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Diagnosis-specific sick leave as a risk marker for disability pension in a Swedish population
  1. Mika Kivimäki1,2,
  2. Jane E Ferrie1,
  3. Jan Hagberg3,
  4. Jenny Head1,
  5. Hugo Westerlund4,
  6. Jussi Vahtera2,
  7. Kristina Alexanderson5
  1. 1
    International Institute for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London, UK
  2. 2
    Finnish Institute of Occupational Health, Helsinki, Finland
  3. 3
    Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  4. 4
    National Institute for Psychosocial Medicine, Stockholm, Sweden
  5. 5
    Section of Social Medicine and Public Health, Department of Health and Society, Linköping University, Linköping, Sweden
  1. Mika Kivimäki, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK; m.kivimaki{at}


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.

  • disability
  • pensions
  • ill health retirement
  • sickness absence
  • mental health

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  • Funding: This study was financially supported by the Swedish Council for Working Life and Social Research and AFA Insurance. MK and JV were supported by the Academy of Finland (projects 105195 and 117604) and the Finnish Work Environment Foundation. JEF was supported by the MRC (grant number G8802774).

  • Competing interests: None.

  • Ethical approval: The study was approved by the Swedish National Data Inspection Board and the local research ethics committee.

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