Diagnosis-specific sick leave as a risk marker for disability pension in a Swedish population

OBJECTIVE: To investigate diagnosis-specific sick leave as a risk marker for subsequent disability pension. DESIGN: A prospective population based cohort study. Exposure to a new medically certified sick leave episode of more than seven days by diagnosis during 1985 was examined in relation to incident cause-specific disability pension through 1996. PARTICIPANTS: The total non-retired population of one Swedish county aged 16 to 49 years, alive and not in receipt of a disability pension at the end of 1985 (176 629 persons; 51% men). MAIN RESULTS: To eliminate confounding by sick leaves that translate into a disability pension, the follow up period for disability pension was started five years after the assessment of sick leave. After adjustment for demographic characteristics, the risk of disability pension from mental disorders was 14.1 times higher (95% confidence interval (CI), 12.1 to 16.4) for those with sick leave for mental disorders than for those with no sick leave. The corresponding hazard ratio for sick leave and disability pension within diagnostic category was 5.7 (95% CI, 5.3 to 6.2) for musculoskeletal diseases and 13.0 (7.7 to 21.8) for gastrointestinal diseases. Irrespective of diagnoses, the hazard ratio for sick leave and disability pension was 3.0 (2.9 to 3.1). CONCLUSIONS: Sick leave may provide an important risk marker for identifying groups at high risk of a disability pension, especially for psychiatric diagnoses.     

Predictive factors for long-term sick leave and disability pension among frequent and normal attenders in primary health care over 5 years

OBJECTIVES: To find predictive factors for long-term sick leave (SL) and disability pension (DP) among frequent attenders (FAs) and normal attenders (NAs) in primary health care. STUDY DESIGN: A cohort study with follow-up over 5 years. METHODS: Groups of FAs and NAs were followed over 5 years. Information about background, situation, sociodemography, life events, social support and sense of coherence were gathered at baseline. Multiple logistic regression analysis was used to determine the influence of each variable on long-term SL and receipt of a DP. RESULTS: During the study period, 18.9% of FAs received long-term SL/DP compared with 6% of NAs. Chronic disease was a predictive factor for long-term SL/DP among FAs [odds ratio (OR) 7.0] and NAs (OR 3.4). Among FAs, a life event was also a predictive factor (OR 2.1). Each additional life event increased the ratio of FAs with long-term SL/DP by 110%. Conflicts and losses had the greatest negative effects on FAs. CONCLUSIONS: FAs are a high-risk group for long-term SL/DP. Besides chronic disease, a life event was the only predictive factor for long-term SL/DP among FAs. These findings indicate that FAs are a vulnerable group for stressful events. Consequently, healthcare personnel should take more notice of life events among FAs.     

Activities and sources of income after a period of long-term sick leave - a population-based prospective cohort study

ABSTRACT: BACKGROUND: There is limited knowledge about what happens to people after long-term sick leave. The aim of this report was to conduct a prospective study of individuals who were on prolonged sick leave during a particular year, considering their activities and sources of income during subsequent years. To enable comparison of different time periods, we used three cohorts of individuals with different starting years. METHODS: Using data from national registers, three separate cohorts were constructed that included all people living in Sweden who were 20-64 years of age (>5 million) in the years 1995, 2000 and 2005, respectively. The individual members of the cohorts were classified into the following groups based on their main source of income and activity in 1995-2008: on long-term sick leave, employed, old-age pensioner, long-term unemployed, disability pensioner, on parental leave, social assistance recipient, student allowance recipient, deceased, or emigrated. RESULTS: Most individuals on long-term (> 6 months) sick leave in 1995 were not employed 13 years later. Only 11% of the women and 13% of the men were primarily in employment after 13 years. Instead, a wide range of alternatives existed, for example, many had been granted disability pension, and about 10% of the women and 17% of the men had died during the follow-up period. A larger proportion of those with long-term sick leave were back in employment when 2005 was the starting year for the follow-up. CONCLUSIONS: The low future employment rates for people on long-term sick leave may seem surprising. There are several possible explanations for the finding: The disorders these people may have, might have entailed longstanding difficulties on the labor market. Besides, long-term absence from work, no matter what its causes were, might have worsen the chances of further employment. The economic cycles may also have been of importance. The improving labor market during later years seems to have improved the chances for employment among those earlier on long-term sick leave.     

Mortality in relation to disability pension: findings from a 12-year prospective population-based cohort study in Sweden

AIMS: Knowledge is limited regarding the association between disability pension (DP) and mortality. The aim of this study was to examine the relative risk (RR) of mortality associated with DP among women and men of different ages over a 12-year period, for DP in general, and for full-time DP, part-time DP, and DP for labour-market reasons, respectively. METHODS: A prospective cohort study was performed covering the total population of the Swedish county of Osterg?tland aged 16-64 years in December 1984 (n = 245,704) followed up from 1985 to 1996. The RR of mortality was analysed in relation to DP, age, and gender using a Cox proportional hazards model. RESULTS: The RR of mortality was higher for DP recipients than for individuals without DP, and this was true for both women (RR 2.79, 95% confidence interval (CI) 2.63 to 2.96) and men (RR 2.97, CI 2.83 to 3.11), and for all age groups. The RR of mortality was highest among the youngest DP recipients. The RR of mortality was especially high the first year of DP and remained elevated over the whole follow-up period. The RR of mortality among part-time DP recipients was lower than among full-time DP recipients and was significantly higher than seen for non-DP recipients. Individuals granted DP for labour-market reasons exhibited much lower RR of mortality than all other DP recipients. CONCLUSIONS: Further research is needed to investigate which factors explain the very high RR of mortality among disability pensioners.     

Incidence of and reasons for disability pension in a Swedish cohort of middle-aged men

The prevalence of disability pensions was investigated among5 birthyear cohorts (1926–30) of male residents in Malmö,Sweden (N=7,697). They were invited to a screening programmein the mid-1970s. Disability pension and mortality data wereidentified from national computerized databases. At the endof follow-up (the calendar year oftheir 58th birthday), 1,391(18%) had been granted a disability pension and 655 (9%) haddied. The most frequent causes for disability pension, accountingfor 74% of the cases, were musculoskeletal diseases, mentaldisorders (including alcohol dependence) and diseases of thecirculatory system. Alcohol dependence was more common amongthose who refrained from participating in the screening programme,while musculoskeletal and neurological diseases were more commonamong those who did participate. Mental disorders (includingalcohol dependence) predominated in younger and musculoskeletaldiseases in older age groups. Both alcohol dependence and non-participationin health screening were related to the risk of a disabilitypension. To be used for identifying subjects at risk for disabilitypension, health screenings should be designed to reach as manyof the usual non-participants as possible and should be targetedat men in younger ages.     

Experiences of participation in occupations of women on long-term sick leave

Abstract

The majority of individuals on long-term sick leave experience negative effects in their lives associated with limitations on their participation, decreased income, and feelings of guilt. The aim was to describe the experiences that women on long-term sick leave have of participation in occupation. Unstructured interviews were used for the data collection, which involved eight women; a grounded theory approach was used. The results showed that the women's long-term sick leave changed their roles, daily habits, and routines, and their participation in occupations was negatively influenced. Their occupational performance also diminished, thereby having a negative influence on their social relationships. However, over time they came to find different strategies that contributed to a feeling of occupational competence and thence they started to rebuild their occupational identity. Through this began the process of occupational adaptation, which resulted in an increased experience of participating in occupation. As a conclusion, it should be noted that occupational therapy interventions should be directed at women on long-term sick leave at an early stage in the rehabilitation process to address the adaptation of their roles, habits, routines, and social environment.     

Experiences of participation in occupations of women on long-term sick leave

The majority of individuals on long-term sick leave experience negative effects in their lives associated with limitations on their participation, decreased income, and feelings of guilt. The aim was to describe the experiences that women on long-term sick leave have of participation in occupation. Unstructured interviews were used for the data collection, which involved eight women; a grounded theory approach was used. The results showed that the women's long-term sick leave changed their roles, daily habits, and routines, and their participation in occupations was negatively influenced. Their occupational performance also diminished, thereby having a negative influence on their social relationships. However, over time they came to find different strategies that contributed to a feeling of occupational competence and thence they started to rebuild their occupational identity. Through this began the process of occupational adaptation, which resulted in an increased experience of participating in occupation. As a conclusion, it should be noted that occupational therapy interventions should be directed at women on long-term sick leave at an early stage in the rehabilitation process to address the adaptation of their roles, habits, routines, and social environment.     

Predictors of disability pension over a 10-year period for men and women

AIMS: The number of people leaving the labour market with a disability pension is high and knowledge regarding risk factors is limited. The aim of this study was to explore work- and non-work-related predictors of disability pension among men and women and to estimate to what extent the gender difference in retirement rate could be explained by factors in and outside work. METHODS: A random sample of 5,940 employees registered in the Danish National Work Environment Cohort Study in 1995 was followed up with regard to labour market status in 2005 using the DREAM register, which contains data on all social transfer payments in the Danish population. Associations between disability pension and measures of ergonomic and psychosocial work environment, public employment, family status, and lifestyle were analysed by Cox regression and the difference in retirement rates adjusted separately for each group of variables. RESULTS: The results showed (a) that both men and women had a higher risk of disability pension when they had work that involved standing or if they smoked; (b) that women in addition had a higher likelihood if they were public employees, had low job security, or low social support at work; (c) that the higher rate of disability pension among women compared with men could not be explained by work environmental factors, lifestyle, or family situation. Public employment was the single factor that explained most of the difference. CONCLUSIONS: Gender differences in exposures and predictors of disability pension were found, but few explanations of the higher rate of disability pension among women.     

Risk of being granted disability pension among incident cancer patients before and after a structural pension reform: A Danish population-based,matched cohort study

ObjectiveThis study aimed to examine the risk of being granted a disability pension (DP) among incident cancer patients up to five years after diagnosis compared to a match control group, before and after the structural reform of the Danish Disability Pension Act in 2013.MethodsAll 20–60-year-old incident cancer-diagnosed individuals from 2000 to 2015 were identified in the Danish Cancer Registry. A control group, not previously diagnosed with cancer, was identified in Statistics Denmark matched by gender, age, education, and household income. Risk differences (RD) in cumulative incidence proportions of being granted a DP between cancer patients and controls were analyzed before and after the reform.ResultsIn total, 111 773 incident cancer patients and 506 904 controls were included in the study. Before reform 10 561 cancer patients and 11 231 controls were granted DP; and 2570 cancer patients and 2646 controls were granted DP after the reform. The adjusted RD of being granted DP was significantly higher for cancer patients versus controls at all time points before the reform. The RD increased the most during the first (RD 3.6, 95% CI 3.5–3.7) and second (RD 7.2, 95% CI 7.0–7.4) follow-up year and levelled off the remaining three years. After the reform, the adjusted RD were lower for all 1–5 follow-up years compared to before the reform (RD range 2.8–7.7, 95% CI 2.6–8.1).ConclusionThe 2013 reform of the Disability Pension Act reduced the risk of cancer patients being granted DP. The impact on a personal level should be further explored.     

Risk factors for sick leave due to low back pain: a prospective study

The objectives of this prospective study were to identify predictive factors for sick leave of 8 days or more due to low back pain (LBSL) and to compare them with predictive factors for low back pain with no or shorter sick leave (LB) in a cohort of French workers. The predictive factors for LBSL were a past history of low back pain (odds ratio [OR], 7.2; 95% confidence interval [CI], 4.1 to 13), a low employment grade (OR, 4.3; 95% CI, 1.7 to 11), heavy smoking (OR, 5.5; 95% CI, 2.3 to 13), a pain score different from zero (OR, 4.9; 95% CI, 2.5 to 9.7), required bending backward or forward at work every day repetitively (OR, 7.4; 95% CI, 2.3 to 23), overall social integration (OR, 2.0; 95% CI, 1.3 to 3.3), and low social support at work (OR, 3.4; 95% CI, 1.6 to 7.3). Low social support at work and bending backward or forward at work were more strongly associated with LBSL than with LB (P = 0.02 and P < 0.01, respectively). The implications of the results of this prospective study are that both the level of biomechanical exposure and the psychosocial work environment, especially social support, represents important dimensions to consider in the reduction of work absenteeism.     

Cancer in a population-based cohort of men and women in registered homosexual partnerships

Cancer patterns among broad populations of homosexual men and women have not been studied systematically. The authors followed 1,614 women and 3,391 men in Denmark for cancer from their first registration for marriage-like homosexual partnership between 1989 and 1997. Ratios of observed to expected cancers measured relative risk. Women in homosexual partnerships had cancer risks similar to those of Danish women in general (overall relative risk (RR) = 0.9, 95% confidence interval (CI): 0.6, 1.4), but only one woman developed cervical carcinoma in situ versus 5.8 women expected (RR = 0.2, 95% CI: 0.0, 0.97). Overall, men in homosexual partnerships were at elevated cancer risk (RR = 2.1, 95% CI: 1.8, 2.5), due mainly to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma (RR = 136, 95% CI: 96, 186) and non-Hodgkin's lymphoma (RR = 15.1, 95% CI: 10.4, 21.4). Anal squamous carcinoma also occurred in excess (RR = 31.2, 95% CI: 8.4, 79.8). After exclusion of Kaposi's sarcoma, non-Hodgkin's lymphoma, and anal squamous carcinoma, no unusual cancer risk remained (RR = 1.0, 95% CI: 0.8, 1.3). With anal squamous carcinoma and HIV/AIDS-associated cancers as notable exceptions in men, cancer incidence rates among homosexual persons in marriage-like partnerships are similar to those prevailing in society at large.     

Risk factors for absenteeism due to sick leave in the petroleum industry

OBJECTIVE

To identify risk factors for absenteeism among workers with sick leave in an oil company.

METHODS

A case-control study (120 cases and 656 controls) nested in a retrospective cohort study following up all employees of an oil company in the North-Northeast of Brazil from 2007 to 2009. The response variable used to represent absenteeism with sick leave was the average incidence of sick leave, defined as the ratio between total sick days and potential working days in the period. Logistic regression techniques were used to investigate the association between average incidence of sick leave > 5.0% over the period and the variables sex, position, age, time at work, shift work, smoking, arterial hypertension, body mass index, physical activity, coronary risk, sleep, glycemia, non-managed diabetes, cardiovascular, digestive, musculoskeletal, neurological and neoplastic diseases, straining body positioning during work, satisfaction at work, relationship with management, and concentrated attention at work.

RESULTS

Average incidence of sick leave higher than 5.0% in the cohort period was 15.5%. The logistic model revealed that workers with average incidence of sick leave higher than 5.0% were 2.6 times more likely to be female; 2.0 time more likely to be smokers; 1.8 time more likely to be former smokers; 2.2 times more likely to report abnormal sleep and 10.5 times more likely to report dissatisfaction with their than workers with average incidence of sick leave ≤ 5.0% in the period.

CONCLUSIONS

In this population, female gender, being a smoker or a former smoker, reporting dissatisfaction with the job and reporting abnormal sleep are good predictors of occupational absenteeism with sick leave.     

The contribution of lifestyle factors to socioeconomic differences in obesity in men and women – a population-based study in Sweden

Background: The objective was to investigate whether and to what extent the association between socioeconomic status and obesity can be explained by lifestyle factors. Methods: The relationship between socioeconomic status (SES) and obesity, and the role of lifestyle factors such as smoking, physical activity, heavy alcohol use, avoidance of dietary fat and propensity to eat fiber-rich food, was studied in a cross-sectional population-based study consisting of 6394 men and women aged 25–74 years in Värmland County in Sweden. Educational level was used for measuring SES. The contribution of the measured lifestyle factors was assessed using logistic regression models. Results: 12% of men and 14% of women were obese. Subjects with high education were leaner than subjects with low education, except among elderly women (65–74 years). Although many lifestyle factors were related to obesity and SES in this study, only a part (18–29%) of the association between educational level and obesity could be explained by the measured lifestyle factors. Physical inactivity and heavy alcohol use were the main factors contributing to this association, whereas smoking and the measured dietary attitudes towards fat and fiber had little additional effect. Conclusions: The findings of this study are consistent with the view that socioeconomic differences in obesity and its consequences can only partly be reduced by changes in lifestyle. Longitudinal studies, a more detailed investigation of the role of dietary factors and more studies including elderly subjects are, however, recommended to further elucidate the association between SES and obesity.     

Socioeconomic inequalities and disability pension in middle-aged men

BACKGROUND: The issue of inequalities in health has generated much discussion and socioeconomic status is considered an important variable in studies of health. It is frequently used in epidemiological studies, either as a possible risk factor or a confounder and the aim of this study was to analyse the relation between socioeconomic status and risk of disability pension. METHODS: Five complete birth year cohorts of middle-aged male residents in Malmo were invited to a health survey and 5782 with complete data constituted the cohort in this prospective study. Each subject was followed for approximately 11 years and nationwide Swedish data registers were used for surveillance. RESULTS: Among the 715 men (12%), granted disability pension during follow-up, three groups were distinguished. The cumulative incidence of disability pension among blue collar workers was 17% and among lower and higher level white collar workers, 11% and 6% respectively. With simultaneous adjustment for biological risk factors and job conditions, the relative risk for being granted a disability pension (using higher level white collar workers as reference) was 2.5 among blue collar workers and 1.6 among lower level white collar workers. CONCLUSIONS: Socioeconomic status, as defined by occupation, is a risk factor for being granted disability pension even after adjusting for work conditions and other risk factors for disease.     

Neighbourhood non-employment and daily smoking: a population-based study of women and men in Sweden

BACKGROUND: To examine whether neighbourhood non-employment is associated with daily smoking after adjustment for individual characteristics, such as employment status. METHODS: Cross-sectional study of a simple, random sample of 31,164 women and men aged 25-64, representative of the entire population in Sweden. Data were collected from the years 1993-2000. The individual variables included age, sex, employment status, occupation and housing tenure. Logistic regression was used in the analysis with neighbourhood non-employment rates measured at small area market statistics level. RESULTS: There was a significant association between neighbourhood non-employment rates and daily smoking for both women and men. After adjustment for employment status and housing tenure the odds ratios of daily smoking were 1.39 (95% CI = 1.22-1.58) for women and 1.41 (95% CI = 1.23-1.61) for men living in neighbourhoods with the highest non-employment rates. The individual variables of unemployment, low occupational level and renting were associated with daily smoking. CONCLUSION: Neighbourhood non-employment is associated with daily smoking. Smoking prevention in primary health care should address both individuals and neighbourhoods.