High systolic blood pressure increases the risk of obtaining a disability pension because of cardiovascular disease: a cohort study of 903 174 Swedish men.
BACKGROUND
Hypertension puts a heavy economic burden on society through large medical care expenditures and productivity losses resulting from disability and premature death. The risk of obtaining a disability pension (DP) because of cardiovascular disease (CVD) has not been explored in previous research. The aim of this study was to investigate the extent to which high systolic blood pressure (BP) among 18-year-old men increases the risk of obtaining a DP in later life, for any reason or specifically because of CVD, compared with men with normal systolic BP.


METHODS
A record linkage was performed involving several nation-wide Swedish registers. The study cohort consisted of men born between 1951 and 1970 who underwent military conscription during 1969-1994, when they were 17-20 years of age. Data on BP, weight, height and muscle strength were obtained from conscription examinations, and information on DP and the underlying International Classification of Diseases diagnosis were retrieved from the Social Insurance Office 1971-2006. Analyses were conducted by Cox proportional hazards regression models with adjustment for several confounding factors.


RESULTS
Among 903 174 men with complete data, mean follow-up time was 26.8 years and 54 524 men (6.0%) attained DP. The risk of obtaining a DP because of CVD among men with moderate/severe hypertension (systolic BP> or =160 mmHg) was moderately increased, fully adjusted hazard ratio = 1.52 (95% confidence interval=1.04-2.22) compared with men with normal systolic BP.


CONCLUSIONS
This large population-based cohort study showed that moderate/severe hypertension in young adulthood conveyed an increased risk of obtaining a DP caused by CVD. Primary prevention of hypertension and optimal early treatment of hypertension may reduce productivity losses because of DP caused by CVD.
Kark
Malin
M
Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institute, Sweden. malin.kark@ki.se
Rasmussen
Finn
F
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D017281:Cost of Illness; D004185:Disability Evaluation; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology; D018868:Insurance, Disability; D008297:Male; D008875:Middle Aged; D010415:Pensions; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D013599:Systole; D055815:Young Adult