{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:54:00Z","timestamp":1787727240040,"version":"build-2784847793"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010805","name":"Medical Research Council of Southeast Sweden","doi-asserted-by":"publisher","award":["FORSS-981466"],"award-info":[{"award-number":["FORSS-981466"]}],"id":[{"id":"10.13039\/100010805","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Cushing's disease (CD) is associated with severely impaired quality of life and shortened life expectancy. Little is known about the socioeconomic consequences of CD and their impact on long-term outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a nationwide study including 371 patients with CD (76% women), diagnosed between 1991 and 2018, and 4 matched controls per patient from the background population. Clinical data were retrieved from the national Swedish pituitary register and socioeconomic data were collected from national Swedish registers from up to 20 years before and up to 20 years after diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The proportion of patients receiving disability pensions was increased, starting 6 years before diagnosis, and increased further thereafter, mainly due to mental and musculoskeletal disorders, to reach around 20%-25% during long-term follow-up. Low educational level in patients with CD was associated with lower rates of employment and increased mortality (adjusted hazard ratio 2.5, 95% CI 1.1-5.4).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>CD is associated with low socioeconomic status that is already noticeable 6 years before diagnosis and remains high during follow-up. Low socioeconomic status, in particular low educational level, is associated with adverse outcome. The findings indicate a need for proactive rehabilitation plans as part of standard management.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejendo\/lvaf021","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T08:36:10Z","timestamp":1740040570000},"page":"159-169","source":"Crossref","is-referenced-by-count":2,"title":["Socioeconomic status and its association with outcome in patients with Cushing's disease"],"prefix":"10.1093","volume":"192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4408-6435","authenticated-orcid":false,"given":"Daniel","family":"Bengtsson","sequence":"first","affiliation":[{"name":"Department of Health, Medicine and Caring Sciences, Link\u00f6ping University , Link\u00f6ping SE-58183 ,","place":["Sweden"]},{"name":"Department of Internal Medicine, Kalmar County Hospital , Kalmar SE-39185 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"J\u00e4r\u00e5s","sequence":"additional","affiliation":[{"name":"JRS Statistics AB , Stockholm SE-11853 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4844-8336","authenticated-orcid":false,"given":"Pia","family":"Burman","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sk\u00e5ne University Hospital, Lund University , Malm\u00f6 SE-20502 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4061-6830","authenticated-orcid":false,"given":"Jeanette","family":"Wahlberg","sequence":"additional","affiliation":[{"name":"School of Medical Sciences, Department of Medicine, \u00d6rebro University, \u00d6rebro University Hospital , \u00d6rebro SE-70182 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0204-9492","authenticated-orcid":false,"given":"Oskar","family":"Ragnarsson","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sahlgrenska University Hospital , Gothenburg SE-41345 ,","place":["Sweden"]},{"name":"Department of Internal Medicine and Clinical Nutrition, University of Gothenburg , Gothenburg SE-40530 ,","place":["Sweden"]},{"name":"Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg , Gothenburg SE-40530 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"issue":"2","key":"2025030501235578100_lvaf021-B1","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1001\/jama.2023.11305","article-title":"Cushing syndrome: a review","volume":"330","author":"Reincke","year":"2023","journal-title":"JAMA"},{"issue":"2","key":"2025030501235578100_lvaf021-B2","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1111\/cen.14014","article-title":"The incidence of endogenous Cushing's syndrome in the modern era","volume":"91","author":"Wengander","year":"2019","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"6","key":"2025030501235578100_lvaf021-B3","doi-asserted-by":"publisher","first-page":"2375","DOI":"10.1210\/jc.2018-02524","article-title":"Overall and disease-specific mortality in patients with Cushing disease: a Swedish nationwide study","volume":"104","author":"Ragnarsson","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2025030501235578100_lvaf021-B4","doi-asserted-by":"publisher","first-page":"bvac045","DOI":"10.1210\/jendso\/bvac045","article-title":"Increased mortality persists after treatment of Cushing's disease: a matched nationwide cohort study","volume":"6","author":"Bengtsson","year":"2022","journal-title":"J Endocr Soc"},{"issue":"2","key":"2025030501235578100_lvaf021-B5","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1111\/joim.13056","article-title":"Psychiatric and neurocognitive consequences of endogenous hypercortisolism","volume":"288","author":"Piasecka","year":"2020","journal-title":"J Intern Med"},{"issue":"11","key":"2025030501235578100_lvaf021-B6","doi-asserted-by":"publisher","first-page":"5325","DOI":"10.1210\/jc.2019-01054","article-title":"Improvement but no normalization of quality of life and cognitive functioning after treatment for Cushing's syndrome","volume":"104","author":"Broersen","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2025030501235578100_lvaf021-B7","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1097\/EDE.0000000000000038","article-title":"Association among socioeconomic status, health behaviors, and all-cause mortality in the United States","volume":"25","author":"Nandi","year":"2014","journal-title":"Epidemiology"},{"issue":"6","key":"2025030501235578100_lvaf021-B8","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1046\/j.1365-2796.2001.00834.x","article-title":"The relationship between educational level and mortality. 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