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Multivariable models assessed employment and productivity determinants. Overall, 67% of patients were employed, yet half reported reduced capacity, unsafe environments, limited career progression, and stigma. Unemployment was associated with female sex, disability, and lower education. Nondisclosure affected one-fourth of patients and one-fifth of caregivers. Work impairment reached 39%; absenteeism was driven by healthcare demands, while presenteeism was associated with disease burden, psychological distress, and immune dysregulation, but not the Ig administration route. Caregivers showed 34% work impairment, with absenteeism linked to care intensity and presenteeism to psychological distress, patient health, and child caregiving. Child caregivers had greater time demands and more part-time employment. In conclusion, IEI substantially impair work productivity, supporting integration of occupational needs into care to improve social inclusion.<\/jats:p>","DOI":"10.70962\/jhi.20260077","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T13:11:11Z","timestamp":1792674671000},"update-policy":"https:\/\/doi.org\/10.70962\/jhi.crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Work participation in inborn errors of immunity: The dual burden on patients and caregivers"],"prefix":"10.70962","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3466-9496","authenticated-orcid":true,"given":"Federica","family":"Pulvirenti","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/011cabk38","id-type":"ROR","asserted-by":"publisher"}],"name":"Reference Centre for Primary Immune Deficiencies, Sapienza University Hospital Policlinico Umberto I 1 , 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