Is There an Association between Long-Term Sick Leave and Disability Pension and Unemployment beyond the Effect of Health Status? - A Cohort Study

Background: Studies have shown that long-term sick leave is a strong predictor of disability pension. However, few have aimed to disentangle the effect of sick leave and of health status. The objective of this study was to investigate whether there is an association between long-term sick leave and disability pension and unemployment, when taking health status into account. Methods/Principal Findings: The study was based on the Stockholm Public Health Cohort, restricted to 13,027 employed individuals (45.9% men) aged 18-59 in 2002 and followed until 2007. Hazard ratios (HR) with 95% Confidence Interval (CI) were estimated by Cox regression models adjusting for socio-demographic factors and five measures of health status. Having been on long-term sick leave increased the risk of disability pension (HR 4.01; 95% CI 3.19-5.05) and long-term unemployment (HR 1.45; 95% CI 1.05-2.00), after adjustment for health status. The analyses of long-term sick leave due to specific illness showed that the increased risk for long-term unemployment was confined to the group on sick leave due to musculoskeletal (HR 1.70 95% CI 1.00-2.89) and mental illness (HR 1.80 95% CI 1.13-2.88) and further that there was an increased risk for short-term unemployment in the group on sick leave due to mental illness (HR1.57 95% CI 1.09-2.26). Conclusions/Significance: Long-term sick leave increases the risks of both disability pension and unemployment even when taking health status into account. The results support the hypothesis that long-term sick leave may start a process of marginalization from the labor market.