Syncope and Its Impact on Occupational Accidents and Employment

Abstract

Background— First-time syncopal episodes usually occur in adults of working age, but their impact on occupational safety and employment remains unknown. We examined the associations of syncope with occupational accidents and termination of employment. Methods and Results— Through linkage of Danish population-based registers, we included all residents 18 to 64 years from 2008 to 2012. Among 3 410 148 eligible individuals, 21 729 with a first-time diagnosis of syncope were identified, with a median age 48.4 years (first to third quartiles, 33.0–59.5), and 10 757 (49.5%) employed at time of the syncope event. Over a median follow-up of 3.2 years (first to third quartiles, 2.0–4.5), 622 people with syncope had an occupational accident requiring hospitalization (2.1/100 person-years). In multiple Poisson regression analysis, the incidence rate ratio in the employed syncope population was higher than in the employed general population (1.44; 95% confidence interval [CI], 1.33–1.55) and more pronounced in people with recurrences (2.02; 95% CI, 1.47–2.78). The 2-year risk of termination of employment was 31.3% (95% CI, 30.4%–32.3%), which was twice the risk of the reference population (15.2%; 95% CI, 14.7%–15.7%), using the Aalen–Johansen estimator. Factors associated with termination of employment were age <40 years (incidence rate ratio, 1.48; 95% CI, 1.37–1.59), cardiovascular disease (1.20; 95% CI, 1.06–1.36), depression (1.72; 95% CI, 1.55–1.90), and low educational level (2.61; 95% CI, 2.34–2.91). Conclusions— In this nationwide cohort, syncope was associated with a 1.4-fold higher risk of occupational accidents and a 2-fold higher risk of termination of employment compared with the employed general population.

Syncope in a Working-Age Population: Recurrence Risk and Related Risk Factors

“…A recent investigation found a 1.4-fold higher risk of work accidents in subjects who suffered from recurrent syncope compared with the employed general population [7]. In addition, work accidents among syncope patients were more frequent in those working in manual labor sectors [7] that are often characterized by high risk.…”

“…However, its consequences may be serious. Indeed, the sudden loss of postural tone and consequent falls may cause severe damage to the fainter [3,29,30] and third parties when occurring during high risk activities [7,13,14]. In keeping with this hypothesis are the Health and Safety at Work in Europe Reports, suggesting that most of fatal accidents occur as a consequence of actions characterized by “loss of control”, “slipping”, ”stumbling”, and “falling”.…”

“…Even clinically benign vasovagal episodes, which account for most of the syncope [1,4,5,6], may end in a fatal event for the individual or for third parties when occurring in hazardous conditions, such as driving coaches or trucks, working close to hot materials or flames, or handling chemicals. A recent paper [7] based on a Danish nationwide cohort of syncope patients aged 18–64 years found a 1.4-fold higher risk of work accidents and a 2-fold higher risk of occupation termination in syncope patients compared to the general working population. Of interest, the incidence rate ratio of work accidents was higher in individuals who suffered from recurrent syncope [7], highlighting the crucial role played by syncope relapse in that subset of patients.…”

“…A recent paper [7] based on a Danish nationwide cohort of syncope patients aged 18–64 years found a 1.4-fold higher risk of work accidents and a 2-fold higher risk of occupation termination in syncope patients compared to the general working population. Of interest, the incidence rate ratio of work accidents was higher in individuals who suffered from recurrent syncope [7], highlighting the crucial role played by syncope relapse in that subset of patients.…”

Do implantable loop recorders impact the survival of patients with recurrent unexplained syncope?

“…Studies have shown that more than 70% of patients have anxiety or depression and require changes to daily activities such as employment or driving [6]. Syncope doubles the risk of occupational accidents termination of employment [10]. Syncope is also a well-known risk factor for falls and associated injuries; 5% of syncope patients present with a severe injury and trauma in the emergency department [11].…”