Impact of gender, co-morbidity and social factors on labour market affiliation after first admission for acute coronary syndrome. A cohort study of Danish patients 2001-2009

Abstract

Background: Over the last decades survival after acute coronary syndrome (ACS) has improved, leading to an increasing number of patients returning to work, but little is known about factors that may influence their labour market affiliation. This study examines the impact of gender, co-morbidity and socio-economic position on subsequent labour market affiliation and transition between various social services in patients admitted for the first time with ACS.

Methods: From 2001 to 2009 all first-time hospitalisations for ACS were identified in the Danish National Patient Registry (n = 79,714). For this population, data on sick leave, unemployment and retirement were obtained from an administrative register covering all citizens. The 21,926 patients, aged 18-63 years, who had survived 30 days and were part of the workforce at the time of diagnosis were included in the analyses where subsequent transition between the above labour market states was examined using Kaplan-Meier estimates and Cox proportional hazards models.

Findings: A total of 37% of patients were in work 30 days after first ACS diagnosis, while 55% were on sick leave and 8% were unemployed. Seventy-nine per cent returned to work once during follow-up. This probability was highest among males, those below 50 years, living with a partner, the highest educated, with higher occupations, having specific events (NSTEMI, and percutaneous coronary intervention) and with no co-morbidity. During five years follow-up, 43% retired due to disability or voluntary early pension. Female gender, low education, basic occupation, co-morbidity and having a severer event (invasive procedures) and receiving sickness benefits or being unemployed 30 days after admission were associated with increased probability of early retirement.

Conclusion: About half of patients with first-time ACS stay in or return to work shortly after the event. Women, the socially disadvantaged, those with presumed severer events and co-morbidity have lower rates of return.

Figure 1. Patients with acute coronary syndrome's transition between various social services.

Work, sick leave and unemployment cover persons in the workforce (3 left boxes with bold lines) at baseline for those aged 18–64 years. The lower box with dotted lines refers to early retirement independent of reason (disability or voluntary), which is an irreversible state, where persons are considered to leave the workforce forever (main outcome). Percentages in bold refer to how many patients ever experience the event during follow-up, while percentages in brackets refer to how many experience the transition as the first event after baseline.

Figure 2. Kaplan-Meier estimates for early retirement after acute coronary syndrome by gender.

Figure 3. Kaplan-Meier estimates for return to work after acute coronary syndrome by gender.