库欣综合征的长期躯体和精神后果有很好的描述,但是社会经济后果在很大程度上是未知的。
我们研究了就业状况,教育水平,抑郁症的风险,以及库欣综合征在诊断前和手术后几年的其他社会经济结果。
全国注册队列研究。
我们使用经过验证的算法来识别1986年1月1日至2017年12月31日在丹麦接受肾上腺(n=199)或垂体库欣综合征(n=225)手术的424例患者。我们获得了诊断前10年(第-10年)至手术后10年(第10年)的社会经济登记数据,并纳入了性别和年龄匹配的参考人群。我们使用改进的泊松回归分析确定了重返工作岗位的预后因素。
与参考人群相比,从第-6年[相对危险度(RR)0.92,95%CI0.84-0.99]到第+10年(RR0.66,95%CI0.57-0.76),患者的就业永久性减少.病假(RR2.15,95%CI1.40-3.32)和残疾抚恤金(RR2.60,95%CI2.06-3.27)在第10年仍然升高。年收入,教育,为人父母,关系状态,抑郁的风险也受到负面影响,但父母身份和关系状态在手术后恢复正常。在患者中,手术后全职工作的负面预测因素包括女性,低教育,合并症,和抑郁症。
库欣综合征在诊断前许多年对广泛的社会经济变量产生负面影响,只有一些在治疗后才恢复正常。这些数据强调了库欣综合征的早期诊断和持续随访的重要性,并非最不重要的,糖皮质激素过量对健康的普遍威胁。
The long-term somatic and psychiatric consequences of Cushing\'s syndrome are well-described, but the socioeconomic consequences are largely unknown.
We studied employment status, educational level, risk of depression, and other socioeconomic outcomes of Cushing\'s syndrome in the years before diagnosis and after surgery.
Nationwide register-based cohort study.
We used a validated algorithm to identify 424 patients operated for adrenal (n = 199) or pituitary Cushing\'s syndrome (n = 225) in Denmark from January 1, 1986 to December 31, 2017. We obtained socioeconomic registry data from 10 years before diagnosis (year -10) to 10 years after surgery (year +10) and included a sex- and age-matched reference population. We identified prognostic factors for returning to work using modified Poisson regression.
Compared to the reference population, the patients\' employment was permanently reduced from year -6 [relative risk (RR) 0.92, 95% CI 0.84-0.99] to year +10 (RR 0.66, 95% CI 0.57-0.76). Sick leave (RR 2.15, 95% CI 1.40-3.32) and disability pension (RR 2.60, 95% CI 2.06-3.27) were still elevated in year +10. Annual income, education, parenthood, relationship status, and risk of depression were also negatively impacted, but parenthood and relationship status normalized after surgery. Among patients, negative predictors of full-time employment after surgery included female sex, low education, comorbidity, and depression.
Cushing\'s syndrome negatively affects a wide spectrum of socioeconomic variables many years before diagnosis of which only some normalize after treatment. The data underpin the importance of early diagnosis and continuous follow-up of Cushing\'s syndrome and, not least, the pervasive health threats of glucocorticoid excess.