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Multimorbidity and Sickness Absence/Disability Pension in Patients With Cluster Headache and Matched References: A
Caroline Ran1, Kristina Alexanderson2, Andrea C Belin2
1From the Department of Neuroscience (C.R., A.C.B.), Karolinska Institutet, SE-171 77; Department of Clinical Neuroscience (K.A., G.A., A.S., C.S.), Karolinska Institutet, SE-171; Department of Neurology (A.S.), Karolinska University Hospital, SE-171 76; and Department of Neurology (C.S.), Danderyd Hospital, SE-182 88 Stockholm, Sweden. caroline.ran@ki.se.
Insights
Patients with cluster headache (CH) experience high rates of multimorbidity, particularly affecting nervous and musculoskeletal systems. This increased comorbidity is linked to significantly higher sickness absence and disability pension days, especially in women.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Cluster headache (CH) is associated with high rates of multimorbidity, yet large-scale studies are limited.
- Understanding the extent of diagnosis-specific multimorbidity in CH patients is crucial.
Purpose of the Study:
- To investigate the prevalence of multimorbidity in cluster headache patients compared to matched references.
- To examine the association between multimorbidity and sickness absence/disability pension in CH patients.
Main Methods:
- A register-based study utilized Swedish national registers (LISA, National Board of Health and Welfare).
- Data included diagnoses (ICD-10), sickness absence, and disability pension for CH patients and matched references (2001-2010).
- Prevalence, mean days of absence/pension, and odds ratios were calculated.
Main Results:
- 91.9% of CH patients had multimorbidity versus 77.6% of references (OR 3.26).
- Nervous system (51.8% vs 15.4%) and musculoskeletal system (39.0% vs 23.7%) diagnoses were significantly higher in CH patients.
- CH patients had more sickness absence/disability pension days (63.15 vs 34.08), with multimorbidity further increasing these days (67.25 vs 40.69).
Conclusions:
- Multimorbidity is significantly more prevalent in cluster headache patients.
- CH patients face higher rates of sickness absence and disability pension, exacerbated by multimorbidity.
- Female CH patients with multimorbidity exhibit particularly high levels of sickness absence and disability pension.
Background And Objectives:
Multimorbidity among patients with cluster headache (CH) is considered to be high, but large studies are lacking. The aims were to explore the occurrence of diagnosis-specific multimorbidity among patients with CH and matched references and possible associations of this with their sickness absence and disability pension.
Methods:
We performed a register-based study of patients with CH and matched references, regarding their multimorbidity, sickness absence, and disability pension. Data were obtained from 2 nationwide registers: Statistics Sweden's Longitudinal Integration Database for Health Insurance and Labor Market Studies (LISA) (for sociodemographics in 2009, sickness absence, and disability pension in 2010) and The National Board of Health and Welfare's specialized outpatient and inpatient registers for diagnosis-specific health care in 2001-2010 (for identifying patients with CH and multimorbidity, defined by ICD-10 codes). The prevalence and number of net days of sickness absence and/or disability pension in 2010 were calculated, in general and by multimorbidity. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated for comparison of each diagnostic group with references without the chosen morbidity.
Results:
We analyzed 3,240 patients with CH, aged 16-64 years, and living in Sweden in 2010 and 16,200 matched references. A higher proportion of patients with CH had multimorbidity (91.9%) than of references (77.6%), OR 3.263 (95% CI 2.861-3.721), both in general and regarding all analyzed diagnostic groups. Differences were particularly high for diagnoses relating to the nervous (CH 51.8% vs references 15.4%), OR 5.922 (95% CI 5.461-6.422), and musculoskeletal (CH 39.0% vs references 23.7%), OR 2.057 (95% CI 1.900-2.227), systems. Multimorbidity rates were overall higher among women in patients with CH (96.4% vs men 89.6%). Patients with CH had a higher mean number of days of sickness absence and disability pension compared with references, 63.15 vs 34.08 days. Moreover, multimorbidity was associated with a higher mean number of such days in patients with CH, 67.25, as compared with references, 40.69 days.
Discussion:
The proportions of multimorbidity were high in both patients with CH and references, however, higher in the patients with CH, who also had higher sickness absence and disability pension levels. In particular, CH patients with multimorbidity and of female sex had high sickness absence and disability pension levels.
