Klas Gustafsson

Consequences of sickness presence and sickness absence on health and work ability: A Swedish prospective cohort study

ObjectiveTo determine whether self-reported sickness presence (SP) and self-reported sickness absence (SA) are specific risk factors for future health problems or reduced work ability in the active workforce.Materials and MethodsThe study population consisted of a cohort based on a random sample (n = 2181) with data for 2004, 2005, and 2006. The subjects were employees aged from 25 to 50 years in 2004. Cross-tabulations were calculated to identify significant background factors (sex, age, education, socioeconomic position), work factors (work demands, control, adjustment latitude), and outcome factors. Block-wise multiple logistic regression analyses were performed for outcome factors (SP, SA, self-rated health, physical complaints, work ability, mental well-being).ResultsSA and SP were found to have negative health consequences; this was particularly pronounced for those with frequent SP or SA. There was a dose-response relationship between the degree of SA, SP and the different health outcomes. The health risks remained, after control for background factors, prior working conditions and initial health. SP also appeared to lead to SA, whereas SA did not have a significant impact on future SP.ConclusionsThe results suggest that both SP and SA are strong predictors of future poor health, physical complaints, low mental well-being and low work ability. The detrimental influence of frequent SP was most pronounced in relation to work ability and physical complaints, although all of the measured health factors were affected. The negative effects of SA on the different health outcomes were similar.

Sickness presence, sickness absence, and self-reported health and symptoms

Purpose - The purpose of this paper is to compare sickness presence (SP) and sickness absence (SA) regarding the strength of their relationship to health/ill-health. In a previous Canadian study a ...

Social integration, Socioeconomic Conditions and Type of ill Health Preceding Disability Pension in Young Women : a Swedish Population Based Study

BackgroundDisability pension has increased in recent decades and is seen as a public health and socioeconomic problem in Western Europe. In the Nordic countries, the increase has been particularly steep among young women.PurposeThe aim was to analyze the influence of low social integration, socioeconomic risk conditions and different measures of self-reported ill health on the risk of receiving disability pension in young women.MethodThe study comprised all Swedish women born in 1960 to 1979, who had been interviewed in any of the annual Swedish Surveys of Living Conditions (1990–2002). The assumed predictors were related to disability pension by Cox proportional hazard regression. The mean number of years of follow-up for the 10,936 women was 7xa0years (SD 3.8), and the study base was restricted to the ages 16 to 43xa0years of age.ResultsAn increased risk of receiving a disability pension was found among lone women, those who had sparse contacts with others, job-seeking women, homemakers, as well as women with low education, and poor private financial situations. A tenfold increase in the risk of receiving a disability pension was found among women reporting a long-standing illness and poor self-rated health, compared to women without a long-standing illness and good self-rated health. Psychiatric diagnoses and symptoms/unspecified illness were the strongest predictors of disability pension, particularly before 30xa0years of age.ConclusionThe study suggests that weak social relations and weak connections to working life contribute to increase the risk of disability pension in young women, also after control for socioeconomic conditions and self-reported ill health. Self-rated health was the strongest predictor, followed by long-standing illness and not having a job (job seekers and homemakers).

Peripheral labour market position and risk of disability pension : a prospective population-based study

Objective To investigate what impact individuals’ position in a labour market core–periphery structure may have on their risk of disability pension (DP) in general and specifically on their risk of DP based on mental or musculoskeletal diagnoses. Methods The study comprised 45u2005567 individuals who had been interviewed for the annual Swedish Surveys of Living Conditions (1992–2007). The medical DP diagnoses were obtained from the Swedish Social Insurance Agency (1993–2011). The assumed predictors were studied in relation to DP by Coxs proportional hazards regression. The analyses were stratified on sex and age, controlling for social background and self-reported long-standing illness at baseline. Results All three indicators underlying the categorisation of the core–periphery structure: employment income, work hours and unemployment, increased the risk of DP in all strata. The risk of DP tended to increase gradually the more peripheral the labour market position was. The risk estimates for DP in general and for DP based on mental diagnoses were particularly high among men aged 20–39 years. Conclusions The core–periphery position of individuals, representing their labour market attachment, was found to be a predictor of future DP. The association was most evident among individuals below 40u2005years of age with regard to DP based on mental diagnoses. This highlights the need for preventative measures that increase the participation of young people in working life.

Disability, sickness, and unemployment benefits among long-term sickness absentees five years before, during, and after a multidisciplinary medical assessment.

Aim: The aim was to describe how a multidisciplinary medical assessment changed the distribution of long-term sickness absentees between three different forms of social security support during a period of eleven years. Methods: The study group (n = 1002) consisted of persons on long-term sickness absence who were referred to a multidisciplinary medical assessment by the Social Insurance Office in Stockholm, Sweden between 1998 and 2007. Register data from the years 1993–2008 were linked to the study group. A calculation was provided for the number of days per person and year on unemployment benefits, sickness benefits, and disability pension, five years before, during, and five years after the assessment. Also, differences in the average number of days per person and year were calculated with one-way analysis of variance. Results: The number of days on sickness benefits increased up to the time of multidisciplinary medical assessment, from 69 to 218 days on average. After the assessment there was a decrease in the average number of days on sickness benefits, from 218 to 16 days. Before the assessment the number of days on disability pension was 21, but this increased after the assessment from 104 days to an average of 272 days five years after the assessment. There were age differences regarding number of compensated days, and these were particularly pronounced for disability days after the assessment. Further, there were significant differences between types of diagnosis in relation to average days on disability pension after the assessment. Conclusion: The study shows that after a multidisciplinary medical assessment there is a rapid increase in disability pension and a dramatic decrease in sickness benefits. The results indicate that for a large number of persons, a Social Insurance Office referral to an assessment does not improve their chances of returning to work, but rather seems to justify disability pension.

Hearing difficulties, ear-related diagnoses and sickness absence or disability pension - a systematic literature review

BackgroundHearing difficulties is a large public health problem, prognosticated to be the ninth leading burden of disease in 2030, and may also involve large consequences for work capacity. However, research regarding sickness absence and disability pension in relation to hearing difficulties is scarce. The aim was to gain knowledge about hearing difficulties or other ear-related diagnoses and sickness absence and disability pension through conducting a systematic literature review of published studies.MethodsStudies presenting empirical data on hearing difficulties or ear-related diagnoses and sick leave or disability pension, published in scientific peer-reviewed journals, were included. Studies were sought for in three ways: in literature databases (Pub-Med, Embase, PsycInfo, SSCI, and Cochrane) through March 2011, through scrutinising lists of references, and through contacts. Identified publications were assessed for relevance and data was extracted from the studies deemed relevant.ResultsA total of 18 studies were assessed as relevant and included in this review, regardless of scientific quality. Fourteen studies presented empirical data on hearing difficulties/ear diagnoses and sick leave and six on these conditions and disability pension. Only two studies presented rate ratios or odds ratios regarding associations between hearing difficulties and sick leave, and only two on hearing difficulties and risk of disability pension. Both measures of hearing difficulties and of sick leave varied considerable between the studies.ConclusionsRemarkably few studies on hearing difficulties in relation to sickness absence or disability pension were identified. The results presented in them cannot provide evidence for direction or magnitude of potential associations.

Future risk for disability pension among people with sickness absence due to otoaudiological diagnoses: a population-based cohort study with a 12-year follow-up.

Hearing difficulties is a growing public health problem and more knowledge of consequences of those difficulties in working life is warranted. Aims: To study the future risk of being granted a disability pension (DP) among people with sickness absence with an otoaudiological diagnoses (OAD) compared to other sickness absentees. Methods: A population-based prospective cohort study of all 40,786 people in a Swedish county who in 1985 were aged 16—64 and had a new sick-leave spell >7 days. Those were followed for 12 years with regard to DP. Hazard ratios (HR) + 95% confidence intervals (CI) of being granted DP was calculated among those with sick leave due to OAD compared to people with sickness absence with other diagnoses. Results: In 1985, 515 people had a new sick-leave spell with an OAD. Twelve years later, 36% of those had been granted DP, compared to 24% of all other sickness absentees. Their HR for DP was 1.42 (95% CI 1.23—1.64) adjusting for gender and age. Compared to men, women with an OAD had a HR of DP of 1.24 (95% CI 0.90—1.71), when adjusted for age. The HR for DP regarding those aged>45 years and sickness absent with OAD was 2.63 (95% CI 1.95—3.55) compared to the sickness absentees with OAD below 45 years of age, adjusted for gender. Conclusions: The risk for future DP was more than 40% higher among those initially on sickness absence due to OAD than among other sickness absentees.

Does Social Isolation and Low Societal Participation Predict Disability Pension? A Population Based Study

Purpose The aim was to examine the potential influence of social isolation and low societal participation on the future risk of receiving disability pension among individuals in Sweden. A specific aim was to describe differences depending on disability pension diagnoses, and how the results were modified by sex and age. Method The study comprised representative samples of Swedish women and men, who had been interviewed in any of the annual Swedish Surveys of Living Conditions between 1990 and 2007. Information on disability pension and diagnoses was added from the Swedish Social Insurance Agency’s database (1991-2011). The mean number of years of follow-up for the 53920 women and men was twelve years (SD 5.5), and the study base was restricted to the ages 20 to 64 years of age. The predictors were related to disability pension by Cox’s proportional hazards regression. Results Social isolation and low societal participation were associated with future disability pension also after control for age, year of interview, socio demographic conditions and self reported longstanding illness. Lone individuals were at increased risk of disability pension, and the effect of living without children was modified by sex and age. An increase in risk was particularly noticeable among younger women who reported that they had sparse contacts with others, and no close friend. Both women and men who reported that they did not participate in political discussions and who could not appeal on a decision by a public authority were also at increased risk. The effects of social isolation were mainly attributed to disability pension with mental diagnoses, and to younger individuals. Conclusions The study suggests that social isolation and low societal participation are predictors of future disability pension. Social isolation and low societal participation increased particularly the risk of future disability pension in mental diagnoses among younger individuals.

Interaction Effects of Social Isolation and Peripheral Work Position on Risk of Disability Pension: A Prospective Study of Swedish Women and Men

Purpose The study examines various combinations of levels of social isolation in private life and peripheral work position as predictors of disability pension (DP). A second aim was to test the potential interaction effects (above additivity) of social isolation and peripheral work position on the future risk of DP, and to provide results for men and women by age. Method The study was based on a sample of 45567 women and men from the Swedish population who had been interviewed between 1992 and 2007. Further information on DP and diagnoses was obtained from the Swedish Social Insurance Agency’s database (1993–2011). The studied predictors were related to DP using Cox’s proportional hazard regression. The analyses were stratified on sex and age (20–39 years, 40–64 years), with control for selected confounders. Results Increased risks of DP were found for most combinations of social isolation and peripheral work position in all strata. The hazard ratios (HRs) for joint exposure to high degree of social isolation and a peripheral work position were particularly strong among men aged 20–39 (HR 5.70; CI 95% 3.74–8.69) and women aged 20–39 (HR 4.07; CI 2.99–5.56). An interaction effect from combined exposure was found for women in both age groups as well as a tendency in the same direction among young men. However, after confounder control the effects did not reach significance. Conclusions Individuals who were socially isolated and in a peripheral work position had an increased risk of future DP. The fact that an interaction effect was found among women indicates that a combination of social isolation and peripheral work position may reinforce adverse health effects. There was no evidence that a peripheral work position can be compensated by a high degree of social intergration in private life.

The actions of the social insurance agency regarding long-term sickness absentees before and after a medical assessment – a study of 384 case files

Abstract Purpose: The purpose of this article is to investigate actions taken by the Social Insurance Agency (SIA) for long-term sickness absentees and possible associations of this with future sick leave or disability pension. Method: For 384 long-term sickness absentees who had had a multidisciplinary medical assessment (MMA) during 2001–2006, three types of data were obtained: (1) case file information about SIA actions, (2) suggested rehabilitation measures from the MMA and (3) sickness absence and disability pension data. Results: Most individuals had been subject to a range of actions by the SIA. Sixty percent had been invited to a coordination meeting, and half of those who assessed by the MMA for vocational rehabilitation were approved to get it by the SIA. Few SIA actions were associated with full or partial return to work. Conclusions: Although the studied individuals had been on sick leave for a long time, the number of SIA actions related to vocational rehabilitation was limited and came late in the sick-leave spell. The information from the MMA was often not used as a basis for further SIA action and seldom resulted in return to work. The positive MMA views on the potential of vocational rehabilitation were not met by SIA actions. Implications for Rehabilitation Suggestions on vocational rehabilitation from a medical assessment was in many cases not used by the social insurance agency in relationship to long-term sickness absentees. Active rehabilitation measures by the social insurance agency were few and came late in the sickness absence process. Few of the activities taken by the social insurance agency enhanced return to work.