title: Hypothyroidism is a predictor of disability pension and loss of labor market income: a Danish register-based study.
abstract: BACKGROUND
  Hypothyroidism is associated with an increased somatic and psychiatric disease burden. Whether there are any socioeconomic consequences of hypothyroidism, such as early retirement or loss of income, remains unclarified.
  
  
  OBJECTIVE
  Our aim was to examine, compared with a matched control group, the risk of receiving disability pension (before the age of 60) and the effect on labor market income in patients diagnosed with hypothyroidism.
  
  
  METHODS
  This was an observational register-based cohort study. By record linkage between different Danish health registers, 1745 hypothyroid singletons diagnosed before the age of 60 were each matched with 4 non-hypothyroid controls and followed for a mean of 5 (range 1-31) years. Additionally, we included 277 same-sex twin pairs discordant for hypothyroidism. The risk of disability pension was evaluated by the Cox regression analysis. Changes in labor market income progression over 5 years were evaluated using a difference in difference model.
  
  
  RESULTS
  With a hazard ratio of 2.24 (95% confidence interval = 1.73-2.89), individuals diagnosed with hypothyroidism had a significantly increased risk of disability pension. This remained significant when adjusting for educational level and comorbidity (hazard ratio = 1.89; 95% confidence interval = 1.42-2.51). In an analysis of labor market income, 2 years before compared with 2 years after the diagnosis of hypothyroidism, the hypothyroid individuals had on average a €1605 poorer increase than their euthyroid controls (P < .001). Essentially similar results were found in the twin population.
  
  
  CONCLUSIONS
  A diagnosis of hypothyroidism before the age of 60 is associated with loss of labor market income and an 89% increased risk of receiving a disability pension.
authors.affiliation: Department of Endocrinology and Metabolism, Odense University Hospital, 5000 Odense C, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Thvilum
authors.forename: Frans
authors.initials: F
authors.lastname: Brandt
authors.forename: Thomas Heiberg
authors.initials: TH
authors.lastname: Brix
authors.forename: Laszlo
authors.initials: L
authors.lastname: Hegedüs
mesh_terms: D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000191:economics* / Q000453:epidemiology*; D007182:Income / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010415:Pensions / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012042:Registries / Q000706:statistics & numerical data; D012179:Retirement / Q000191:economics / Q000706:statistics & numerical data