Smoking status and productivity loss among working age cancer survivors in the United States.

524 Background: In the US, smoking is linked to health-related work productivity loss. However, little research has examined whether smoking is associated with labor force participation, inability to work, and missed workdays among cancer survivors. Methods: The National Health Interview Survey (NHIS; 2013-2019 and 2022-2023) data were used to identify cancer survivors ages 18-64 years. The sample was stratified by smoking status (currently smoke, formerly smoked, and never smoked). The associations with smoking status were assessed using multivariable logistic regressions for productivity loss measures, including labor force participation (working or looking for a job), inability to work due to health, and any missed workdays. Multivariable negative binomial regression examined association of smoking status and number of missed workdays (top-coded by NHIS at ≥130 days). All analyses controlled for sociodemographic characteristics, survey year, and region, accounting for the complex survey design. Results: In total, 8,203 (weighted n = 7,048,624) cancer survivors ages 18-64 years were identified, of whom, 1,793 (weighted n = 1,387,882; 19.7%) currently smoked, 2,189 (weighted n = 1,889,235; 26.5%) formerly smoked, and 4,221 (weighted n = 3,771,507; 53.5%) never smoked. In adjusted analyses, labor force participation rate was similar by smoking status, but inability to work due to health varied significantly (Table). Compared to survivors who never smoked, those who formerly smoked and currently smoked were more likely to report inability to work due to health (18.0%, 20.0%, and 23.9%, respectively). Moreover, working survivors (n = 5,320) who currently smoked were more likely to report any missed workdays than those who never smoked, and experienced higher number of missed workdays compared to those who formerly smoked. Conclusions: Smoking is associated with health-related work productivity loss among cancer survivors; quitting smoking may increase labor force participation and reduce missed workdays. Smoking cessation efforts can improve health and reduce productivity loss among working age cancer survivors in the US. Multivariable regressions of predicted margins of productivity loss among cancer survivors ages 18-64 years, 2013-2019 and 2022-2023 NHIS. Smoking status Labor force participation Inability to work Adjusted % (95CI) p Adjusted mean (95CI) p Never 62.6% (60.9%, 64.3%) ref 18.0% (16.5%, 19.5%) ref Former 61.4% (59.1%, 63.7%) 0.445 20.0% (18.3%, 21.8%) 0.070 Current 59.4% (56.7%, 62.2%) 0.061 23.9% (21.9%, 26.0%) <.001 Any missed workdays Actual missed workdays Never 53.8% (51.6%, 55.9%) ref 9.87 (95% CI: 8.61, 11.12) ref Former 56.4% (53.2%, 59.5%) 0.180 9.88 (95% CI: 8.47, 11.29) 0.987 Current 59.7% (55.6%, 63.8%) 0.016 13.09 (95% CI: 9.63, 16.56) 0.092