Socioeconomic status and survival of cirrhosis patients: a Danish nationwide cohort study.
BACKGROUND
Low socioeconomic status is a risk factor for liver cirrhosis, but it is unknown whether it is a prognostic factor after cirrhosis diagnosis. We examined whether marital status, employment, and personal income were associated with the survival of cirrhosis patients.


METHODS
Using registry-data we conducted a population-based cohort study of 1,765 Danish cirrhosis patients diagnosed in 1999-2001 at age 45-59 years. Follow-up ended on 31 December 2003. With Cox regression we examined the associations between marital status (never married, divorced, married), employment (employed, disability pensioner, unemployed), personal income (0-49, 50-99, 100+ percent of the national average) and survival, controlling for gender, age, cirrhosis severity, comorbidity, and substance abuse.


RESULTS
Five-year survival was higher for married patients (48%) than for patients who never married (40%) or were divorced (34%), but after adjustment only divorced patients had poorer survival than married patients (adjusted hazard ratio for divorced vs. married = 1.22, 95% CI 1.04-1.42). Five-year survival was lower for disability pensioners (31%) than for employed (46%) or unemployed patients (48%), also after adjustment (adjusted hazard ratio for disability pensioners vs. employed = 1.35, 95% CI 1.09-1.66). Personal income was not associated with survival.


CONCLUSIONS
Marital status and employment were associated with the survival of cirrhosis patients. Specifically, divorced cirrhosis patients and cirrhosis patients who never married had a poorer survival than did married cirrhosis patients, and cirrhosis patients who were disability pensioners had a poorer survival than did employed or unemployed cirrhosis patients. The poorer survival for the divorced and for the disability pensioners could not be explained by differences in other socioeconomic factors, gender, age, cirrhosis severity, substance abuse, or comorbidity. Personal income was not associated with survival.
Jepsen
Peter
P
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. pj@dce.au.dk.
Vilstrup
Hendrik
H
Andersen
Per Kragh
PK
Sørensen
Henrik Toft
HT
D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004651:Employment; D005260:Female; D006801:Humans; D007182:Income; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000191:economics* / Q000401:mortality*; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D012923:Social Class; D015996:Survival Rate