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Disability pension after coronary revascularization: a prospective nationwide register-based Swedish cohort study
Katharina Zetterström1, Marjan Vaez2, Kristina Alexanderson2
1Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden katharina.zetterstrom@ki.se.
Insights
Disability pension (DP) after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is common, particularly for women and CABG patients. Long-term sick leave before treatment is a strong predictor of future DP.
Area of Science:
- Cardiology
- Public Health
- Health Economics
Background:
- Limited scientific understanding exists regarding disability pension (DP) rates following coronary revascularization procedures.
- Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are common revascularization methods.
- Investigating factors influencing DP post-revascularization is crucial for patient management and healthcare policy.
Purpose of the Study:
- To determine the incidence of disability pension (DP) within five years after a first-time CABG or PCI.
- To identify socio-demographic and medical risk factors associated with receiving DP after revascularization.
- To compare DP rates between CABG and PCI patients.
Main Methods:
- A nationwide, population-based cohort study utilizing Swedish registers.
- Inclusion of 34,643 patients aged 30-63 undergoing their first CABG or PCI between 1994-2003.
- Exclusion of patients on DP or old-age pension prior to the study, and those with reintervention within 30 days.
- Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HR) for DP.
Main Results:
- 32.4% of patients were granted DP within five years post-revascularization.
- Women had a significantly higher hazard ratio (HR 1.55) for DP compared to men.
- CABG patients exhibited a higher HR (1.35) for DP than PCI patients.
- Long-term sick leave in the preceding year was the strongest predictor for DP.
- Diabetes mellitus remained a significant risk factor for DP regardless of revascularization type.
Conclusions:
- Disability pension is a common outcome after coronary revascularization, with higher incidence in women and CABG recipients.
- Pre-existing conditions, including mental and musculoskeletal disorders, and particularly long-term sickness absence, are significant risk factors for future DP.
- These findings highlight the need for targeted interventions and support for high-risk individuals post-revascularization.
Background:
Scientific knowledge on disability pension (DP) after revascularization by coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) is scarce. The aim was to study the incidence of and risk factors for being granted DP in the 5 years following a first CABG or PCI, accounting for socio-demographic and medical factors.
Methods:
This is a nationwide population-based study using Swedish registers including all patients 30-63 years of age (n = 34,643, 16.4% women) who had a first CABG (n = 14,107) or PCI (n = 20,536) during 1994-2003. All were alive and without reintervention 30 days after the procedure and were not on DP or old-age pension. Multivariable adjusted Cox proportional hazard ratios (HR) for DP were estimated with 95% confidence intervals (CI).
Results:
In 5 years following revascularization, 32.4% had been granted DP and the hazard ratio (HR) was higher in women (HR 1.55, 95% CI 1.48-1.62), and in CABG patients compared with PCI patients (HR 1.35, 95% CI 1.30-1.40). Long-term sick leave in the year before intervention was the strongest predictor for DP following revascularization. After adjustments for socio-demographic factors and sick-leave days in the 12 months before revascularization, HR remained high in all patients with diabetes mellitus regardless of type of revascularization.
Conclusions:
DP after coronary revascularization was common, especially among women and CABG patients. Most studied medical covariates, including mental and musculoskeletal disorders, were risk factors for future DP, especially long-term sickness absence.
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