Syncope and Its Impact on Occupational Accidents and Employment

The incidence of syncope peaks in early working age, yet there are few data on its impact on occupational safety and employment. The consequences of syncope in the workplace are important to establish because the lifetime prevalence of syncope is 35%, and one third of patients experience recurrent syncope within few years. Approximately 3.4 million workers are treated in emergency departments for occupational injuries in the United States each year, and globally 3.5 healthy life-years per 1000 workers are lost because of occupational injuries. About one third of occupational injuries are because of either falls or traffic accidents, which may be preventable. Syncope, characterized by a sudden loss of consciousness with subsequent spontaneous and complete recovery, could lead to an occupational accident if it occurs during working hours. A recent study showed that patients with previous syncope had almost twice the risk of motor vehicle crashes compared with the general population; however, the potential association of syncope with occupational accidents remains unknown. Besides the direct consequences of a syncope, several studies have suggested that syncope is associated with impaired quality of life comparable to that of patients with chronic disorders. Plausibly, one of the main reasons for poor quality of life after syncope could be interference with employment and work life. In 1 study, half of the patients with syncope reported that it influenced their ability to work. The impact of syncope on employment merits further research. Consequently, we analyzed data from a nationwide cohort to examine the association between syncope and risks of subsequent occupational accidents and termination of employment. 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. (Circ Cardiovasc Qual Outcomes. 2017;10:e003202. DOI: 10.1161/CIRCOUTCOMES.116.003202.)