Diagnosis and duration of sickness absence as predictors for disability pension: Results from a three-year,multi-register based* and prospective study

Abstract

Aim: A study was undertaken to identify predictors for the transition from long-term sickness absence into disability pension with special emphasis on routinely collected medical information (e.g. diagnoses on sickness certificates) and the duration of sickness-absence spells. Methods: The study used a 10% random sample of the Norwegian population of working age (the KIRUT database). Individuals below 60 years of age, with spells of long-term sickness absence starting in 1990 - 91, where the medical diagnoses on the sickness certificates were known, were identified. This group (4,432 men and 5,645 women) was followed up for three years after the end of sickness absence with regard to disability pension and working status. Results: In logistic regression the following predictors significantly increased the risk of obtaining disability pension during the first three years after the long-term sickness spell: age, part-time employment, and duration of absence >197 days. Higher education and having children <11 years significantly decreased the risk. Having the medical diagnoses ``mental problems'' and diseases in the nervous system, respiratory system, and circulatory systems indicated high risk (compared with musculoskeletal disease). The diagnostic groups ``pregnancy-related disease'' and ``injuries'' implied low risk for disability pension. In separate regressions for both genders the ``protective effect'' of having small children remained only for women. High risk for sickness absence caused by ``mental problems'' reached significance only for men. Conclusions and implications: Several risk factors for transition from long-term sickness absence into disability pension were identified. The finding that spells of sickness absence with duration up to seven months did not imply increased risk of disability during the first three years may have implications for interventions aimed at long-term sickness absentees.

Keywords

disability pension long-term sickness absence predictors transition.

Get full access to this article

View all access options for this article.

References

Tellnes G. Sickness certification [dissertation]. Oslo: University of Oslo, Department of Community Medicine , 1990.

Alexanderson K. Sickness absence in a Swedish county, with reference to gender, occupation, pregnancy and parenthood [dissertation]. Linkoping: Linkoping University, Department of Community Medicine, 1995.

International Social Security Association. Absenteeism and social security, Studies and Research No 16. Geneva: International Social Security Association, 1981.

Henrekson M. , Lannto K. , Persson M. Bruk og misbruk av sjukførsakringen [Use and abuse of sickness insurance] . Stockholm: SNS forlag, 1992 [in Swedish].

Sykefravær og uførepensjonering - et inkluderende arbeidsliv [Sickness absence and disability pensioning- an including labour market]. Oslo: NOU 2000:27 [Governmental review, in Norwegian].

Coggon D. Sickness absence: the doctor's role. Br Med J 1988; 297: 636 - 7.

The Norwegian social insurance scheme - a survey. Oslo: Norwegian Social Insurance Administration, 1988.

Om Trygdeetatens oppfølging av langtidssykemeldte [The Audit Commission's investigation into the NIA's monitoring and supervision of the long-term sick-listed]. Oslo: Document no.3: 9 1998/99 Stortingets Riksrevisjon [Audit Commission of the Norwegian Parliament], 1999 [in Norwegian].

Alexanderson K. Sickness absence: a review of performed studies with focus on levels of exposures and theories utilised. Scand J Soc Med 1998; 26(4): 241 - 9.

10.

Hansen H-T , ed. Kunnskapsstatus for den nordisk trygdeforskningen på 1990-tallet [Review of Nordic research on Social insurance in the 1990s]. Bergen: Foundation for Research in Economics and Business Administration, 1999 [in Norwegian].

11.

Manson NO , Rastam L. , Eriksson KF , et al. Socioeconomic inequalities and disability pension in middle aged men. Int J Epidemiol 1998; 27: 1019 - 25.

12.

Aarts LJM , de Jong PR Economic aspects of disability behaviour. Amsterdam : North-Holland, 1992.

13.

Holte HH , Tambs K. , Bjerkedal T. Manual work as a predictor for disability pensioning with osteoarthritis among the employed in Norway 1971 - 1990. Int J Epidemiol 2000; 29: 487 - 94.

14.

Krause N. , Lynch J. , Kaplan GA , Cohen RD , Goldberg DE , Salonen JT Predictors of disability retirement. Scand J Work Environ Health 1997; 23: 403 - 13.

15.

Mansson NO , Merlo J. , Ostergren PO The use of analgesics and hypnotics in relation to self-rated health and disability pension - a prospective study of middle-aged men. Scand J Public Health 2001; 29[2]: 133 - 9.

16.

Selander, J. and S.U. Marnetoft , Risk factors for disability pension among unemployed women on long-term sick-leave. Int J Rehabil Res 1999; 22(4): 277 - 82.

17.

Borg K. , Hensing G. , Alexanderson K. Predictive factors for disability pension - an 11-year follow up of young persons on sick leave due to neck, shoulder, or back diagnoses. Scand J Public Health 2001; 29(2): 104 - 12.

18.

Gjesdal S. , Bratberg E. The role of gender in long-term sickness absence and transition to permanent disability benefits. Eur J Public Health 2002 ; 12: 180 - 6.

19.

20.

Hosmer DW , Lemeshow S. Applied logistic regression. New York: Wiley, 1989.

21.

StataCorp 2001. Stata statistical software: Release 7.0. College Station, TX: Stata Corporation.

22.

Härdle W. Applied non-parametric regression. Cambridge: Cambridge University Press, 1991.

23.

Haldorsen EMH , Kronholm K. , Skouen JS , Ursin H. Multimodal cognitive behavioural treatment of patients sick listed for musculoskeletal pain: a randomised controlled study. Scand J Rheumatol 1998; 27: 16 - 25.

24.

Hagen KB , Holte HH , Tambs K. , Bjerkedal T. Socio-economic factors and disability retirement from back pain. A 1983 - 1993 population-based prospective study in Norway. Spine 2000; 25: 2480 - 5.

25.

Hensing G. , Spak K. Psychiatric disorders as a factor in sick leave due to other diagnoses. Brit J Psychiatry 1998; 172: 359 - 63.

26.

Alexandersson K. , Sydsjo A. , Hensing G. , Sydsjø G. , Carstensen J. Impact of pregnancy on gender differences in sickness absence. Scand J Soc Med 1996; 24: 169 - 76.

27.

Mastekaasa A. Parenthood, gender and sickness absence. Soc Sci Med 2000; 50: 1827 - 42.

28.

Hensing G. , Brage S. , Nygård JF Sandanger I. , Tellnes G. Sickness absence with psychiatric disorders: an increased marginalisation among men. Soc Psychiatry Psychiatr Epidemiol 2000; 35: 335 - 40.

29.

Laitinen-Krispijn S. , Bijl RV Mental disorders and employee sickness absence: the NEMESIS study. Netherlands Mental Health Survey and Incidence Study. Soc Psychiatry Psychiatr Epidemiol 2000; 35: 71 - 7.

30.

Nystuen P. , Hagen KB , Herrin J. Mental health problems as a cause of long-term sick leave in the Norwegian workforce. Scand J Public Health 2001; 29: 175 - 82.

31.

Blank N. , Diderichsen F. Short-term and long-term sick leave in Sweden: relationship with social circumstances, working conditions and gender. Scand J Soc Med 1995; 4: 265 - 72.