing the work status of patients with CKD, rather than the other way around. Second, the survey used in this study did not consider the participants' motivation to seek employment. Therefore, we could only examine the prevalence of CKD and absence of employment, without being able to determine whether unemployed individuals lack the drive to seek work. Further studies are required to address this issue. Finally, although we adjusted for covariates related to CKD and work status, the possibility of residual confounding owing to unmeasured variables remains. Other potential confounding factors may exist, and their effects cannot be excluded.
Despite these limitations, this study had several strengths. To our knowledge, this is the first quantitative investigation to establish an association between CKD and employment status in East Asia. Moreover, our use of KNHANES data, which accurately represent the entire Korean population, allows the extrapolation of the present findings to the broader Korean population. The reliability of the participants’ CKD and diabetes statuses was strengthened by meticulous analysis of laboratory data, including eGFR and HbA1c levels. Consequently, the outcomes of this study can potentially inform policy discussions, help integrate treatment and employment services, and thereby enhance the patients’ quality of life.
In conclusion, our study demonstrated a significant association between CKD and employment status, highlighting the impact of CKD on the prevalence of unemployment. Additionally, our findings suggest that patients with CKD have a higher likelihood of securing precarious employment than that in individuals without CKD. Patients with early- or late-stage CKD face challenges in maintaining a balance between work and health and may receive inadequate support at their workplace. Given these findings, it is crucial for clinicians and policymakers to engage in effective communication regarding the work situation of patients with CKD and address potential issues affecting their overall well-being. Active interventions, legislation, and supportive measures are necessary to improve the quality of life of patients with CKD in relation to employment.