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Diagnosis-specific sick leave as a long-term predictor of disability pension: a 13-year follow-up of the GAZEL cohort study
  1. K Alexanderson1,
  2. M Kivimäki2,
  3. J E Ferrie2,
  4. H Westerlund1,3,
  5. J Vahtera4,
  6. A Singh-Manoux2,5,
  7. M Melchior5,
  8. M Zins5,6,
  9. M Goldberg5,6,
  10. J Head2
  1. 1Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Epidemiology and Public Health, University College London Medical School, London, UK
  3. 3Stress Research Institute, Stockholm University, Sweden
  4. 4Finnish Institute of Occupational Health, Helsinki, Finland
  5. 5INSERM, U1018 Occupational and Social Determinants of Health, Villejuif, France
  6. 6Centre for research in Epidemiology and Population Health, Versailles Saint Quentin University, Villejuif, France
  1. Correspondence to Professor, Kristina Alexanderson, Division of Insurance Medicine, Department of Clinical Neuroscience, Berzelius väg 3, Karolinska Institutet, SE-171 77 Stockholm, Sweden; kristina.alexanderson{at}


Background Factors that increase the risk of labour market exclusion are poorly understood. In this study, we examined the extent to which all-cause and diagnosis-specific sick leave predict subsequent disability pension (DP).

Methods Prospective cohort study of 20 434 persons employed by the French national gas and electric company (the GAZEL study). New sick-leave spells >7 days in 1990–1992 were obtained from company records. Follow-up for DP was from 1994 to 2007.

Results The HR, adjusted for age and occupational position, for DP was 3.5 (95% CI 2.7 to 4.5) in men and 2.6 (95% CI 1.9 to 3.5) in women with one or more sick-leave spells >7 days compared with those with no sick leave. The strongest predictor of DP was sick leave with a psychiatric diagnosis, HR 7.6 (95% CI 5.2 to 10.9) for men and 4.1 (95% CI 2.9 to 5.9) for women. Corresponding HRs for sick leave due to circulatory diagnoses in men and women were 5.6 (95% CI 3.7 to 8.6) and 3.1 (95% CI 1.8 to 5.3), for respiratory diagnoses 3.9 (95% CI 2.6 to 5.8) and 2.6 (95% CI 1.7 to 4.0), and musculoskeletal diagnoses 4.6 (95% CI 3.4 to 6.4) and 3.3 (95% CI 2.2 to 4.8), respectively.

Conclusions Sick leave with a psychiatric diagnosis is a major risk factor for subsequent DP, especially among men. Sick leave due to musculoskeletal or circulatory disorders was also a strong predictor of DP. Diagnosis-specific sick leave should be recognised as an early risk marker for future exclusion from the labour market.

  • Sick leave
  • sick-leave diagnoses
  • disability pension
  • ill-health retirement
  • psychiatric
  • disabling disease
  • occupational health
  • psychiatric
  • sickness absence

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  • Funding This work was supported by an ESRC Research Seminar Series Competition 2007/8 (RES-451-26-0491). KA was supported by the Swedish Council for Working Life and Social Research. MK and JV are supported by the Academy of Finland (grants #117604, #124271, #124322 and 129262) and the EU New OSH ERA research programme, JEF, AS-M and JH are supported by the National Institutes on Aging (NIA RO1AG013196). AS-M is supported by a EUYRI award from the European Science Foundation. HW is supported by the Swedish Council for Working Life and Social Research (2004-2021, 2007-1143). MM is supported by a “Young researcher” program from France's National Research Agency (ANR). The GAZEL cohort study was funded by EDF-GDF and INSERM and received grants from the ‘Cohortes Santé TGIR Program’, Agence nationale de la recherché (ANR) and Agence française de sécurité sanitaire de l'environnement et du travail (AFSSET).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of The French Commission Nationale Informatique et Libertés.

  • Provenance and peer review Not commissioned; externally peer reviewed.