Citation

Wang M, Alexanderson K, Runeson BS, Mittendorfer-Rutz E. Eur. J. Public Health 2016; 26(6): 1061-1069.

Affiliation

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Copyright

(Copyright © 2016, Oxford University Press)

DOI

10.1093/eurpub/ckw101

PMID

27418585

Abstract

BACKGROUNDS: Stricter regulations including time limits for sick leave have been introduced in Sweden in 2008, which might have resulted in higher morbidity in those on longer sick-leave spells after the introduction. This study aimed to examine (i) the association between all-cause and diagnosis-specific sickness absence and sick-leave duration with subsequent morbidity and suicide mortality and (ii) differences in socio-demographics and morbidity in individuals on sickness absence regarding changes of social insurance regulations.

METHODS: A population-based prospective study was conducted of two cohorts of individuals who lived in Sweden, aged between 20 and 64 years at 31 December 2005 (n = 4 477 678) and at 31 December 2008 (n = 4 500 400), respectively. Each of the cohorts was followed regarding inpatient healthcare and suicide. Hazard ratios (HR) and 95% confidence intervals were estimated by Cox regression models.

RESULTS: In the multivariate analyses, all-cause and diagnosis-specific sickness absence and sick-leave duration showed higher HRs for inpatient care and suicide in both cohorts (range of HR:1.10-2.59). HRs of inpatient care and suicide among individuals with mental sickness absence 2009 were reduced more after controlling for morbidity-related covariates, than such sickness absence in 2006. Individuals with mental and somatic sickness absence and sickness absence > 180 days in 2009 had higher HRs of somatic inpatient care than those on sickness absence in 2006.

CONCLUSIONS: Diagnosis-specific sickness absence and long-term sickness absence in 2009 might be associated with more severe morbidity or work incapacity than in 2006 due to the stricter regulations.

© The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Language: en