Sickness absence in primary aldosteronism and in references: a Swedish longitudinal cohort study

Background

Primary aldosteronism (PA) is a common cause of hypertension and is associated with higher cardiovascular and renal morbidity, however, its impact on sickness absence is unknown.

Aim

To explore sickness absence (SA) and disability pension (DP) in patients with PA and in matched reference groups with and without hypertension.

Methods

An 8-year longitudinal cohort study using linked Swedish register data. We identified 838 patients with PA, aged 18–67 years in 2019 and two matched reference groups with (N = 8380) and without hypertension (N = 8380), respectively. Outcomes included annual rates with SA (in spells >14 days) or DP, mean annual net days, and trajectories of SADP days. Odds ratios (OR) of sociodemographics, morbidities, and treatments, respectively, were calculated for trajectory membership.

Results

Patients with PA had a higher mean annual proportion with SA than patients with hypertension (21% vs 17%) and people without hypertension (10%). Mean annual SA days were 27, 20, and 9, respectively. Although DP was less prevalent in PA, the combined annual number of SA and DP days was similar in PA and hypertension (54 vs 53), respectively, and higher than in those without hypertension (25). Trajectory analysis identified four patterns of SADP days/year among patients with PA; 12% had persistently high SADP days. Belonging to this trajectory was associated with female sex (OR 2.0 (95%CI 1.2-3.3)), higher age (>50 years OR > 2), no university education (OR > 2), unmarried (OR: 2.0), rural residence (OR 2.0), cardiovascular disease (OR 2.5), and treatment with mineralocorticoid receptor antagonists (OR 2.3).

Conclusions

PA is associated with substantial and sustained sickness absence and disability pension, comparable to that observed in hypertension and higher than in individuals without hypertension. These findings extend the clinical impact of PA beyond cardiovascular morbidity and highlight the importance of considering work capacity in its management.

Key messages

• While most PA patients maintained low levels of sickness absence and disability pension (SADP), a notable subgroup experienced persistent long-term SADP.

• The results extend PA aspects beyond traditional clinical outcomes, highlighting its broader societal and functional impact. More knowledge and focus is needed on how to preserve their work capacity.