Sick leave absence and the relationship between intra-generational social mobility and mortality: health selection in Sweden

Abstract

Background: Poor health could influence how individuals are sorted into occupational classes. Health selection has therefore been considered a potential modifier to the mortality class gradient through differences in social mobility. Direct health selection in particular may operate in the short-term as poor health may lead to reduced work hours or achievement, downward social mobility, unemployment or restricted upward mobility, and death. In this study, the relationship between social mobility and mortality (all-cause, cancer-related, cardiovascular disease-related (CVD), and suicide) is explored when the relationship is adjusted for poor health. Methods: Using Swedish register data (1996-2012) and discrete time event-history analysis, odds ratios and average marginal effects (AME) of social mobility and unemployment on mortality are observed before and after accounting for sickness absence in the previous year. Results: After adjusting for sickness absence, all-cause mortality remained lower for men after upward mobility in comparison to not being mobile (OR 0.82, AME-0.0003, CI − 0.0003 to − 0.0002). Similarly, upward mobility continued to be associated with lower cancer-related mortality for men (OR 0.85, AME-0.00008, CI − 0.00002 to − 0.0002), CVD-related mortality for men (OR 0.76, AME-0.0001, CI − 0.00006 to − 0.0002) and suicide for women (OR 0.67, AME-0.00002, CI − 0.000002 to − 0.00003). The relationship between unemployment and mortality also persisted across most causes of death for both men and women after controlling for previous sickness absence. In contrast, adjusting for sickness absence renders the relationship between downward mobility and cancer-related mortality not statistically different from the non-mobile. Conclusions: Health selection plays a role in how downward mobility is linked to cancer related deaths. It additionally accounts for a portion of why upward mobility is associated with lower mortality. That health selection plays a role in how social mobility and mortality are related may be unexpected in a context with strong job protection. Job protection does not, however, equalize opportunities for upward mobility, which may be limited for those who have been ill. Because intra-generational upward mobility and mortality remained related after adjusting for sickness absence, other important mechanisms such as indirect selection or social causation should be explored.

The relationship between work disability and subsequent suicide or self-harm: A systematic scoping review

“…Eight prospective or retrospective cohort studies showed a higher rate of suicide during follow-up among people with a sickness absence spell during the study inception period, compared to those without sickness absence (32)(33)(34)(35)(36)(37)(38)(39). Multiple of these studies observed that people with longer sickness absence spells, and those with multiple spells, are at increased risk of suicide than those with short or no absences (32,33,36,38), and that those whose absence is due to mental health conditions are at increased risk of suicide (34)(35)(36)(37)(38).…”

“…Eight prospective or retrospective cohort studies showed a higher rate of suicide during follow-up among people with a sickness absence spell during the study inception period, compared to those without sickness absence (32)(33)(34)(35)(36)(37)(38)(39). Multiple of these studies observed that people with longer sickness absence spells, and those with multiple spells, are at increased risk of suicide than those with short or no absences (32,33,36,38), and that those whose absence is due to mental health conditions are at increased risk of suicide (34)(35)(36)(37)(38). Two of these cohort studies observed similar associations between mental health related sickness absence, and sick leave duration, and intentional self-harm (38,39), while other studies also observed that there was increased rate of suicide or intentional self-harm in people with sickness absence due to musculoskeletal disorders (38) (35) or other conditions including injury/poisoning, digestive, circulatory, nervous and respiratory disease (38).…”

The relationship between work disability and subsequent suicide or self-harm: A scoping review

“…Eight prospective or retrospective cohort studies showed a higher rate of suicide during follow-up among people with a sickness absence spell during the study inception period, compared to those without sickness absence [33][34][35][36][37][38][39][40]. Multiple of these studies observed that people with longer sickness absence spells, and those with multiple spells, are at increased risk of suicide than those with short or no absences [33,34,37,39], and that those whose absence is due to mental health conditions are at increased risk of suicide [35][36][37][38][39].…”

Study on the Spatial Differentiation of Public Health Service Capabilities of European Union under the Background of the COVID-19 Crisis

“…Compared with those countries with lower economies, countries with stronger economic power have stronger public health service capabilities, correspondingly stronger detection capabilities, and more resources and capabilities to detect infected patients. This has a direct and positive effect on the number of diagnoses [ 46 ].…”