Morbidity and suicide mortality following sick leave in relation to changes of social insurance regulations in Sweden

Résumé

textbfBACKGROUNDS: Stricter regulations including time limits for sick leave have been introduced in Sweden in 2008, which might have resulted in higher morbidity in those on longer sick-leave spells after the introduction. This study aimed to examine (i) the association between all-cause and diagnosis-specific sickness absence and sick-leave duration with subsequent morbidity and suicide mortality and (ii) differences in socio-demographics and morbidity in individuals on sickness absence regarding changes of social insurance regulations. textbfMETHODS: A population-based prospective study was conducted of two cohorts of individuals who lived in Sweden, aged between 20 and 64 years at 31 December 2005 (n = 4 477 678) and at 31 December 2008 (n = 4 500 400), respectively. Each of the cohorts was followed regarding inpatient healthcare and suicide. Hazard ratios (HR) and 95% confidence intervals were estimated by Cox regression models. textbfRESULTS: In the multivariate analyses, all-cause and diagnosis-specific sickness absence and sick-leave duration showed higher HRs for inpatient care and suicide in both cohorts (range of HR:1.10-2.59). HRs of inpatient care and suicide among individuals with mental sickness absence 2009 were reduced more after controlling for morbidity-related covariates, than such sickness absence in 2006. Individuals with mental and somatic sickness absence and sickness absence textgreater 180 days in 2009 had higher HRs of somatic inpatient care than those on sickness absence in 2006. textbfCONCLUSIONS: Diagnosis-specific sickness absence and long-term sickness absence in 2009 might be associated with more severe morbidity or work incapacity than in 2006 due to the stricter regulations. SUÈDE EUROPE ADULTE GENRE HOMME FEMME SUICIDE-COMPLÉTÉ ABSENTÉISME CHÔMAGE