title: Increased risk of long-term sickness absence, lower rate of return to work, and higher risk of unemployment and disability pensioning for thyroid patients: a Danish register-based cohort study.
abstract: BACKGROUND
  Little is known about how thyroid diseases affect work ability.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the risk of work disability for patients with thyroid disease compared with the general population.
  
  
  METHODS
  In a longitudinal register study, outpatients (n = 862) with nontoxic goiter, hyperthyroidism, Graves' orbitopathy (GO), autoimmune hypothyroidism, or other thyroid diseases and their matched controls (n = 7043) were observed in the years 1994-2011 in Danish national registers of social benefits, health, and work characteristics. Cox regression analyses estimated adjusted hazard ratios (HRs) for the first year after diagnosis and subsequent years.
  
  
  METHODS
  Transitions between work, long-term sickness absence, unemployment, and disability pension were measured.
  
  
  RESULTS
  Patients differed significantly from the general population with regard to sickness absence, disability pension, return from sickness absence, and unemployment. In the first year after diagnosis, higher risks of sickness absence was seen for GO (HR 6.94) and other hyperthyroid patients (HR 2.08), who also had lower probability of returning from sickness absence (HR 0.62) and higher risk of disability pension (HR 4.15). Patients with autoimmune hypothyroidism showed a lower probability of returning from sickness absence (HR 0.62). In subsequent years, GO patients had significantly higher risk of sickness absence (HR 2.08), lower probability of return from sickness absence (HR 0.51), and unemployment (HR 0.52) and a higher risk of disability pension (HR 4.40). Hyperthyroid patients also had difficulties returning from sickness absence (HR 0.71).
  
  
  CONCLUSIONS
  Thyroid patients' risk of work disability is most pronounced in the first year after diagnosis and attenuates in subsequent years. GO patients have the highest risk of work disability.
authors.affiliation: The National Research Centre for the Working Environment (M.A.N., J.P., J.B.B.), DK-2100 Copenhagen, Denmark; Department of Public Health (M.A.N., J.B.B.), Section of Social Medicine, University of Copenhagen, Copenhagen DK-1014, Denmark; Department of Medical Endocrinology (T.W., A.K.R., U.F.-R), Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark; Department of Endocrinology and Metabolism (S.J.B., L.H.), Odense University Hospital, Odense DK-5000, Denmark; and QualityMetric (an Optum company) (J.B.B.), Lincoln, Rhode Island 02865.
authors.forename: M A
authors.initials: MA
authors.lastname: Nexo
authors.forename: T
authors.initials: T
authors.lastname: Watt
authors.forename: J
authors.initials: J
authors.lastname: Pedersen
authors.forename: S J
authors.initials: SJ
authors.lastname: Bonnema
authors.forename: L
authors.initials: L
authors.lastname: Hegedüs
authors.forename: A K
authors.initials: AK
authors.lastname: Rasmussen
authors.forename: U
authors.initials: U
authors.lastname: Feldt-Rasmussen
authors.forename: J B
authors.initials: JB
authors.lastname: Bjorner
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006042:Goiter / Q000453:epidemiology; D006111:Graves Disease / Q000453:epidemiology; D006801:Humans; D006980:Hyperthyroidism / Q000453:epidemiology; D007037:Hypothyroidism / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010415:Pensions / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data; D062707:Return to Work / Q000706:statistics & numerical data; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D013959:Thyroid Diseases / Q000453:epidemiology*; D014478:Unemployment / Q000706:statistics & numerical data*; D055815:Young Adult