Work Loss and Income before and after diagnosis of Addison's Disease: A Population-based Longitudinal Study.

Abstract

The impact of autoimmune Addison's disease (AAD) on work ability and income over time remains unclear. To evaluate differences and temporal trends in income and lost workdays among patients with AAD before and after diagnosis, versus matched general population comparators. Nationwide, register-based cohort study. Sweden. We linked the Swedish Addison Register with national health registers to identify 716 working-age individuals (20-62 years) with incident AAD 2003-2019 and 3,271 general population comparators matched by sex, age, county, calendar year, and education level. Annual work loss, taxable earnings, and disposable income were examined over a 10-year period around diagnosis using linear (work loss) and quantile (earnings, income) regression. Patients with AAD had significantly more work loss than comparators from one year before to three years after diagnosis, with the largest difference the year after diagnosis (mean difference: 30.5 days; 95% CI: 22.9-38.0). Median taxable earnings were lower in patients with AAD one year before (median difference: -1,107 $; 95% CI: -2,042 to -173; p = 0.02) and one year after diagnosis (-1,105 $; 95% CI: -2,166 to -43; p = 0.04). Disposable income was also reduced one year after diagnosis (median difference: -1,084 $; 95% CI: -1,813 to -354; p = 0.004). In AAD, increased work loss and reduced earnings and income were concentrated around diagnosis, peaking in the year after. Reassuringly, both absence from work and income were normalized within four years following diagnosis.