title: Disability pension after coronary revascularization: a prospective nationwide register-based Swedish cohort study.
abstract: BACKGROUND
  Scientific knowledge on disability pension (DP) after revascularization by coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) is scarce. The aim was to study the incidence of and risk factors for being granted DP in the 5 years following a first CABG or PCI, accounting for socio-demographic and medical factors.
  
  
  METHODS
  This is a nationwide population-based study using Swedish registers including all patients 30-63 years of age (n = 34,643, 16.4% women) who had a first CABG (n = 14,107) or PCI (n = 20,536) during 1994-2003. All were alive and without reintervention 30 days after the procedure and were not on DP or old-age pension. Multivariable adjusted Cox proportional hazard ratios (HR) for DP were estimated with 95% confidence intervals (CI).
  
  
  RESULTS
  In 5 years following revascularization, 32.4% had been granted DP and the hazard ratio (HR) was higher in women (HR 1.55, 95% CI 1.48-1.62), and in CABG patients compared with PCI patients (HR 1.35, 95% CI 1.30-1.40). Long-term sick leave in the year before intervention was the strongest predictor for DP following revascularization. After adjustments for socio-demographic factors and sick-leave days in the 12 months before revascularization, HR remained high in all patients with diabetes mellitus regardless of type of revascularization.
  
  
  CONCLUSIONS
  DP after coronary revascularization was common, especially among women and CABG patients. Most studied medical covariates, including mental and musculoskeletal disorders, were risk factors for future DP, especially long-term sickness absence.
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden katharina.zetterstrom@ki.se.
authors.forename: Katharina
authors.initials: K
authors.lastname: Zetterström
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Marjan
authors.initials: M
authors.lastname: Vaez
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Torbjörn
authors.initials: T
authors.lastname: Ivert
authors.affiliation: Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pehrsson
authors.affiliation: AstraZeneca R&D, Mölndal, Sweden Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Hammar
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Department of Analysis and Forecasts, Swedish Social Insurance Agency, Stockholm, Sweden.
authors.forename: Margaretha
authors.initials: M
authors.lastname: Voss
mesh_terms: D000041:Absenteeism; D000328:Adult; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010415:Pensions; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D018582:Sick Leave; D012959:Socioeconomic Factors; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome
keywords: Comorbidity; coronary revascularization; disability pension; insurance medicine; sick leave