Work Loss and Income Before and After Diagnosis of Addison's Disease: A Population-Based Longitudinal Study

The effect of autoimmune Addison's disease (AAD) on work ability and income over time remains unclear.

This work aimed to evaluate differences and temporal trends in income and lost workdays among patients with AAD before and after diagnosis, vs matched general population comparators. This nationwide, register-based cohort study was conducted in Sweden. We linked the Swedish Addison Register with national health registers to identify 716 working-age individuals (aged 20-62 years) with incident AAD 2003 to 2019 and 3271 general-population comparators matched by sex, age, county, calendar year, and education level. Annual work loss, taxable earnings, and disposable income were examined over a 10-year period around diagnosis using linear (work loss) and quantile (earnings, income) regression.

Patients with AAD had significantly more work loss than comparators from 1 year before to 3 years after diagnosis, with the largest difference the year after diagnosis (mean difference: 30.5 days; 95% CI, 22.9-38.0 days). Median taxable earnings were lower in patients with AAD 1 year before (median difference: $-1107; 95% CI, $-2042 to $-173; P = .02) and 1 year after diagnosis ($-1105; 95% CI, $-2166 to $-43; P = .04). Disposable income was also reduced 1 year after diagnosis (median difference: $-1084; 95% CI, $-1813 to $-354; P = .004).

In AAD, increased work loss and reduced earnings and income were concentrated around diagnosis, peaking in the year after. Reassuringly, both absence from work and income normalized within 4 years following diagnosis.