title: Venous thromboembolism and subsequent permanent work-related disability.
abstract: Essentials The burden of venous thromboembolism (VTE) related to permanent work-related disability is unknown. In a cohort of 66 005 individuals, the risk of work-related disability after a VTE was assessed. Unprovoked VTE was associated with 52% increased risk of work-related disability. This suggests that indirect costs due to loss of work time may add to the economic burden of VTE.
  
  
  
  Background The burden of venous thromboembolism (VTE) related to permanent work-related disability has never been assessed among a general population. Therefore, we aimed to estimate the risk of work-related disability in subjects with incident VTE compared with those without VTE in a population-based cohort. Methods From the Tromsø Study and the Nord-Trøndelag Health Study (HUNT), Norway, 66 005 individuals aged 20-65 years were enrolled in 1994-1997 and followed to 31 December 2008. Incident VTE events among the study participants were identified and validated, and information on work-related disability was obtained from the Norwegian National Insurance Administration database. Cox-regression models using age as time-scale and VTE as time-varying exposure were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for sex, body mass index, smoking, education level, marital status, history of cancer, diabetes, cardiovascular disease and self-rated general health. Results During follow-up, 384 subjects had a first VTE and 9862 participants were granted disability pension. The crude incidence rate of work-related disability after VTE was 37.5 (95% CI, 29.7-47.3) per 1000 person-years, vs. 13.5 (13.2-13.7) per 1000 person-years among those without VTE. Subjects with unprovoked VTE had a 52% higher risk of work-related disability than those without VTE (HR, 1.52; 95% CI, 1.09-2.14) after multivariable adjustment, and the association appeared to be driven by deep vein thrombosis. Conclusion VTE was associated with subsequent work-related disability in a cohort recruited from the general working-age population. Our findings suggest that indirect costs because of loss of work time may add to the economic burden of VTE.
authors.affiliation: K.G.Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway. sigrid.brakkan@uit.no.|Hematological Research Group (HERG), Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway. sigrid.brakkan@uit.no.|Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway. sigrid.brakkan@uit.no.
authors.forename: S K
authors.initials: SK
authors.lastname: Braekkan
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Grosse
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Okoroh
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Tsai
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: S C
authors.initials: SC
authors.lastname: Cannegieter
authors.affiliation: Department of Hematology, Trondheim University Hospital, Trondheim, Norway.
authors.forename: I A
authors.initials: IA
authors.lastname: Naess
authors.affiliation: HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Krokstad
authors.affiliation: K.G.Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.|Hematological Research Group (HERG), Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.|Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
authors.forename: J-B
authors.initials: JB
authors.lastname: Hansen
authors.affiliation: Research Group Epidemiology of Chronic Diseases, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
authors.forename: F E
authors.initials: FE
authors.lastname: Skjeldestad
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications; D015331:Cohort Studies; D006233:Persons with Disabilities; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009664:Norway; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000453:epidemiology*; D020246:Venous Thrombosis / Q000150:complications; D055815:Young Adult
keywords: deep vein thrombosis; disability; risk; venous thromboembolism