Sick leave and disability pension in a cohort of TMD-patients – The Swedish National Registry Studies for Surgically Treated TMD (SWEREG-TMD)

Abstract

Background Temporomandibular disorders (TMD) are common and affect approximately 10% of the adult population. TMD is usually associated with headache, pain in the masticatory muscles and/or the temporomandibular joint, clicking or crepitations during mandibular movement as well as painful and/or reduced mouth opening. This study aimed to investigate the level TMD-patients use social insurance benefits before and after their first time of diagnosis or first surgical event, compared to the general population. Furthermore, the aim was to investigate the differences in the use of social insurance benefits between surgically and non-surgically treated TMD-patients that were diagnosed in a hospital setting. Methods All Swedish citizens aged 23–59 diagnosed with TMD in a hospital setting and/or surgically treated for the condition during 1998–2016 were identified via the Swedish National Board of Health and Welfare. A non-exposed comparison cohort was collected via the Total Population Registry. Outcome and sociodemographic data were collected via Statistics Sweden. Main outcome was annual net days on sick leave and disability pension five years before (-T5) and five years after (T5) diagnosis and/or surgical treatment (T0). Regression analysis was conducted with generalized estimated equations. Results The study included 219 255 individuals (73% female) – 19 934 in the exposed cohort and 199 321 in the comparison cohort. The exposed group was classified into three subgroups: non-surgical, surgically treated once, and surgically treated twice or more. The mean annual net days of sick leave and disability pension combined during the ten-year follow-up was 61 days in the non-surgical group, 76 days in the surgically treated once group, and 104 days in the surgically treated twice or more subgroup. The corresponding number for the non-exposed comparison cohort was 32 days. Conclusion Patients diagnosed with TMD in a hospital setting are 2–3 times more dependent on the use of social benefits than the general population. The reliance on sick leave and disability pension is seen as early as five years before diagnosis, and the reliance remains after surgical treatment. The reliance is stronger in patients with several surgical interventions. These findings indicate that patients diagnosed with TMD constitute a patient group with a high burden of health issues causing long-term dependence on social security benefits.

The Role of Mental Health and Behavioral Disorders in the Development of Temporomandibular Disorder: A SWEREG-TMD Nationwide Case-Control Study

“…A flowchart describing the recruitment process is presented in Figure 1 , which is a modified model of earlier published data. 29 The total study population consisted of 366 437subjects –33 315 cases and 333 122controls. In total, 120 individuals were excluded due to lack of index date or because of no possible match between the delivered data sets (see Figure 1 ).…”

Diseases of the musculoskeletal system and connective tissue in relation to temporomandibular disorders—A SWEREG-TMD nationwide case-control study

“…The recruitment process and exclusion of study subjects are described in Fig 1 , which is a modified model of earlier presented data [ 4 ]. A total of 366 437 subjects were in the study population; of these, 33 315 cases and 333 122 controls were identified.…”

“… Flow-chart of the recruitment process, Sweden, 1998–2016, 33 315 cases and 333 122 controls. The figure is a modified model of earlier published data from SWEREG-TMD [ 4 ]. ICD-10: International Classification of Diseases 10 th Revision.…”

“…As the diagnoses are common in the general population in relation to the association with TMD, improved early interventions should lower the number of patients requiring surgical treatment, reducing unnecessary medical procedures and risk of post-surgical complications. Considering the formidable impact on societal costs that TMD patients with multiple surgical interventions bestow on the society, a reduction in the number of these patients should therefore have a substantial effect on reducing societal costs associated with the treatment [ 4 ].…”

“…Painful TMD affects around 10% of the population and is the second most common cause of pain in the orofacial area, and the second most common musculoskeletal condition causing disability and pain, after chronic back pain [ 1 – 3 ]. TMD is therefore expected to have a substantial effect on health-related societal costs, as shown in a recent study from the Swedish National Registry Studies for Surgically Treated TMD (SWEREG-TMD), where TMD patients were found to be two to three times more reliant on sick-leave and disability pension than the general population [ 4 ]. The etiology of temporomandibular disorder (TMD) is a multifaceted arrangement of biological, psychological, sleep quality and parafunctional factors, and the onset of TMD pain is believed to be a result of both premorbid conditions as well as bio-psychosocial changes over time [ 5 , 6 ].…”