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The socio-economic consequences of Cushing's syndrome: a nationwide cohort study

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CONTEXT: The long-term somatic and psychiatric consequences of Cushing's syndrome are well-described, but the socio-economic consequences are largely unknown.

OBJECTIVE: We studied employment status, educational level, risk of depression, and other socio-economic outcomes of Cushing's syndrome in the years before diagnosis and after surgery.

DESIGN: Nationwide register-based cohort study.

METHODS: We used a validated algorithm to identify 424 patients operated for adrenal (n=199) or pituitary Cushing's syndrome (n=225) in Denmark from Jan 1, 1986 to Dec 31, 2017. We obtained socio-economic registry data from ten years before diagnosis (year -10) to ten years after surgery (year +10) and included a sex- and age-matched reference population. We identified prognostic factors for returning to work using modified Poisson regression.

RESULTS: Compared to the reference population, the patients' employment was permanently reduced from year -6 (relative risk 0.92, 95%CI 0.84-0.99) to year +10 (RR 0.66, 95%CI 0.57-0.76). Sick leave (RR 2.15, 95%CI 1.40-3.32) and disability pension (RR 2.60, 95%CI 2.06-3.27) were still elevated in year +10. Annual income, education, parenthood, relationship status, and risk of depression were also negatively impacted, but parenthood and relationship status normalized after surgery. Among patients, negative predictors of fulltime employment after surgery included female sex, low education, comorbidity, and depression.

CONCLUSION: Cushing's syndrome negatively affects a wide spectrum of socio-economic variables many years before diagnosis of which only some normalize after treatment. The data underpin the importance of early diagnosis and continuous follow-up of Cushing's syndrome, and, not least, the pervasive health threats of glucocorticoid excess.

Translated title of the contributionSocio-økonomiske konsekvenser af Cushings syndrom: et national kohortestudie
Original languageEnglish
JournalThe Journal of clinical endocrinology and metabolism
Volume107
Issue7
Pages (from-to)e2921–e2929
Number of pages9
ISSN0021-972X
DOIs
Publication statusPublished - Jul 2022

Bibliographical note

© The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

    Research areas

  • Cushing's syndrome, hypercortisolism, Pituitary ACTH Hypersecretion, Adrenal Gland Neoplasms, Socio-economic analysis, employment, Income

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