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

Abstract

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.

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

“…Similarly, our findings that the combined SA and DP days was higher the year before the date of first childbirth than in the other study years follow previous studies reporting an increase in SA levels during pregnancy [2–7, 11]. During pregnancy, many women experience different types of symptoms that can affect their work capacity and in some occupations it might be more difficult to adjust work conditions accordingly.…”

“…The finding that women who gave birth during the follow-up–in particular those who gave several births–had lower combined SA and DP days two and three years before and after the first childbirth relative to their counterparts who remained nulliparous are in line with those of the few previous studies in this field [5, 6], including our recent study among all nulliparous women aged 18–39 years living in Sweden in 1994, 1999 and 2004 [11]. They suggest a health selection into childbirth, i.e.…”

“…Further studies with information on morbidity (e.g. 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].…”

“…Pregnancy and childbirth are associated with a temporarily higher risk of SA [2–7], with the majority of women having at least one SA spell at some point during pregnancy [8–10]. In a recent study, we have also found that women who gave birth during the study period had higher mean combined SA and disability pension (DP) days during the year before their first delivery than their counterparts who remained nulliparous; otherwise women who gave birth, especially those with several births, had fewer days of combined SA and DP than women not giving birth [11].…”

Sickness absence in relation to first childbirth in nulliparous women, employed in the education and care branches in the public or private sectors: A Swedish longitudinal cohort study

“…A population-based longitudinal cohort study was conducted, based on nationwide register microdata. A cohort used in previous studies [ 4 , 6 , 34 ] was used to identify the cohort for this study, including all nulliparous women aged 18–39 years, residents in Sweden in 2002–2004, and employed in the education (preschool through high school) and care (i.e., healthcare, child care, elderly care, etc.) branches.…”