Associations between Childbirth, Hospitalization and Disability Pension: A Cohort Study of Female Twins

Björkenstam, Emma; Narusyte, Jurgita; Alexanderson, Kristina; Ropponen, Annina; Kjeldgård, Linnea; Svedberg, Pia

doi:10.1371/journal.pone.0101566

Cited by 11 publications

(20 citation statements)

References 36 publications

(34 reference statements)

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“…However, with improvements in medical care, more women with severe diseases who earlier had to refrain from pregnancy due to disease might now choose otherwise. In line with the above-mentioned results, a Swedish twin study also indicated a health selection into giving birth 11. It also emphasised their findings regarding multiple hospitalisations before subsequent DP.…”

Section: Discussionsupporting

confidence: 70%

“…Yet, it is unclear whether women have elevated rates of SA also during the years preceding their first childbirth. Findings from twin studies have shown that women who gave birth had lower average number of SA days compared with their nulliparous twin sisters 5 10 11. After delivery the average number of SA days was similar in both groups.…”

Section: Introductionmentioning

confidence: 99%

“…There might also be a positive health selection into giving birth, where women not giving birth may have poorer health and thus are unable to, or choose not to give birth 5 10 11. However, with these three studies having included twins only, the generalisability to the general population is unclear.…”

Section: Introductionmentioning

confidence: 99%

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Sickness absence and disability pension before and after first childbirth and in nulliparous women: longitudinal analyses of three cohorts in Sweden

et al. 2019

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ObjectiveChildbirth is suggested to be associated with elevated levels of sickness absence (SA) and disability pension (DP). However, detailed knowledge about SA/DP patterns around childbirth is lacking. We aimed to compare SA/DP across different time periods among women according to their childbirth status.DesignRegister-based longitudinal cohort study.SettingSweden.ParticipantsThree population-based cohorts of nulliparous women aged 18–39 years, living in Sweden 31 December 1994, 1999 or 2004 (nearly 500 000/cohort).Primary and secondary outcome measuresSum of SA >14 and DP net days/year.MethodsWe compared crude and standardised mean SA and DP days/year during the 3 years preceding and the 3 years after first childbirth date (Y−3to Y+3), among women having (1) their first and only birth during the subsequent 3 years (B1), (2) their first birth and at least another delivery (B1+), and (3) no childbirths during follow-up (B0).ResultsDespite an increase in SA in the year preceding the first childbirth, women in the B1 group, and especially in B1+, tended to have fewer SA/DP days throughout the years than women in the B0 group. For cohort 2005, the mean SA/DP days/year (95% CIs) in the B0, B1 and B1+ groups were for Y−3: 25.3 (24.9–25.7), 14.5 (13.6–15.5) and 8.5 (7.9–9.2); Y−2: 27.5 (27.1–27.9), 16.6 (15.5–17.6) and 9.6 (8.9–10.4); Y−1: 29.2 (28.8–29.6), 31.4 (30.2–32.6) and 22.0 (21.2–22.9); Y+1: 30.2 (29.8–30.7), 11.2 (10.4–12.1) and 5.5 (5.0–6.1); Y+2: 31.7 (31.3–32.1), 15.3 (14.2–16.3) and 10.9 (10.3–11.6); Y+3: 32.3 (31.9–32.7), 18.1 (17.0–19.3) and 12.4 (11.7–13.0), respectively. These patterns were the same in all three cohorts.ConclusionsWomen with more than one childbirth had fewer SA/DP days/year compared with women with one childbirth or with no births. Women who did not give birth had markedly more DP days than those giving birth, suggesting a health selection into childbirth.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

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Sickness absence and disability pension before and after first childbirth and in nulliparous women: longitudinal analyses of three cohorts in Sweden

et al. 2019

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“…specific medical diagnoses) need to more closely investigate the importance of health selection into giving birth [11]. A Swedish twin study, which by design could account for an important part of the genetic and environmental confounding factors shared by sisters, found evidence for a similar health selection into giving birth; an important finding of that study was that DP was often proceeded by several hospitalizations [39].…”

Section: Discussionmentioning

confidence: 99%

Sickness absence and disability pension before and after first childbirth and in nulliparous women by numerical gender segregation of occupations: A Swedish population-based longitudinal cohort study

et al. 2019

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BackgroundPregnancy is associated with a temporarily increased sickness absence (SA) risk. This association may vary by the level of occupational gender segregation; however, knowledge in this area is limited. We studied whether trends in SA and disability pension (DP) in the years before and after first childbirth among women with one or more childbirths and with no childbirth during the study period varied by occupational gender segregation.MethodsWe conducted a population-based register study involving nulliparous women aged 18–39 years, living in Sweden in 2002–2004 (n = 364,411). We classified participants in three childbirth groups as: (1) no childbirth in 2005 or in the next 3.75 years, (2) first childbirth in 2005 and no births in the subsequent 3.75 years, and (3) first childbirth in 2005 and at least one additional birth in the subsequent 3.75 years, and into five categories based on the rate of women in their occupations. We compared crude and standardized mean annual net SA and DP days during the three years before and the three years after 2005 across the childbirth and occupational gender segregation categories.ResultsWomen in extremely male-dominated occupations had or tended to have somewhat higher mean combined SA and DP days than women in gender-integrated occupations; women in female-dominated occupations had comparable or tended to have slightly higher mean SA and DP days than women in gender-integrated occupations. Except for the year before the first childbirth, women who gave birth, especially those who gave several births, had generally a lower mean combined standardized SA and DP days than nulliparous women. We found no substantial differences in trends in SA and DP around the time of first childbirth according to occupational gender segregation.ConclusionsTrends in SA and DP around the time of first childbirth did not vary by occupational gender segregation.

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“…In a cohort of Swedish twin sisters (n=5118), they found a strong association between morbidity, measured in terms of hospitalisation, and the risk of SA and DP. 29 To what extent findings from this selected and rather small group of twin sisters are generalisable to the total population is unclear. Also, it would be of interest to include wider information on morbidity than hospitalisation in such analyses.…”

Section: Introductionmentioning

confidence: 93%

Childbirth, morbidity, sickness absence and disability pension: a population-based longitudinal cohort study in Sweden

et al. 2020

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ObjectiveTo investigate associations of morbidity with subsequent sickness absence (SA) and disability pension (DP) among initially nulliparous women with no, one or several childbirths during follow-up.DesignLongitudinal register-based cohort study.SettingSweden.ParticipantsNulliparous women, aged 18 to 39 years and living in Sweden on 31 December 2004 and the three preceding years (n=492 504).Outcome measuresAnnual mean DP and SA days (in SA spells >14 days) in the 3 years before and after inclusion date in 2005.MethodsWomen were categorised into three groups: no childbirth in 2005 nor during the follow-up, first childbirth in 2005 but not during follow-up, and having first childbirth in 2005 and at least one more during follow-up. Microdata were obtained for 3 years before and 3 years after inclusion regarding SA, DP, mortality and morbidity (ie, hospitalisation and specialised outpatient healthcare, also excluding healthcare for pregnancy, childbirth and puerperium). HRs and 95% CIs for SA and DP in year 2 and 3 after childbirth were estimated by Cox regression; excluding those on DP at inclusion.ResultsAfter controlling for study participants’ prior morbidity and sociodemographic characteristics, women with one childbirth had a lower risk of SA and DP than those who remained nulliparous, while women with more than one childbirth had the lowest DP risk. Morbidity after inclusion that was not related to pregnancy, childbirth or the puerperium was associated with a higher risk of future SA and DP, regardless of childbirth group. Furthermore, morbidity both before and after childbirth showed a strong association with SA and DP (HR range: 2.54 to 13.12).ConclusionWe found a strong positive association between morbidity and both SA and DP among women, regardless of childbirth status. Those who gave birth had lower future SA and DP risk than those who did not.

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Associations between Childbirth, Hospitalization and Disability Pension: A Cohort Study of Female Twins

Cited by 11 publications

References 36 publications

Sickness absence and disability pension before and after first childbirth and in nulliparous women: longitudinal analyses of three cohorts in Sweden

Sickness absence and disability pension before and after first childbirth and in nulliparous women: longitudinal analyses of three cohorts in Sweden

Sickness absence and disability pension before and after first childbirth and in nulliparous women by numerical gender segregation of occupations: A Swedish population-based longitudinal cohort study

Childbirth, morbidity, sickness absence and disability pension: a population-based longitudinal cohort study in Sweden

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