RESEARCH REPORTS

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

Mika Kivimäki^1,2, Jane E Ferrie¹, Jan Hagberg³, Jenny Head¹, Hugo Westerlund⁴, Jussi Vahtera², Kristina Alexanderson⁵

¹ International Institute for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London, UK
² Finnish Institute of Occupational Health, Helsinki, Finland
³ Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
⁴ National Institute for Psychosocial Medicine, Stockholm, Sweden
⁵ Section of Social Medicine and Public Health, Department of Health and Society, Linköping University, Linköping, Sweden

Correspondence to:
Mika Kivimäki, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK; m.kivimaki{at}ucl.ac.uk

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.

Keywords: disability; pensions; ill health retirement; sickness absence; mental health

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