The Socioeconomic Consequences of Cushing’s Syndrome: A Nationwide Cohort Study

Abstract

Abstract Context The long-term somatic and psychiatric consequences of Cushing’s syndrome are well-described, but the socioeconomic consequences are largely unknown. Objective We studied employment status, educational level, risk of depression, and other socioeconomic 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 January 1, 1986 to December 31, 2017. We obtained socioeconomic registry data from 10 years before diagnosis (year −10) to 10 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 (RR) 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 full-time employment after surgery included female sex, low education, comorbidity, and depression. Conclusion Cushing’s syndrome negatively affects a wide spectrum of socioeconomic 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.