October 18, 2016
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VTE linked to permanent disability, pension reliance

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Working-aged individuals who experienced venous thromboembolism had a high likelihood of permanent work-related disability, according to a cohort study conducted in Norway.

Survivors of VTE remain at risk for recurrence and other long-term complications, such as post-thrombotic syndrome and pulmonary hypertension.

“Even though it is plausible to assume that chronic complications of VTE would affect functional activities and working ability, the long-term effect of VTE on activity limitations or disability has been scarcely investigated,” Sigrid K. Brækkan, PhD, epidemiologist in the department of clinical medicine at University of Tromsø, in Norway, and colleagues wrote. “To the best of our knowledge, a population-based study addressing the long-term association between VTE and work-related disability has not been performed.”

Thus, Brækkan and colleagues evaluated the association between first VTE and work-related disability in a cohort recruited from the general population of Norway.

The researchers evaluated data from 66,005 individuals aged 20 years to 65 years (mean age at inclusion, 41.3 ± 11.2 years; 51.2% women) from two population-based health surveys conducted in Norway between 1994 and 1997.

Incident VTE events were identified from hospital discharge diagnosis registries and validated by trained personal. The researchers classified VTE events as PE — with or without concurrent DVT — or DVT without PE, and as provoked or unprovoked.

The researchers determined work-related disability status by accessing disability pension data from the Norwegian National Insurance Administration. Disability pensions are granted to individuals whose earning ability has been permanently impaired by at least 50% due to illness, disease, injury or disability.

The mean follow-up was 12.3 years.

A total of 384 individuals experienced a VTE event during follow-up. These individuals tended to be older (mean age, 45.1 ± 9.8 years vs. 41.3 ± 11.2 years), have a higher BMI (26.9 ± 4.3 vs. 25.6 ± 3.9) and were more likely to have paid work (73.7% vs. 66.2%).

A greater proportion of those who developed VTE had histories of cancer (4.7% vs. 1.9%) and cardiovascular disease (3.9% vs. 1.8%).

A total of 9,862 individuals received a disability pension during follow-up, including 72 (19%) individuals with VTE. Individuals with VTE who received a disability pension tended to be older (mean, 55.5 ± 6 years vs. 50.5 ± 10.2 years), have DVTs (72.2% vs. 64.1%) and have unprovoked VTEs (50% vs. 44.2%).

The incidence ratio (IR) of work-related disability per 1,000 person-years was 37.5 (95% CI, 29.7-47.3) among individuals with VTE, compared with 13.5 (95% CI, 13.2-13.7) for those without VTE.

An age- and sex-adjusted analysis showed that individuals with VTE had a 62% higher likelihood of work-related disability than those without VTE (HR = 1.62; 95% CI, 1.29-2.04).

A subgroup analysis showed that individuals with DVT had an 80% higher risk (HR = 1.8; 95% CI, 1.37-2.63) of permanent work-related disability than those without DVT. Although the risk for work-related disability among individuals with PE was increased, it did not reach statistical significance.

Further, individuals with unprovoked VTE had a 67% higher risk (HR = 1.67; 95% CI, 1.19-2.34) for work-related disability than those without, which remained significant after adjustments (HR = 1.52; 95% CI, 1.09-2.14).

The researchers acknowledged study limitations, including their lack of data on post-thrombotic syndrome or recurrence during follow-up. Further, the researchers did not have access to data on concurrent diseases — such as cancer or cardiovascular disorders — during follow-up.

“We have, for the first time, shown that VTE was associated with subsequent work-related disability in a cohort recruited from the general working-age population,” Brækkan and colleagues wrote. “Our findings suggest that indirect costs because of loss of work time add to the economic burden of VTE.” – by Cameron Kelsall

Disclosure: The researchers report no relevant financial disclosures.