Sickness Absence in Primary Aldosteronism and References: a Longitudinal Cohort Study

OBJECTIVE: Primary aldosteronism (PA) is a common cause of hypertension and is associated with increased cardiovascular morbidity. However, its impact on work capacity remains unknown. We investigated sickness absence and disability pension among patients with PA and in matched reference groups with and without hypertension. METHODS: A nationwide eight-year longitudinal cohort study based on linked register data, including 838 individuals with PA aged 18-67 in 2019 and two matched reference cohorts with and without hypertension. Outcomes included annual proportions of individuals with sickness absence (in spells >14 days) or disability pension, mean annual net days, and trajectories of absence days. RESULTS: Patients with PA had a higher mean annual proportion with sickness absence than individuals with hypertension (21% (range: 18-23%) vs 17% (range: 17-19%) and those without hypertension (10% (range: 9-12%)). Mean annual sickness absence days were 27, 20, and 9, respectively. The combined mean annual number of sickness absence and disability pension days was similar in PA and hypertension (54 (range: 40-66) vs 53 (range: 50-57), and higher than in those without hypertension (25 (range: 22-29)). Trajectory analysis identified four patterns of absence days; 12% of patients with PA had persistently high absence, significantly associated with female sex, higher age, lower education, unmarried status, rural residence, cardiovascular disease, and treatment with mineralocorticoid receptor antagonists. CONCLUSION: 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 clinical management. OBJECTIVE: Primary aldosteronism (PA) is a common cause of hypertension and is associated with increased cardiovascular morbidity. However, its impact on work capacity remains unknown. We investigated sickness absence and disability pension among patients with PA and in matched reference groups with and without hypertension. METHODS: A nationwide eight-year longitudinal cohort study based on linked register data, including 838 individuals with PA aged 18-67 in 2019 and two matched reference cohorts with and without hypertension. Outcomes included annual proportions of individuals with sickness absence (in spells >14 days) or disability pension, mean annual net days, and trajectories of absence days. RESULTS: Patients with PA had a higher mean annual proportion with sickness absence than individuals with hypertension (21% (range: 18-23%) vs 17% (range: 17-19%) and those without hypertension (10% (range: 9-12%)). Mean annual sickness absence days were 27, 20, and 9, respectively. The combined mean annual number of sickness absence and disability pension days was similar in PA and hypertension (54 (range: 40-66) vs 53 (range: 50-57), and higher than in those without hypertension (25 (range: 22-29)). Trajectory analysis identified four patterns of absence days; 12% of patients with PA had persistently high absence, significantly associated with female sex, higher age, lower education, unmarried status, rural residence, cardiovascular disease, and treatment with mineralocorticoid receptor antagonists. CONCLUSION: 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 clinical management.