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Sickness Absence with Musculoskeletal Diagnoses: An Eleven-Year Follow-Up of Young Persons
Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In Sweden, as well as in most Western countries, sickness absence is a major public health problem that has increased in recent years. This is a complex phenomenon related not only to ill health factors, but also to other factors on the levels of the individual, the family, the workplace, and the society. Most studies of sickness absence are cross sectional, which makes it difficult to investigate aetiological factors. A longitudinal study design is preferable, because sick-leave spells can have a long duration and are often due to chronic or recurrent disorders.

Objectives: The aim of the present research was to conduct a pilot study to gain further information about factors associated with sickness absence and disability pension, perceptions of contacts with rehabilitation professionals, and self-rated health over time among younger persons initially on sick leave with low-back, neck, or shoulder diagnoses.

Material and methods: An eleven-year prospective cohort study of all individuals who, in 1985, were aged 25–34 years, lived in the municipality of Linköping, Sweden, and had a sick-leave spell ≥ 28 days with low-back, neck, or shoulder diagnoses (n = 213, 61% women). The following information was obtained from registers: number of sick-leave days and spells in 1982–1984; diagnosis and demographical data in 1985 (age, sex, occupation, citizenship, marital status, and income); data on each sick-leave period (date, full/part time), disability pension (date, diagnoses, temporary/permanent, full/part time); emigration (date), and death (date, cause) from 1985 to 1 September 1996. In 1996, a questionnaire was sent to members of the cohort (response rate 73%). Different measures were used to analyse sickness absence and disability pension over the eleven-year period, possible risk factors for disability pension were tested by Cox regression, and possible factors predicting future low levels of sickness absence were tested by logistic regression. Based on the questionnaire perceptions of encounters with rehabilitation professionals were analysed with factor analyses and linear regression, and the so called health-line (a method to collect data on self-rated health over time) was tested, and the results were compared with data on sickness absence and disability ension.

Results: The members of the cohort turned out to be a high-risk group for disability pension. After 11 years, 26% of the women and 14% of the men had been granted such benefits, mainly due to musculoskeletal diagnoses, but also with psychiatric diagnoses for half of the men and 17% of the women. Full-time pension was granted more often to men than to women. The women had higher levels of sickness absence. An extended Cox regression model proved suitable for prediction of disability pension. Taking citizenship and long-term sickness absence into consideration, the women had a 1.9 times higher risk of being granted disability pension than the men. Predictors for future low levels of sickness absence were a history of low sickness absence, having a white-collar job, and being married. These associations were not discerned when a pathogenic approach was used, which implies that factors other than the opposite risk factor for disability pension are associated with future low sickness absence. Three dimensions of the individuals’ contacts with professionals were identified: supportive treatment, distant treatment, and empowering treatment.

Women perceived both social insurance officers and health care professionals as more supportive than the men did. Contact with social insurance officers was experienced as more supportive and empowering by persons on disability pension than by those not receiving such benefits. Data collected using the health-line (i.e., self-rated health from 1985 to 1995) was correlated with data on annual mean number of sick-leave days and days on disability pension. No tendency to recall bias was noted.

Conclusions: Additional research is needed to elucidate the situation of women on sick leave with low-back, neck, and shoulder diagnoses. Further testing and practical application of statistical and epidemiological models for analysing sickness absence and disability pension data should be carried out to ascertain the validity and usefulness of such models.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2003. , 75 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 786
Keyword [en]
sickness absence, sick leave, ill health, disability pension, musculoskeletal diagnoses, low back, neck, shoulder, clients’ perceptions of treatment, health-line, self-rated health
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-5210ISBN: 91-7373-545-0 (print)OAI: oai:DiVA.org:liu-5210DiVA: diva2:21149
Public defence
2003-05-07, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Note
On the day of the public defence the status of the article I was: Submitted; article III was: Accepted; article IV was: Submitted and article V was: In press.Available from: 2006-01-18 Created: 2006-01-18 Last updated: 2012-01-25Bibliographically approved
List of papers
1. Sickness absence with low-back, shoulder, or neck diagnoses: An 11-year follow-up regarding gender differences in sickness absence and disability pension
Open this publication in new window or tab >>Sickness absence with low-back, shoulder, or neck diagnoses: An 11-year follow-up regarding gender differences in sickness absence and disability pension
2005 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, Vol. 25, no 2, 115-124 p.Article in journal (Refereed) Published
Abstract [en]

Background: There is very little knowledge on the long-term outcomes of sickness absence. The aim was to investigate sickness absence and disability pensions over 11 years in a cohort of young persons initially long-term sick listed with back, neck, or shoulder diagnoses.

Method: A prospective population-based cohort study of all 213 individuals in the Municipality of Linköping, Sweden, who in 1985 were aged 25-34 and had at least one new sick-leave spell > 28 days with such diagnoses.

Main results: More women (61%) than men fulfilled the inclusion criteria. In 1996, 22% of the cohort (14% of the men, 26% of the women) had been granted disability pension; 76% of these individuals with musculoskeletal and the rest with psychiatric diagnoses. Partial disability pension was granted to 59% of the women, 17% of the men. Women were more often granted temporary disability pension than men.

Conclusions: This proved to be a high-risk group for disability pension. There were large and somewhat unexpected gender differences regarding incidence and type of disability pension. It has been debated how soon physicians should be concerned about the risk of long-term disability regarding these diagnoses; at four or eight weeks of sickness absence - our results support the former, at least for women.

Keyword
sickness absence, sick leave, disability pension, back diagnoses, neck diagnoses, shoulder diagnoses, gender
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13672 (URN)
Available from: 2006-01-18 Created: 2006-01-18 Last updated: 2009-04-21
2. Predictive factors for disability pension: An 11-year follow up of young persons on sick leave due to neck, shoulder, or back diagnoses
Open this publication in new window or tab >>Predictive factors for disability pension: An 11-year follow up of young persons on sick leave due to neck, shoulder, or back diagnoses
2001 (English)In: Scandinavian journal of public health, ISSN 1403-4948, Vol. 29, no 2, 104-112 p.Article in journal (Refereed) Published
Keyword
Back, Diagnoses, Disability, Pension, Neck, Diagnoses, Shoulder, Diagnoses, Sickness, Absence
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13673 (URN)10.1080/14034940152393363 (DOI)
Available from: 2006-01-18 Created: 2006-01-18 Last updated: 2009-04-28
3. Risk factors for disability pension over 11 years in a cohort of young persons initially sick-listed with low back, neck, or shoulder diagnoses
Open this publication in new window or tab >>Risk factors for disability pension over 11 years in a cohort of young persons initially sick-listed with low back, neck, or shoulder diagnoses
2004 (English)In: Scandinavian journal of public health, ISSN 1403-4948, Vol. 32, no 4, 272-278 p.Article in journal (Refereed) Published
Abstract [en]

Aim: A study was undertaken to ascertain whether the differences in risk in relation to gender and citizenship observed in a previous study of the same cohort would remain if more recent data on sickness absence were used. Methods: This was an 11-year prospective population-based cohort study. The dataset includes all individuals in a Swedish city who, in 1985, were aged 25 - 34 and had a sick-leave spell≥28 days with neck, shoulder, or back diagnoses (n=213). The data covered the following: for 1985 - 96, disability pension, emigration, and death; for 1982 - 96, sickness absence; for 1985, sex and citizenship. The data were subjected to Cox regression analyses with a time-dependent covariate. Results: Disability pension was granted to 22% (n=46) of the cohort. The relative risk for disability pension increased by 9.3 with each sick-leave spell≥90 days during the two previous years. The risk was higher for women than men, and also higher for foreign citizens than Swedes. Conclusion: Many studies have revealed a gender difference in the risk of being on disability pension, and it was found that this difference was still apparent when sick leave during the follow-up period is taken into account. Thus, the reason for the gender differences ought to be found among other factors than prior levels of sickness absence.

Keyword
back pain, disability pension, sickness absence, sick leave
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13674 (URN)10.1080/14034940310019524 (DOI)
Available from: 2006-01-18 Created: 2006-01-18 Last updated: 2009-04-28
4. Prediction of future low levels of sickness absence among young persons sick listed with low-back, neck, or shoulder diagnoses
Open this publication in new window or tab >>Prediction of future low levels of sickness absence among young persons sick listed with low-back, neck, or shoulder diagnoses
2004 (English)In: Work : a journal of prevention, assessment & rehabilitation, ISSN 1051-9815, Vol. 23, no 2, 159-167 p.Article in journal (Refereed) Published
Abstract [en]

In recent years sickness absence has increased in most Western countries. Risk factors for sickness absence and disability pension have been emphasised in studies, while focus on factors predicting low sickness absence is very rare. This paper is an attempt to apply such a perspective in an 11-year prospective cohort study of young persons n = 213) who in 1985 were sick listed ≥ 28 days with back, neck, or shoulder diagnoses. Having had no sick-leave spells > 14 days in 1992-1996 was used as the outcome measure. Sixty-nine persons (34%) had no such spells, with an unexpected similar proportion of men and women. Data on prior sick leave and demographic variables were analysed using univariate and multiple logistic regression. Factors that predicted low sickness absence were having prior low sickness absence, being a white-collar worker, and being married. We concluded that individuals with a history of low sickness absence have an increased odds for remaining in the work force after a single long sick-leave spell, and might need less attention in rehabilitation compared to persons with a history of high sickness absence. Focusing on low sickness absence led to different results than those discussed in previous studies on risk factors for disability pension.

Keyword
sick leave, musculoskeletal diagnoses, back pain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13675 (URN)
Available from: 2006-01-18 Created: 2006-01-18 Last updated: 2009-04-28
5. Client’s perceptions of contacts with professionals within health care and social insurance offices
Open this publication in new window or tab >>Client’s perceptions of contacts with professionals within health care and social insurance offices
Show others...
2003 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, Vol. 31, no 4, 275-282 p.Article in journal (Refereed) Published
Abstract [en]

Aims: An increasing number of people interact with professionals within healthcare and social insurance offices during periods of sick leave due to musculoskeletal disorders. Knowledge of clients' perceptions of such contact is scarce. This study analysed clients' perceptions of their contact with professionals within healthcare and social insurance offices.

Methods: A cohort study was conducted in the municipality of Linköping, Sweden. Participants were all citizens who in 1985 were aged 25 - 34 years and had at least one new sick-leave spell due to back, neck, or shoulder diagnoses exceeding 28 days (n=213). In 1996, 11 years after inclusion, a questionnaire about perception of contact with professionals, self-perceived health, and mental health was administered. Register data on sickness absence and disability pension from 1985 - 96 were also obtained.

Results: Factor analysis indicated the existence of three dimensions of contact with professionals: supportive treatment, distant treatment, and empowering treatment. Women perceived their contact with both social insurance officers and healthcare professionals as more supportive than did the men. Respondents with disability pensions perceived their contact with social insurance officers as more supportive and empowering than persons without disability pensions. Respondents with mental health problems perceived their contact with both types of professionals as more distant. Respondents with neck/shoulder diagnoses perceived their contact with healthcare professionals as more empowering than respondents with low back diagnoses.

Conclusion: There was a relationship between clients' perceptions of contact with professionals and the sex, disability pension, diagnosis, and mental health of clients.

Keyword
clients' perspective of treatment, musculoskeletal diagnoses, sick leave
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13676 (URN)10.1080/14034940210165037 (DOI)
Available from: 2006-01-18 Created: 2006-01-18 Last updated: 2012-04-02
6. The health-line: a method for collecting data on self-rated health over time: a pilot study
Open this publication in new window or tab >>The health-line: a method for collecting data on self-rated health over time: a pilot study
2001 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, Vol. 29, no 3, 233-239 p.Article in journal (Refereed) Published
Abstract [en]

Background: There is a need for an instrument to record a life-course perspective of self-rated health.

Aim: To test the ''health-line'', a simple, comprehensive method of collecting data on self-rated health over time.

Method: In 1996, a questionnaire was mailed to people who in 1985 were aged between 25 and 34 years old and had a sick-leave spell >28 days with ''back diagnoses''. They were asked to rate their global health graphically with a ''health-line'' for the years 1985-95. Official data on sick leave and disability pension were obtained for the same period. In all, 37 out of 52 men and 60 out of 83 women answered; that is, they drew a health-line.

Result: A statistically significant negative correlation between the mean number of absence days due to ill health and the health-line data was found for every year (r = -0.35 to -0.53; p < 0.001 ) and for the whole period 1985-95 (r = -0.546; p < 0.001) respectively.

Conclusion: The method worked well and is well worth further development and testing.

Keyword
Health-LINE, Ill, Health, Life-LINE, Self-RATED, Health, Sick, Leave, Sickness, Absence
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13677 (URN)10.1080/140349401316983662 (DOI)
Available from: 2006-01-18 Created: 2006-01-18 Last updated: 2009-05-29

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