Ervasti Jenni, Virtanen Marianna, Lallukka Tea, Friberg Emilie, Mittendorfer-Rutz Ellenor, Lundström Erik, Alexanderson Kristina
Research and Service Centre of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland.
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
BMJ Open. 2017 Sep 29;7(9):e017910. doi: 10.1136/bmjopen-2017-017910.
We examined the risk of disability pension before and after ischaemic heart disease (IHD) or stroke event, the burden of stroke compared with IHD and which factors predicted disability pension after either event.
A population-based cohort study with follow-up 5 years before and after the event. Register data were analysed with general linear modelling with binary and Poisson distributions including interaction tests for event type (IHD/stroke).
All people living in Sweden, aged 25‒60 years at the first event year, who had been living in Sweden for 5 years before the event and had no indication of IHD or stroke prior to the index event in 2006‒2008 were included, except for cases in which death occurred within 30 days of the event. People with both IHD and stroke were excluded, resulting in 18 480 cases of IHD (65%) and 9750 stroke cases (35%).
Disability pension.
Of those going to suffer IHD or stroke event, 25% were already on disability pension a year before the event. The adjusted OR for disability pension at first postevent year was 2.64-fold (95% CI 2.25 to 3.11) for people with stroke compared with IHD. Economic inactivity predicted disability pension regardless of event type (OR=3.40; 95% CI 2.85 to 4.04). Comorbid mental disorder was associated with the greatest risk (OR=3.60; 95% CI 2.69 to 4.83) after an IHD event. Regarding stroke, medical procedure, a proxy for event severity, was the largest contributor (OR=2.27, 95% CI 1.43 to 3.60).
While IHD event was more common, stroke involved more permanent work disability. Demographic, socioeconomic and comorbidity-related factors were associated with disability pension both before and after the event. The results help occupational and other healthcare professionals to identify vulnerable groups at risk for permanent labour market exclusion after such an event.
我们研究了缺血性心脏病（IHD）或中风事件前后领取残疾抚恤金的风险、中风与IHD相比的负担以及哪些因素可预测这两种事件后领取残疾抚恤金的情况。
一项基于人群的队列研究，对事件前后5年进行随访。使用具有二元和泊松分布的一般线性模型分析登记数据，包括事件类型（IHD/中风）的交互检验。
所有在首次事件年份年龄为25至60岁、在事件发生前已在瑞典居住5年且在2006 - 2008年索引事件之前无IHD或中风迹象的瑞典居民均被纳入，但事件发生后30天内死亡的病例除外。同时患有IHD和中风的人被排除，结果有18480例IHD病例（65%）和9750例中风病例（35%）。
残疾抚恤金。
在那些即将发生IHD或中风事件的人中，25%在事件发生前一年就已领取残疾抚恤金。与IHD患者相比，中风患者在事件后第一年领取残疾抚恤金的校正比值比为2.64倍（95%置信区间2.25至3.11）。无论事件类型如何，经济不活跃都可预测领取残疾抚恤金的情况（比值比 = 3.40；95%置信区间2.85至4.04）。IHD事件后，合并精神障碍与最大风险相关（比值比 = 3.60；95%置信区间2.69至4.83）。对于中风，作为事件严重程度指标的医疗程序是最大的影响因素（比值比 = 2.27，95%置信区间1.43至3.60）。
虽然IHD事件更常见，但中风导致的永久性工作残疾更多。人口统计学、社会经济和合并症相关因素在事件前后均与残疾抚恤金相关。这些结果有助于职业和其他医疗保健专业人员识别在这类事件后有永久劳动力市场排斥风险的弱势群体。
