Academic journal article Scandinavian Journal of Work, Environment & Health

Predictors of Permanent Work Disability among [Less-Than or Equal To]50-Year-Old Patients Undergoing Percutaneous Coronary Intervention

Academic journal article Scandinavian Journal of Work, Environment & Health

Predictors of Permanent Work Disability among [Less-Than or Equal To]50-Year-Old Patients Undergoing Percutaneous Coronary Intervention

Article excerpt

Hard end points such as mortality, morbidity, and target vessel revascularization rates are well documented after percutaneous coronary intervention (PCI), but relatively scarce data exist on occupational health outcomes. Among patients of working age, permanent disability pension has major socioeconomic consequences for both the individual and the society. Nevertheless, little is known about the rate and reasons for permanent work disability (PWD).

In this pre-specified analysis of the CRAGS (Coronary aRtery diseAse in younG adultS) registry we sought to assess the role of periprocedural factors related to PCI in the incidence, indications, and determinants of permanent disability pension in long-term follow-up of ≤50-year-old patients who have undergone PCI (1-3).

Methods

This study is part of a larger multicenter collaboration designed to describe outcomes among ≤50-yearold patients revascularized for coronary artery disease (CRAGS). This substudy comprised all 1003 consecu - tive PCI ≤50-year-old patients who underwent PCI at three university hospitals (Oulu, Tampere and Turku) and one central hospital (Vaasa) in Finland during 2002- 2012. Invasive treatment of coronary disease is mainly centralized and the participating hospitals are the treating hospitals within their geographical catchment area.

The study complies with the Declaration of Helsinki, and the locally appointed ethics committees of participating hospital have approved the research protocol.

Data on PWD pension (starting date, primary and secondary diagnosis) were acquired from the Finnish Centre for Pensions, which governs the statutory pension security in Finland, and which in turn consists of a defined benefit earnings-related pension that accrues from work as well as residence-based national pension and guarantee pension that ensure minimum security. The statutory pension system in Finland consists of two main parts - earnings-related and residence-based national pensions. The earnings-related pension, managed by various providers who belong to the Finnish Centre for Pensions, covers the entire workforce, including the self-employed. None of the patients were eligible for old-age pension during follow-up. Ninetythree patients on PWD already prior to index procedure were excluded from further analysis. Periprocedural data and baseline comorbidities along with data on post procedural morbidity were acquired from local hospital registries which enabled complete follow up as treatment of the events of interest (cardiac- and cerebrovascular) are centralized. Data on date and mode of death was acquired from the Finnish national registry, Statistics Finland.

Data on the number of insured and the incidence and category (cardiovascular, musculoskeletal and psychiatric) of PWD in each age group in the general population between 2007-2011 was obtained from the Finnish Center for Pensions. Statistics from a group comprised of 45-year-old insured patients were used for comparison with the study population (mean age 45 years). Major adverse cardiac and cerebrovascular event (MACCE) is defined as a composite of myocardial infarction (MI), repeat revascularization and stroke. Death was not included as MACCE was evaluated as a factor influencing PWD.

The main outcomes of interest were PWD defined as grant of disability pension during follow-up and predictors thereof. Secondary measures were predictors of cardiac disability defined as PWD with a cardiac diagnosis. Statistical analysis was performed with SPSS Statistics version 22.0 (IBM, Armonk, NY, USA) and R version 2.15.3. Categorical variables are reported as counts and percentages, continuous variables as mean and standard deviation (SD) or median and interquartile range (IQR). Fisher's exact test, Chi square, independent samples T-test and Kaplan-Meier were used for univariate analysis. Cox proportional hazards models were employed to identify predictors of permanent disability by including clinically important variables with a P-value <0. …

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