Sequences of sickness absence, disability pension and unemployment four years before and five years after musculoskeletal diagnosis among Swedish twins

Aims: To investigate sustainable working life via identification of time-related sequences of sickness absence (SA), disability pension (DP) and unemployment four years before and five years after the first musculoskeletal diagnosis in a Swedish twin cohort. Other aims were to account for familial confounding and to examine the associations between sequences and sociodemographic characteristics.

Methods: Among 28,474 Swedish twins, the patterns of interruptions of working life four years before the first M00-M99 diagnosis (MSD) and five years after MSD diagnosis were investigated with a sequence analysis in a seven-element state space consisting of sustainable working life, unemployment >90 days, moderate SA/DP (30-179 days), almost full year of SA/DP (180-365 days), full year of SA/DP (⩾ 365 days), death, and old-age pension.

Results: The six-cluster solution had the best fit to the data. Five clusters had varying patterns of interruptions of sustainable working life (Clusters 2-6, n = 537-1949 with SA/DP, unemployment, but also accounting death and old-age pension) compared with the largest cluster with primarily sustainable working life (n = 23,316). Age, sex and familial factors affected the likelihood of belonging to the clusters with SA/DP.

Conclusions: Most Swedish twins with or without MSD diagnosis have a sustainable working life, although MSD was both prevalent and a strong risk factor for belonging to the clusters with SA/DP. Thus, early prevention of MSD and prevention of recurrent or long sickness absences due to any cause would be merited while paying special attention to women also.