Determinants for return to work among sickness certified patients in general practice

Abstract

BackgroundLong-term sickness absence is one of the main risk factors for permanent exit out of the labour market. Early identification of the condition is essential to facilitate return to work. The aim of this study was to analyse possible determinants of return to work and their relative impact.MethodsAll 943 subjects aged 18 to 63 years, sickness certified at a Primary Health Care Centre in Sweden from 1 January until 31 August 2004, were followed up for three years. Baseline information on sex, age, sick leave diagnosis, employment status, extent of sick leave, and sickness absence during the year before baseline was obtained, as was information on all compensated days of sick leave, disability pension and death during follow-up.ResultsSlightly more than half the subjects were women, mean age was 39 years. Half of the study population returned to work within 14 days after baseline, and after three years only 15 subjects were still on sick leave. In multivariate proportional hazards regression analysis the extent of previous sick leave, age, being on part-time sick leave, and having a psychiatric, musculoskeletal, cardiovascular, nervous disease, digestive system, or injury or poisoning diagnosis decreased the return to work rate, while being employed increased it. Marital status, sex, being born in Sweden, citizenship, and annual salary had no influence. In logistic regression analyses across follow-up time these variables altogether explained 88-90% of return to work variation.ConclusionsReturn to work was positively or negatively associated by a number of variables easily accessible in the GP’s office. Track record data in the form of previous sick leave was the most influential variable.

Sick leave diagnoses and return to work: a Swedish register study

“…Even though women have higher sickness absence, this seems to be restricted to short-term sick leave [24] rather than long-term sick leave [3]. In the Swedish context, a recent study found no association between female gender and RTW [6]. Hence, even though the onset of sick leave may differ between women and men, the same ailment seems to hamper RTW to the same degree for both women and men.…”

“…Adjustment was made for available variables previously reported to be potentially associated with sick leave, in general [19], or RTW, in particular [2,3,6]. There is a risk of over adjustment but the size of the available data reduces the risk of type II errors.…”

“…Over time, there has been a shift in the RTW literature from medically determined models to focus more on the workplace, cultural, economic and social factors [4]. Nevertheless, the medical reason for the sickness episode seems to be of great importance for the length of sick leave and a more diagnosis-based approach within primary care, which handles the majority of sick leave cases, has been suggested for early screening of individuals at risk for long-term sick leave [5,6]. In Sweden, diagnosis has also been brought to the fore in sick listing, with emphasis put on reduced work ability due to a specific diagnosis.…”

“…Earlier studies have, in general, focused either on broad categories of diagnoses due to limited study size [6,8] or on more specific categories such as mental disorders or musculoskeletal diseases, which are the most common causes of prolonged sick leave [9][10][11][12][13][14][15]. Even though differences in recovery due to different diseases and disorders are supposedly common knowledge in the medical profession and clinical practice, no thorough description across different diagnoses as regards RTW is at hand.…”

Health in women on long-term sick leave because of pain or mental illness

“…During 2010-2012, 41 000 individuals in Sweden lost their sick leave benefits, not because their health had improved, but because of the newly introduced time restrictions. From a medical rehabilitation point of view, it is of interest to investigate different aspects of health in this group as the various health situations are major determinants for returning to work (Von Celsing et al, 2012).…”