The employment status and related factors of Taiwanese workers after acute myocardial infarction

Objectives: In Taiwan, the rising incidence of acute myocardial infarction and younger patients with the infarction may have implications for the labor market. However, the long-term effects of the illness on the labor market remain unclear. Therefore, we explored the changes in the employment status and factors influencing the employment of patients with acute myocardial infarction. Methods: This cohort study used data from the National Health Insurance Research Database, Labor Insurance Database, Cause of Death Statistics, and household registration records from 2011 to 2017. Patients aged 30-59 years who were hospitalized for acute myocardial infarction for the first time between 2013 and 2014 were enrolled in this study. We observed the employment rate of the survivors at 6, 12, 24, and 36 months after the onset of the disease and the factors influencing their employment status. Results: We enrolled 2,659 workers with acute myocardial infarction. The proportion of employed survivors decreased from 94.1% at 6 months to 86.4% at 36 months after the onset. The likelihood of not being employed was higher among patients who were older, with lower salary, and with more comorbidities. In terms of the risk of unemployment at 36 months after the onset, patients aged 50–59 years had a 2.63 times higher risk than those aged 30–39 years (95% CI: 1.57–4.41); patients with a salary of less than NT$20,000 had a 2.86 times higher risk than those earning more than NT$60,000 (95% CI: 1.67–4.92); and patients with Charlson Comorbidity Index of more than 3 points had a 1.57 times higher risk than those without comorbidities (95% CI: 1.07–2.31). The difference in the effects of gender, urbanization, and education level on employment did not reach statistical significance. Conclusions: In Taiwan, this study is the first to explore the effects of acute myocardial infarction on the employment status. Patients who are older, with low salary, and multiple comorbidities are more likely to become unemployed after the onset of the disease, in addition to unemployment cause by death. Understanding the difficulties related to employment of such patients with acute myocardial infarction is necessary in promoting a patient-friendly workplace environment.