Disability Pension at the Time of Coronary Revascularisation Is Associated with Higher Five-Year Mortality; A Swedish Nationwide, Register-Based Prospective Cohort Study.
BACKGROUND
Although coronary revascularisation by coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are common procedures, little is known regarding disability pension (DP) at the time of coronary revascularisation and its association with mortality. The aim was to investigate the five-year mortality following a first coronary revascularisation among women and men on DP, compared with those not on DP at the time of intervention, accounting for socio-demographic and medical factors.


METHODS
A nationwide prospective population-based cohort study was conducted, using national registers including 70,040 patients (80% men), aged 30-64 years, with a first CABG (n = 24,987; 36%) or PCI (n = 45,053; 64%) during 1994-2006 in Sweden, who were alive 30 days after the intervention. The main outcome was all-cause and cause-specific mortality within five years or through 31 December 2006, following CABG and PCI, and the exposure was DP at the time of a first coronary revascularisation. Information on DP, patient characteristics, date and cause of death was obtained from nationwide registers. Hazard ratios (HR) with 95% confidence intervals (CI) for the outcome were estimated, using Cox proportional hazard regression analyses. All analyses were stratified by type of intervention and gender.


RESULTS
Four percent died following coronary revascularisation. Cardiovascular disease was the most common cause of death (54%), followed by neoplasms (25%). Regardless of type of intervention, gender and after multivariable adjustments, patients on DP had a higher HR for five-year mortality compared with those not on DP at time of revascularisation (CABG: women HR 2.14; 95% CI 1.59-2.89, men HR 2.09; 1.84-2.38, PCI: women HR 2.25; 1.78-2.83, men HR 1.95; 1.72-2.21). Young women on DP at the time of PCI had a substantially higher HR (HR 4.10; 95% CI: 2.25-7.48).


CONCLUSIONS
Patients on DP at the time of first coronary revascularisation had a higher five-year risk of mortality compared with those not on DP.
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
Katharina
K
Zetterström
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Analysis and Forecasts, Swedish Social Insurance Agency, Stockholm, Sweden.
Margaretha
M
Voss
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
Kristina
K
Alexanderson
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Torbjörn
T
Ivert
Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Kenneth
K
Pehrsson
AstraZeneca R&D, Mölndal, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Niklas
N
Hammar
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
Marjan
M
Vaez
D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000401:mortality; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009204:Myocardial Revascularization; D010415:Pensions; D062645:Percutaneous Coronary Intervention; D011159:Population Surveillance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D013548:Sweden / Q000453:epidemiology