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

Abstract

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.

Sickness absence and disability pension three years before and seven years after first childbirth: A Swedish population-based cohort study

“…Yet, it is unclear whether findings from the long-term follow-up of the Swedish-born twin cohort generalize to women in the general population. We have carried out population-based longitudinal cohort studies of initially nulliparous women aged 16–39 years, selecting study participants with reference to years 1995, 2000 or 2005, and including data from three years before to three years after the birth date [ 1 , 5 , 20 , 21 ]. Findings showed that, during the year before pregnancy, women who gave birth had higher levels of SA/DP than women who remained nulliparous.…”

“…Findings showed that, during the year before pregnancy, women who gave birth had higher levels of SA/DP than women who remained nulliparous. In all other periods, women giving birth had lower SA/DP days than women who remained nulliparous, with SA/DP levels being lowest in women with more than one birth [ 1 , 5 , 20 , 21 ]. In order to add knowledge, we aimed to study this for a later time period, also using a longer follow-up than in previous studies.…”

Family-Related Life Events as Predictors of Labor Market Marginalization Trajectories

“…Moreover, studies from the Nordic countries have shown that not giving birth is a risk factor for SA and DP compared with women giving birth 26,27 . Somatic and mental morbidity both before and after childbirth showed a strong association with SA and DP 27 . However, previous studies have mainly focused on single family-related life event and knowledge on the effects of stability and change of family life (eg, transition from unmarried to married, from marriage to divorce, or from not having to having children, etc) on LMM trajectories is particularly limited.…”

“…On the other hand, some studies have demonstrated that the multiple roles have a positive influence on health and well-being 25 . Moreover, studies from the Nordic countries have shown that not giving birth is a risk factor for SA and DP compared with women giving birth 26,27 . Somatic and mental morbidity both before and after childbirth showed a strong association with SA and DP 27 .…”