From long-term sickness absence to disability retirement: diagnostic and occupational class differences within the working-age Finnish population

Abstract

Background: It is well documented that sickness absence is strongly associated with disability retirement. A longterm sickness absence (LTSA) in particular increases the risk of disability retirement, but little is known about the variation of this risk across diagnostic causes. Further, as occupational classes differ in their diagnostic profiles, it is likely that the role of diagnosis in the pathway from LTSA to disability retirement varies between occupational classes. We examined how LTSA of different diagnostic causes predicts all-cause disability retirement and disability retirement due to the same diagnostic group or due to some other diagnostic group than that which caused the LTSA spell in different occupational classes. Methods: Cox proportional hazards models were used to analyse a 70% random sample of all employed Finns aged 25-62 Finns in 2006 (N = 1,458,288). Disability retirement was followed from 2007 to 2014. The risk of disability retirement was compared between occupational classes with at least one LTSA spell due to musculoskeletal diseases, mental disorders, respiratory diseases, or circulatory diseases and those who had no LTSA spells due to these diagnostic groups during 2005. Results: Those who had LTSA due to musculoskeletal diseases or mental disorders transferred more often to disability retirement due to same diagnostic group, whereas those who had LTSA due to respiratory or circulatory diseases transferred more often to disability retirement due to some other diagnostic group. The largest occupational class differences in all-cause disability retirement were found among those with LTSA due to mental disorders. For men, the hazard ratios (HR) varied from HR 5.70 (95% confidence interval (CI) 5.00-6.52) in upper nonmanual employees to 2.70 (95% CI 2.50-2.92) in manual workers. For women, the corresponding HRs were 3.74 (95% CI 3.37-4.14) in upper non-manual employees and 2.32 (95% 2.17-2.50) in manual workers. Conclusions: The association between LTSA and disability retirement varies between diagnostic groups, and the strength of this association further depends on the person's occupational class and gender.

Incidence and Length of Sickness Absence among Hierarchical Occupational Classes and Non-Wage-Earners: A Register Study of 1.6 Million Finns

“…Reducing sickness absence entails two steps: first, preventing the occurrence of absence episodes, and second, preventing the prolongation of episodes that have already started. Especially long sickness absence is a strong predictor of permanently leaving the work force through disability retirement [ 8 , 9 , 10 , 11 ]. Great savings on the direct and indirect costs of work disability could be achieved through maintaining work ability in the working-age population and preventing long sickness absences.…”

“…The covariates included gender, age (used in age bands 25–34, 35–44, 45–54 and 55–62 years), marital status (married, never married including those with unknown marital status, and divorced or widowed) and region of residence (four large regions based on geographic location) at the end of 2012, and taxable yearly income during 2012 (including both earned income and capital income, classified into quintiles). These covariates were taken into account since various socio-demographic variables are important predictors of sickness absence and may also confound the association between occupational class and disability [ 10 , 11 , 12 , 13 , 14 , 21 ].…”

“…Each year, around 10% of non-retired Finns have long sickness absence spells that exceed 10 working days, entitling to sickness allowance paid by the Social Insurance Institution of Finland [ 5 ]. Sickness absence overall, and long sickness absence in particular, is strongly associated with poor health, disability retirement and even mortality [ 6 , 7 , 8 , 9 , 10 , 11 ]. Knowledge of the determinants of sickness absence and of the accumulation of sickness absence days is important to be able to target effective measures that aim to prevent both incidence and prolongation of sickness absence and to curb its harmful consequences.…”

Process of Work Disability: From Determinants of Sickness Absence Trajectories to Disability Retirement in a Long-Term Follow-Up of Municipal Employees

“…This is in line with a more recent Danish study, which found that back disorders, mental disorders, and cancer were the health problems predicting long-term sickness absences in a two-year register based follow-up of a general population sample [ 42 ]. Long sickness absences due to mental problems showed large differences by occupational class with any disability retirement among Finns in 2007–2014 [ 43 ].…”

Frequent attenders of three outpatient health care schemes in Finland: characteristics and association with long-term sickness absences, 2016–2018

“…This generally higher attendance rate may be reflected in the higher proportion of FAs as well. Musculoskeletal disorders are both clearly more frequent [ 48 ] and pose a greater risk for disability retirement [ 49 ] among lower non-manual and manual employees than among upper non-manual employees. These disorders probably account for the higher FA rate in the OHS scheme as well.…”