An initiative for a more inclusive working life and its effect on return-to-work after sickness absence: a multistate longitudinal cohort study

Abstract

ObjectivesTo reduce sickness absence (SA) and increase work participation, the tripartite Agreement for a More Inclusive Working Life (IA) was established in Norway in 2001. IA companies have had access to several measures to prevent and reduce SA. Our aim in this paper was to estimate the average effect of having access to IA at the time of entering a first SA on later return-to-work (RTW) and on time spent in other work-related states. A secondary objective was to study how effects varied between women and men, and individuals with SA due to either musculoskeletal or psychological diagnoses.DesignPopulation-based observational multistate longitudinal cohort study.SettingIndividual characteristics and detailed longitudinal records of SA, work and education between 1997-2011 were obtained from population-wide registries.ParticipantsEach individual born in Norway 1967–1976 who entered full-time SA during 2004–2011, with limited earlier SA, was included (n=187 930).Primary and secondary outcome measuresIndividual multistate histories containing dated periods of work, graded SA, full-time SA, non-employment and education.MethodsData were analysed in a multistate model with 500 days of follow-up. The effect of IA was assessed by estimating differences in state probabilities over time, adjusted for confounders, using inverse probability weighting.ResultsIA increased the probability of work after SA, with the largest difference between groups after 29 days (3.4 percentage points higher (95% CI 2.5 to 4.3)). Differences in 1-year expected length of stay were 8.4 additional days (4.9 to 11.9) in work, 7.6 (4.8 to 10.3) fewer days in full-time SA and 1.6 (-0.2 to 3.4) fewer days in non-employment. Similar trends were found within subgroups by sex, musculoskeletal and psychological diagnoses. The robustness of the findings was studied in sensitivity analyses.ConclusionMeasures to prevent and reduce SA, as given through IA, were found to improve individuals’ RTW after entering SA.

The effects of a national, voluntary agreement for a more inclusive working life on work participation following long-term sickness absence: a Norwegian cohort study

“…These results also support the concept of “communicating vessels”, where reducing one exit method results in increased exit by another route ( 35 ). A recent study into those beginning SA episodes between 2004–2011 in the same cohort similarly found a decreased risk of non-employment (not in work, education, or SA) in IA companies ( 14 ). The differences between IA and non-IA companies appear after around 60 days, suggesting that the measures may work effectively for diagnoses where adjustments reduce the risk of relapse over time.…”

“…The similarity between the present study findings and research into general SA could indicate that the mechanism by which the IA Agreement affects recurrent SA is not very different. Although IA companies may have higher rates of SA, previous studies suggest that the IA Agreement may have a small positive effect on SA duration (14,33). If the IA Agreement works mainly by shortening SA duration, this may contribute to achieving the overall goal of reducing SA by reducing working days lost, rather than reducing the occurrence of SA (8).…”

“…However, between 2001 and 2018, SA has only been reduced by 12.4%, short of the 20% goal (9). Possible effects of the IA Agreement on SA have been investigated in several studies, with results varying from no effect to a possible positive effect of reducing SA prevalence and duration (10)(11)(12)(13)(14). A recent report indicated that recurrent SA may contribute to difficulties in reducing the overall SA rate, leading to a renewed focus on this in the current IA Agreement (8,15).…”