甲状腺患者长期病假风险增加、复工率降低、失业和领取残疾抚恤金风险更高：一项基于丹麦登记处的队列研究。
Increased risk of long-term sickness absence, lower rate of return to work, and higher risk of unemployment and disability pensioning for thyroid patients: a Danish register-based cohort study.
作者信息
Nexo M A, Watt T, Pedersen J, Bonnema S J, Hegedüs L, Rasmussen A K, Feldt-Rasmussen U, Bjorner J B
机构信息
The National Research Centre for the Working Environment (M.A.N., J.P., J.B.B.), DK-2100 Copenhagen, Denmark; Department of Public Health (M.A.N., J.B.B.), Section of Social Medicine, University of Copenhagen, Copenhagen DK-1014, Denmark; Department of Medical Endocrinology (T.W., A.K.R., U.F.-R), Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark; Department of Endocrinology and Metabolism (S.J.B., L.H.), Odense University Hospital, Odense DK-5000, Denmark; and QualityMetric (an Optum company) (J.B.B.), Lincoln, Rhode Island 02865.
出版信息
J Clin Endocrinol Metab. 2014 Sep;99(9):3184-92. doi: 10.1210/jc.2013-4468. Epub 2014 Jun 17.
CONTEXT
Little is known about how thyroid diseases affect work ability.
OBJECTIVE
The objective of this study was to evaluate the risk of work disability for patients with thyroid disease compared with the general population.
DESIGN, SETTING, AND PARTICIPANTS: In a longitudinal register study, outpatients (n = 862) with nontoxic goiter, hyperthyroidism, Graves' orbitopathy (GO), autoimmune hypothyroidism, or other thyroid diseases and their matched controls (n = 7043) were observed in the years 1994-2011 in Danish national registers of social benefits, health, and work characteristics. Cox regression analyses estimated adjusted hazard ratios (HRs) for the first year after diagnosis and subsequent years.
MAIN OUTCOME MEASURES
Transitions between work, long-term sickness absence, unemployment, and disability pension were measured.
RESULTS
Patients differed significantly from the general population with regard to sickness absence, disability pension, return from sickness absence, and unemployment. In the first year after diagnosis, higher risks of sickness absence was seen for GO (HR 6.94) and other hyperthyroid patients (HR 2.08), who also had lower probability of returning from sickness absence (HR 0.62) and higher risk of disability pension (HR 4.15). Patients with autoimmune hypothyroidism showed a lower probability of returning from sickness absence (HR 0.62). In subsequent years, GO patients had significantly higher risk of sickness absence (HR 2.08), lower probability of return from sickness absence (HR 0.51), and unemployment (HR 0.52) and a higher risk of disability pension (HR 4.40). Hyperthyroid patients also had difficulties returning from sickness absence (HR 0.71).
CONCLUSIONS
Thyroid patients' risk of work disability is most pronounced in the first year after diagnosis and attenuates in subsequent years. GO patients have the highest risk of work disability.
背景
关于甲状腺疾病如何影响工作能力，人们了解甚少。
目的
本研究的目的是评估甲状腺疾病患者与普通人群相比工作致残的风险。
设计、地点和参与者：在一项纵向登记研究中，于1994年至2011年在丹麦社会福利、健康和工作特征国家登记处观察了患有非毒性甲状腺肿、甲状腺功能亢进、格雷夫斯眼病（GO）、自身免疫性甲状腺功能减退或其他甲状腺疾病的门诊患者（n = 862）及其匹配对照（n = 7043）。Cox回归分析估计了诊断后第一年及随后几年的调整后风险比（HRs）。
主要结局指标
测量了工作、长期病假、失业和残疾抚恤金之间的转变情况。
结果
患者在病假、残疾抚恤金、病假返回和失业方面与普通人群有显著差异。在诊断后的第一年，GO患者（HR 6.94）和其他甲状腺功能亢进患者（HR 2.08）的病假风险较高，他们病假返回的概率也较低（HR 0.62），残疾抚恤金风险较高（HR 4.15）。自身免疫性甲状腺功能减退患者病假返回的概率较低（HR 0.62）。在随后几年中，GO患者的病假风险显著较高（HR 2.08），病假返回概率较低（HR 0.51），失业风险较高（HR 0.52），残疾抚恤金风险较高（HR 4.40）。甲状腺功能亢进患者病假返回也有困难（HR 0.71）。
结论
甲状腺疾病患者工作致残的风险在诊断后的第一年最为明显，在随后几年中有所减轻。GO患者工作致残的风险最高。
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