Kristina Alexanderson

Health in Sweden : the National Public Health Report 2005.

Health in Sweden – The National Public Health Report 2005 : Scandinavian Journal of Public Health

How to measure sickness absence ? Literature review and suggestion of five basic measures

Objective — To examine different sick-leave measures used in sickness absence research, and to suggest a systematic way of assessing sickness absence. Methods — A review and analysis of five major studies on sick-leave performed 1983—1988 with an epidemiological approach. Results — Terminology and measures used varied in the different studies reviewed. The choice of a certain measure was seldom discussed in relation to the aim of the study. Based on the review five measures are suggested: frequency, length, incidence rate, cumulative incidence and duration. The definition of incidence rate is new and is a measure useful in studies of recurrent events within epidemiology. Conclusions — We have reviewed sick-leave measures previously used in the literature and suggested five basic measures for assessing sick-leave.

Chapter 1. Aim, background, key concepts, regulations, and current statistics

. the dramatic increase in sickness absence that has occurred in Sweden in recent years; . hypotheses concerning the consequences of being sick listed; . sick-listing practices by physicians. This chapter presents a brief description of these three aspects and a review of the key factors concerning the physician’s role in conjunction with sick listing and key concepts such as disease, the sick role, and insurance. Finally, trends in sickness absence are briefly reviewed as are the regulations concerning reimbursement for sickness absence in Sweden and several other European countries.

MULTIDISCIPLINARY INTERVENTIONS: REVIEW OF STUDIES OF RETURN TO WORK AFTER REHABILITATION FOR LOW BACK PAIN

OBJECTIVE The aim of this study was to analyse the efficacy of multidisciplinary interventions on return to work for people on sick leave due to low back pain. METHODS A systematic review of published studies was performed, including a meta-analysis. Identified publications were assessed for relevance and study quality. RESULTS A meta-analysis based on 5 studies from Scandinavia verified the scientific evidence for the efficacy of multidisciplinary interventions on return to work. CONCLUSION Although long-term sick leave due to low back pain represents a large problem for the community and multidisciplinary interventions are often advocated, surprisingly few published studies have return to work as an outcome. There is evidence for a clinically relevant effect of multidisciplinary interventions on return to work.

Diagnosis-specific sickness absence as a predictor of mortality : the Whitehall II prospective cohort study

Objective To investigate whether knowing the diagnosis for sickness absence improves prediction of mortality. Design Prospective cohort study established in 1985-8. Sickness absence records including diagnoses were obtained from computerised registers. Setting 20 civil service departments in London. Participants 6478 civil servants aged 35-55 years. Main outcome measures All cause, cardiovascular, and cancer mortality until 2004, average follow-up 13 years. Results After adjustment for age, sex, and employment grade, employees who had one or more medically certified spells of sickness absence (>7 days) in a three year period had a mortality 1.7 (95% CI 1.3 to 2.1) times greater than those with no medically certified spells. Inclusion of diagnoses improved the prediction of all cause mortality (P=0.03). The hazard ratio for mortality was 4.7 (2.6 to 8.5) for absences with circulatory disease diagnoses, 2.2 (1.4 to 3.3) for surgical operations, and 1.9 (1.2 to 3.1) for psychiatric diagnoses. Psychiatric absences were also predictive of cancer mortality (2.5 (1.3 to 4.7)). Associations of infectious, respiratory, and injury absences with overall mortality were less marked (hazard ratios from 1.5 to 1.7), and there was no association between musculoskeletal absences and mortality. Conclusions Major diagnoses for medically certified absences were associated with increased mortality, with the exception of musculoskeletal disease. Data on sickness absence diagnoses may provide useful information to identify groups with increased health risk and a need for targeted interventions.

Predictive factors for disability pension — An 11-year follow up of young persons on sick leave due to neck, shoulder, or back diagnoses:

AIMS Although back diagnoses are recurrent and the main diagnoses behind sickness absence and disability pension surprisingly few longitudinal studies have been performed. This study identifies predictive factors for disability pension among young persons initially sick-listed with back diagnoses. METHODS An 11-year prospective cohort study was conducted, including all individuals in a Swedish city who, in 1985, were aged 25-34 and sick-listed > or =28 days owing to neck, shoulder, or back diagnoses (n = 213). The following data was obtained: disability pension, emigration, and death for 1985-96, sickness absence for 1982-84, and demographics in 1985 regarding sex, income, occupation, marital status, diagnosis, socioeconomic group, and citizenship. Cox regression and life tables were used in the analyses. RESULTS In 1996, i.e. within 11 years, 22% of the individuals (27% of the women and 14% of the men) had been granted disability pension. The relative risk for disability pension was higher for women (2.4; p = 0.010), persons with foreign citizenship (3.6; p=0.009), and those who had had >14 sick-leave days per spell during the three years before inclusion, compared to those with <7 days/spell (3.1; p=0.003). CONCLUSIONS This cohort of young persons proved to be a high-risk group for disability pension. Some of the factors known to predict long-time sickness absence also predict disability pension in a cohort of already sick-listed persons.

Illness, disease, and sickness absence: an empirical test of differences between concepts of ill health

Objectives: In studies of public health and morbidity different concepts of ill health are often seen as interchangeable alternatives. With the help of extensive population information this research intends to show how different concepts and measurements produce very different pictures of health and ill health. The concept trilogy of “illness,” “disease,” and “sickness” is used to capture different aspects of ill health. Design: Cross sectional data were obtained through comprehensive interview surveys 1988–2001 and registers of sickness absence. Because of lack of data some years had to be excluded. Settings: Swedish population. Participants: Annual data for around 3500 employed and self employed persons. Main results: Most people have some sort of illness or complaint. Fewer could be registered with a disease. Even fewer had been on sick leave. The overlap was fairly low. There also was an obvious discrepancy between reporting having a disease and a subject’s rating of general health. It was shown that the different concepts showed different trends over time. Conclusions: The discrepancies between the concepts imply that you have to be very careful when using public health data to illustrate different aspects of morbidity. The comparatively low degree of overlap between them shows that they represent different realities. There is a need to do further empirical research about how different aspects of morbidity are interrelated. Their lack of interrelation seems to be an important research area worth developing further.

Chapter 9. Consequences of being on sick leave

The possible consequences of sick leave can be measured at different levels in society. This chapter focuses on the consequences from the perspective of the sick-listed individual. Sick leave may have both positive and negative consequences for the individual, e.g. regarding disease, health, working life, social life, lifestyle, and emotional aspects. Some of these factors have been investigated in different studies. However, scientific evidence is insufficient since there are too few studies on the consequences of sickness absence and disability pension. The lack of relevant studies is the most striking observation from the review of studies on the consequences of being sick listed.

Epidemiology of Sickness Absence in a Swedish County in 1985, 1986 and 1987 A Three Year Longitudinal Study with Focus on Gender, Age and Occupation

In order to get a better epidemiological base for preventive intervention in the county of Östergötland, Sweden, a comprehensive study of sickness absence was done. During the years 1985, 1986 and 1987, all new periods of sick-leave exceeding seven days were registered with demographic variables. This information was related to data about the total population of Östergötland. Each year approx. 45,000 persons had approx. 61,000 sickness spells. These figures were stable over the years while the number of sick-leave days increased. Blue-collar occupations had the highest sick-leave rates and the female sick-leave rate was higher in general and much higher in most male-dominated occupations. The male rate was lower within female-dominated areas, except among secretaries and textile workers. Females in extremely male-dominated groups had the highest rates, while both male and female sick-leave rates were lower in more gender-integrated occupations.

Frequency and nature of problems associated with sickness certification tasks: A cross-sectional questionnaire study of 5455 physicians

Objective. To study the frequency and nature of problems associated with physicians’ sickness certification practices. Design. Cross-sectional questionnaire study. Setting. Stockholm and Östergötland Counties in Sweden. Subjects. Physicians aged ≤64 years, n =7665, response rate 71% (n =5455). Main outcome measures. The frequency of consultations involving sickness certification, the frequency and nature of problems related to sickness certification. Results. A total of 74% (n =4019) of the respondents had consultations including sickness certification at least a few times a year. About half of these physicians had sickness certification cases at least six times a week, and 1 out of 10 (9.4%) had this more than 20 times a week. The items that the highest percentage of physicians rated as very or fairly problematic included: handling conflicts with patients over certification, assessing work ability, estimating optimal length and degree of absence, and managing prolongation of sick leave initially certified by another physician. There were large differences in frequency and nature of problems between different types of clinics/practices. General practitioners had the highest frequency of problems concerning sickness certification while the lowest was found among specialists in internal medicine and surgery. Conclusion. Sickness certification should be recognized as an important task also for physicians other than general practitioners. The physicians experienced problems with numerous tasks related to sickness certification and these varied considerably between types of clinics. The high rate of problems experienced may have consequences for the physicians’ work situation, for patients, and for society.