Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Cancer Registry of Norway, Oslo, Norway.
Breast. 2019 Jun;45:48-55. doi: 10.1016/j.breast.2019.02.012. Epub 2019 Mar 2.
Women diagnosed with breast cancer during working age are at increased risk of permanent absence from work, but the underlying medical causes have rarely been studied. We examined the risk of cause-specific sick leave, disability pension, and the competing event death after a breast cancer diagnosis in a population-based cohort study.
From the Breast Cancer Data Base Sweden, we identified 16,603 women diagnosed with stage I-III breast cancer between 2000 and 2012, and 63,773 control women. Using multi-state modelling, we calculated probabilities and durations of sick leave, disability pension, and death by registered cause, together with cause-specific hazard ratios.
Five years after diagnosis, causes other than cancer accounted for around half of all sick leave (3.5% out of 6.8% of women) and disability pension (1.4% out of 2.6%) in women with breast cancer. Compared with control women, women with breast cancer were at increased risk of sick leave and disability pension due to mental disorders (HR 1.24, 95% CI 1.15-1.33 and HR 1.54, 95% CI 1.29-1.85, respectively) and disability pension due to inflammatory diseases (HR 1.46, 95% CI 1.05-2.03). The risk of sick leave and disability pension due to cardiovascular disease was also elevated, although only statistically significant for disability pension in women diagnosed after 2005 (HR 2.24, 95% CI 1.22-4.13).
Follow-up, support, and rehabilitation programs for women diagnosed with breast cancer must address a wide range of psychological and physical conditions to limit the consequences on working life.
在工作年龄段被诊断患有乳腺癌的女性永久性缺勤的风险增加，但很少有研究探讨其潜在的医学原因。我们在一项基于人群的队列研究中，检查了女性在诊断出乳腺癌后，因特定原因申请病假、残疾养老金和竞争事件死亡的风险。
我们从瑞典乳腺癌数据库中，确定了 2000 年至 2012 年间被诊断为 I 期至 III 期乳腺癌的 16603 名女性和 63773 名对照女性。使用多状态建模，我们计算了因特定原因申请病假、残疾养老金和死亡的概率和持续时间，以及特定原因的风险比。
在诊断后 5 年内，除癌症以外的原因导致乳腺癌女性的病假（占女性病假总人数的 6.8%中的 3.5%）和残疾养老金（占残疾养老金总人数的 2.6%中的 1.4%）各占一半左右。与对照女性相比，患有乳腺癌的女性因精神障碍而申请病假和残疾养老金的风险增加（HR 1.24，95%CI 1.15-1.33 和 HR 1.54，95%CI 1.29-1.85），因炎症性疾病而申请残疾养老金的风险也增加（HR 1.46，95%CI 1.05-2.03）。心血管疾病导致的病假和残疾养老金风险也有所上升，尽管仅在 2005 年后被诊断出的女性中，残疾养老金的风险具有统计学意义（HR 2.24，95%CI 1.22-4.13）。
对于被诊断患有乳腺癌的女性，后续随访、支持和康复计划必须解决广泛的心理和身体状况，以限制其对工作生活的影响。
