Transitioning from sickness absence to disability pension—the impact of poor health behaviours: a prospective Swedish twin cohort study

ObjectivesTo investigate the association between three poor health behaviours (current smoker, high consumption of alcohol and low physical activity levels) and the transition to disability pension (DP) among individuals who have recently been sickness absent. Furthermore, we aimed to explore whether having multiple poor health behaviours increased the risk of transitioning from sickness absence (SA) to DP.DesignProspective twin cohort study.SettingSweden.ParticipantsTwins aged 20–46 who had participated in a survey and been on SA (>14 days) in the year preceding baseline (date of answering the questionnaire).Main outcome measureIncident DP during the follow-up which ended on 31 December 2012 (mean 5.2 years). A national register with full coverage provided data on DP.ResultsThe Cox proportional-hazards regression analyses showed that current smokers had a higher risk of transitioning from SA to DP compared with never smokers (HR 1.76; 95% CI 1.08 to 2.84). Alcohol use and lack of physical activity as well as poor health behaviour sum score showed no significant associations.ConclusionsBeing a current smoker influences the transition from SA to DP. Although non-significant, there were indications that more physical activity and fewer poor health behaviours could reduce the risk of exiting the labour market through DP. Improving health behaviours among people on SA could be a valuable tool for preventing the transition to DP.

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Do poor health behaviors have an impact on the transition from sick leave to disability pension?

European Journal of Public Health ◽

10.1093/eurpub/ckz185.165 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

P Svedberg ◽

B Helgadóttir ◽

L Mather ◽

J Narusyte ◽

A Ropponen ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Health Behaviors ◽

Sickness Absence ◽

Disability Pension ◽

Cox Proportional Hazards ◽

Poor Health ◽

Physical And Mental Health ◽

Public Health Perspective ◽

Current Smoking

Abstract Background High age, being a woman, and having low socioeconomic status are among the important risk factors for transitioning from sickness absence (SA) to disability pension (DP). But, little is known about the effect of poor health behaviors, although there are indications that poor health behaviors increase the risk of both SA and DP. The aims were to study the associations between three poor health behaviors (current smoking, high alcohol consumption and low physical activity levels) and DP among individuals who recently been sickness absent, and to explore whether having multiple poor health behaviors increased the risk of transitioning from SA to DP. Methods This prospective cohort study included 1991 twin individuals aged 20-46 who participated in a survey in 2005 and who had been on long-term SA in the two years preceding baseline (date of answering the survey) data collection of health behaviors (smoking, alcohol and physical activity) and relevant covariates. The participants were followed up for incident all-cause DP until the 31st of December 2012 (mean follow-up 5.2 years). National register data of SA and DP were used, and the association between each health behavior and DP was estimated using Cox proportional hazards regression analyses. The results are presented as Hazard Ratios (HR) with 95% Confidence Intervals (CI). Results Results showed that compared to never smoking, current smoking was associated with a higher risk of transitioning from SA to DP (HR 1.76, 95%CI 1.08-2.84). Alcohol use, lack of physical activity or having several poor health behaviors showed no significant associations. Conclusions Being a current smoker influences the risk of transitioning from SA to DP. Poor health behaviors are well established risk factors for poor physical and mental health. Hence, from a public health perspective it is important to emphasize the value of improving health behaviors in general but also among people with a history of SA. Key messages Many factors including health behaviors influence the risk of transitioning from sickness absence to permanent work incapacity in terms of disability pension. Supporting people on sickness absence to improve their health behaviors, e.g. smoking cessation, could be a promising approach to prevent exit from the labor market through disability pension.

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Suicide attempt following sickness absence and disability pension due to common mental disorders: a prospective Swedish twin study

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-019-01803-w ◽

2019 ◽

Vol 55 (8) ◽

pp. 1053-1060 ◽

Cited By ~ 1

Author(s):

M. Wang ◽

L. Mather ◽

P. Svedberg ◽

E. Mittendorfer-Rutz

Keyword(s):

Mental Disorders ◽

Suicide Attempt ◽

Sickness Absence ◽

Disability Pension ◽

Depressive Disorders ◽

Proportional Hazards ◽

Common Mental Disorders ◽

Cox Proportional Hazards ◽

Shared Environment ◽

Familial Factors

Abstract Purpose The aim of this study was to investigate if sickness absence and disability pension (SA/DP) in general and due to specific common mental disorders (CMDs) are associated with subsequent suicide attempt among women and men by taking familial factors (genetics and shared environment) into consideration. Methods This register-based cohort study includes 4871 twin pairs 18–65 years of age discordant for SA/DP due to CMDs 2005–2010. Twins were followed up for suicide attempt from inpatient and specialised outpatient care until December 2012. Conditional Cox proportional hazards regression models, adjusting for familial factors, were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results SA/DP due to CMDs was associated with a higher risk of suicide attempt (HR 3.14, CI 2.51–3.93). The risk of suicide attempt was five times higher among men and three times higher among women, compared to the SA/DP unaffected co-twins. In the diagnosis-specific analysis, SA/DP due to anxiety disorders resulted in the highest HR (4.09, CI 2.37–7.06) for suicide attempt, followed by depressive disorders (HR 3.70, CI 2.66–5.14) and stress-related disorders (HR 1.96, CI 1.35–2.84). The stratified analysis on zygosity indicates that there seems to be a genetic influence on the associations between SA/DP due to CMDs and suicide attempt, particularly among women and among those with SA/DP due to depressive disorders. Conclusions SA/DP due to CMDs was a risk factor for suicide attempt among women and men. Genetic factors might explain part of the associations for women and for those with SA/DP due to depressive disorders.

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Are service and patient indicators different in the presence or absence of nurse practitioners? The EDPRAC cohort study of Australian emergency departments

BMJ Open ◽

10.1136/bmjopen-2018-024529 ◽

2019 ◽

Vol 9 (7) ◽

pp. e024529

Author(s):

Sandy Middleton ◽

Glenn Gardner ◽

Anne Gardner ◽

Julie Considine ◽

Gerard Fitzgerald ◽

...

Keyword(s):

Cohort Study ◽

Nurse Practitioners ◽

Quality Indicator ◽

Emergency Departments ◽

Proportional Hazards ◽

Waiting Times ◽

Cox Proportional Hazards ◽

Number Of Patients ◽

Indicator Data ◽

The Impact

ObjectivesTo evaluate the impact of nurse practitioner (NP) service in Australian public hospital emergency departments (EDs) on service and patient safety and quality indicators.Design and settingCohort study comprising ED presentations (July 2013–June 2014) for a random sample of hospitals, stratified by state/territory and metropolitan versus non-metropolitan location; and a retrospective medical record audit of ED re-presentations.MethodsService indicator data (patient waiting times for Australasian Triage Scale categories 2, 3, 4 and 5; number of patients who did not-wait; length of ED stay for non-admitted patients) were compared between EDs with and without NPs using logistic regression and Cox proportional hazards regression, adjusting for hospital and patient characteristics and correlation of outcomes within hospitals. Safety and quality indicator data (rates of ED unplanned re-presentations) for a random subset of re-presentations were compared using Poisson regression.ResultsOf 66 EDs, 55 (83%) provided service indicator data on 2 463 543 ED patient episodes while 58 (88%) provided safety and quality indicator data on 2853 ED re-presentations. EDs with NPs had significantly (p<0.001) higher rates of waiting times compared with EDs without NPs. Patients presenting to EDs with NPs spent 13 min (8%) longer in ED compared with EDs without NPs (median, (first quartile–third quartile): 156 (93–233) and 143 (84–217) for EDs with and without NPs, respectively). EDs with NPs had 1.8% more patients who did not wait, but similar re-presentations rates as EDs with NPs.ConclusionsEDs with NPs had statistically significantly lower performance for service indicators. However, these findings should be treated with caution. NPs are relatively new in the ED workforce and low NP numbers, staffing patterns and still-evolving roles may limit their impact on service indicators. Further research is needed to explain the dichotomy between the benefits of NPs demonstrated in individual clinical outcomes research and these macro system-wide observations.

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Combination of diabetes mellitus and lack of habitual physical activity is a risk factor for functional disability in Japanese

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000901 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000901

Author(s):

Kazuya Fujihara ◽

Yasuhiro Matsubayashi ◽

Mayuko Harada Yamada ◽

Masaru Kitazawa ◽

Masahiko Yamamoto ◽

...

Keyword(s):

Physical Activity ◽

Functional Disability ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Habitual Physical Activity ◽

Term Care ◽

Patients With Diabetes ◽

The Impact

ObjectiveDeclining healthy life expectancy due to functional disability is relevant and urgent because of its association with decreased quality of life and also for its enormous socioeconomic impact. The aim of this study is to examine the impact of diabetes, hypertension, dyslipidemia and physical activity habits on functional disability among community-dwelling Japanese adults.Research design and methodsThis is a population-based retrospective cohort study including 9673 people aged 39–98 years in Japan (4420, men). Functional disability was defined as a condition meeting Japan’s new long-term care insurance certification requirements for the need of assistance in the activities of daily living whether by caregivers or assistive devices. Cox proportional-hazards regression model identified variables related to functional disability.ResultsMedian follow-up was 3.7 years. During the study period, 165 disabilities occurred in the overall study population. Multivariate analysis showed that diabetes (HR 1.74 (95% CI 1.12 to 2.68)) and no physical activity habit (HR 1.83 (1.27 to 2.65)) presented increased risks for disability. HR for disability increased with the number of risk factors (HR of individuals with four conditions, 3.96 (1.59 to 9.99) vs individuals with none of those conditions as a reference). HR for disability among patients with diabetes with and without a physical activity habit was 1.68 (0.70 to 4.04) and 3.19 (1.79 to 5.70), respectively, compared with individuals without diabetes with a physical activity habit.ConclusionsThe combination of diabetes and lack of habitual physical activity is predictive of functional disability in Japanese. Habitual physical activity attenuates the risk of functional disability in patients with diabetes.

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Independent effects of waist circumference and physical activity on all-cause mortality in Canadian women

Applied Physiology Nutrition and Metabolism ◽

10.1139/h05-038 ◽

2006 ◽

Vol 31 (3) ◽

pp. 271-276 ◽

Cited By ~ 24

Author(s):

Peter T Katzmarzyk ◽

Cora L Craig

Keyword(s):

Physical Activity ◽

Cohort Study ◽

Waist Circumference ◽

Physical Inactivity ◽

Proportional Hazards ◽

Leisure Time Physical Activity ◽

Smoking Status ◽

Cox Proportional Hazards ◽

Independent Effects

The purpose of this study was to determine the independent effects of waist circumference (WC) and physical inactivity on the risk of mortality in women. This prospective cohort study included 5421 female participants 20-69 years of age in the 1981 Canada Fitness Survey. WC was measured with an anthropometric tape and leisure-time physical activity levels over the previous 12 months were assessed with a questionnaire. Mortality surveillance was conducted by data linkage with the Canadian Mortality Database through 31 December, 1993. The hazard ratios (HR) of mortality were estimated using Cox proportional hazards regression with age, smoking status, and alcohol con sumption included as covariates in all models. A total of 225 deaths occurred over an average of 12.4 years of follow up (67 500 person-years of follow up). Physical activity (HR = 0.78; 95% C.I.: 0.64-0.95) and WC (HR = 1.17; 95% C.I.: 1.05-1.31) were associated with mortality when included in separate regression models. When included in the same model, both physical activity (HR = 0.79; 95% CI: 0.65-0.96) and WC (HR = 1.16; 95% C.I.: 1.04-1.30) remained independent significant predictors of mortality. In conclusion, physical inactivity and high WC have significant independent risks of premature mortality among women.Key words: death, obesity, cohort study, Canada Fitness Survey.

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Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species

Antibiotics ◽

10.3390/antibiotics9050254 ◽

2020 ◽

Vol 9 (5) ◽

pp. 254 ◽

Cited By ~ 2

Author(s):

Caroline Derrick ◽

P. Brandon Bookstaver ◽

Zhiqiang K. Lu ◽

Christopher M. Bland ◽

S. Travis King ◽

...

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Proportional Hazards ◽

Bloodstream Infections ◽

Cox Proportional Hazards ◽

Third Generation ◽

Cox Proportional Hazards Regression ◽

Proportional Hazards Regression ◽

Definitive Therapy ◽

The Impact

Objectives: There is debate on whether the use of third-generation cephalosporins (3GC) increases the risk of clinical failure in bloodstream infections (BSIs) caused by chromosomally-mediated AmpC-producing Enterobacterales (CAE). This study evaluates the impact of definitive 3GC therapy versus other antibiotics on clinical outcomes in BSIs due to Enterobacter, Serratia, or Citrobacter species. Methods: This multicenter, retrospective cohort study evaluated adult hospitalized patients with BSIs secondary to Enterobacter, Serratia, or Citrobacter species from 1 January 2006 to 1 September 2014. Definitive 3GC therapy was compared to definitive therapy with other non-3GC antibiotics. Multivariable Cox proportional hazards regression evaluated the impact of definitive 3GC on overall treatment failure (OTF) as a composite of in-hospital mortality, 30-day hospital readmission, or 90-day reinfection. Results: A total of 381 patients from 18 institutions in the southeastern United States were enrolled. Common sources of BSIs were the urinary tract and central venous catheters (78 (20.5%) patients each). Definitive 3GC therapy was utilized in 65 (17.1%) patients. OTF occurred in 22/65 patients (33.9%) in the definitive 3GC group vs. 94/316 (29.8%) in the non-3GC group (p = 0.51). Individual components of OTF were comparable between groups. Risk of OTF was comparable with definitive 3GC therapy vs. definitive non-3GC therapy (aHR 0.93, 95% CI 0.51–1.72) in multivariable Cox proportional hazards regression analysis. Conclusions: These outcomes suggest definitive 3GC therapy does not significantly alter the risk of poor clinical outcomes in the treatment of BSIs secondary to Enterobacter, Serratia, or Citrobacter species compared to other antimicrobial agents.

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Role of social benefits for future long-term sickness absence, disability pension and unemployment among individuals on sickness absence due to mental diagnoses: a competing risk approach

International Archives of Occupational and Environmental Health ◽

10.1007/s00420-021-01825-5 ◽

2021 ◽

Author(s):

Annina Ropponen ◽

Jurgita Narusyte ◽

Mo Wang ◽

Sanna Kärkkäinen ◽

Lisa Mather ◽

...

Keyword(s):

Sickness Absence ◽

Cumulative Incidence ◽

Disability Pension ◽

Social Insurance ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Social Benefits

Abstract Purpose To investigate associations between social benefits and disability pension (DP), long-term sickness absence (LTSA, ≥ 90 days), or unemployment among Swedish twins with sickness absence (SA) due to mental diagnoses. Methods This population-based prospective twin study included register data on first incident SA spell (< 90 days) due to mental diagnoses (ICD 10 codes F00-F99) during the follow-up 2005–2016. SA < 90 days due to other diagnoses than mental diagnoses or any other social insurance benefit was identified for the preceding year of the first incident SA spell due to mental diagnoses (coded yes/no). Comparing those with any previous social benefits vs without, cumulative incidence curve to compare time to an event, and Cox proportional hazards models for cause-specific hazard ratios (HR, 95% confidence intervals, CI) treating first incident DP, LTSA and unemployment as competing risks were modeled. Results During follow-up, 21 DP, 1619 LTSA, and 808 unemployment events took place. Compared to those without, those with at least one benefit had a higher risk for DP (HR 5.03; 95%CI 1.80, 14.01), LTSA (1.67; 1.50, 1.84) and unemployment (1.24; 1.03, 1.50). The cumulative incidence for DP was very low, < 1%, for LTSA 80% with any previous social benefits vs. 60% without, and for unemployment ≤ 5%. Conclusion Social benefits received during the preceding year of SA due to mental diagnoses (< 90 days) predict DP, LTSA, and unemployment. Hence, previous social benefits may provide means for early identification of persons at risk for exit from labor market.

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Kjønnsforskjeller i overgang fra langtidssykmelding til uførepensjon i 1997-2002

Norsk Epidemiologi ◽

10.5324/nje.v19i2.590 ◽

2010 ◽

Vol 19 (2) ◽

Author(s):

Sturla Gjesdal

Keyword(s):

Gender Differences ◽

Sick Leave ◽

Sickness Absence ◽

Disability Pension ◽

Proportional Hazards ◽

Sociodemographic Factors ◽

Cox Proportional Hazards ◽

Research Database ◽

Permanent Disability

Bakgrunn: Denne studien undersøker overgangen fra langtidssykmelding til uførepensjonering for å se om man her kan finne noe av forklaringen på den observerte overhyppighet av uførepensjonering blant kvinner.Metode og materiale: Prospektiv nasjonal kohortstudie som inkluderer 66 083 kvinner og 47 073 menn i alderen 16-62 år som var sykmeldt lenger enn åtte uker i 1997. Data er hentet fra FD-trygd. Kvinner som var sykmeldt med en W-diagnose (svangerskapsrelatert) ble ekskludert fra analysen pga alder og lav uførefrekvens. Kohorten ble fulgt opp i fem år med overgang til uførepensjon som endepunkt. Betydning av kjønn ble estimert ved hjelp av Cox' proporsjonal hasards analyse, kontrollert for sosiodemografiske faktorer. Vi gjorde separate analyser for de sykmeldte med muskel- og skjelettdiagnoser, psykiske diagnoser, hjerte/lungediagnoser og "andre" sykmeldingsdiagnoser, også med stratifisering for bostedsfylke.Resultater: 22% av de sykmeldte mennene og 24% av kvinnene var uførepensjonert etter fem års oppfølging. Etter justering for sosiodemografiske faktorer var risiko for uførepensjon fortsatt høyere for kvinner med muskel- og skjelettdiagnoser, men høyere for menn i de andre diagnosegruppene og totalt.Konklusjon: Risiko for uførepensjon blant langtidssykmeldte kvinner er ikke høyere enn hos langtidssykmeldte menn. Tvert imot, etter korreksjon for sosiodemografiske variabler, er det langtidssykmeldte menn som har størst risiko for å bli uførepensjonert, særlig innen gruppen som var sykmeldt for en psykisk lidelse. Siden langtidssykefraværet er høyere blant kvinner enn blant menn, er likevel totaleffekten en større uføretilgang blant kvinnelige langtidssykmeldte. Gjesdal S. Gender differences in transition from long-term sickness absence to permanent disability pension, 1997-2002. Nor J Epidemiol 2009; 19 (2): 193-202. ENGLISH SUMMARYBackground: The study investigates the transition from long-term sickness absence to permanent disability pension (DP) in Norway. The aim is to assess whether gender differences in this process explain the observed female excess in disability pensioning in Norway.Methods and data: Prospective national cohort study including 66,083 women and 47,073 men aged 16-62 years, with a spell of sick leave longer than 8 weeks in 1997. The data is obtained from a national research database (FD-trygd). Women on sick leave with a pregnancy related diagnosis were excluded. The endpoint was granting of a DP. The effect of gender on the risk of obtaining a DP was estimated by means of Cox' proportional hazards analysis, adjusted for sociodemographic factors. Separate analyses were carried out for those with diagnoses indicating diseases in the musculoskeletal, mental, and cardiovascular and respiratory groups combined. Stratified analyses for county of residence were also performed.Results: 22% of the male and 24% of the female sample obtained a DP during follow-up. Adjusted for sociodemographic factors the risk of DP was still higher for women with musculoskeletal diagnoses, but higher for men in the remaining diagnostic groups and overall.Conclusion: The risk of DP after sickness absence is not higher in women compared to men. On the contrary, after adjustment for relevant sociodemographic variables, men on sick-leave have the highest risk of a future DP. This is most evident among those on sick-leave with a mental diagnosis. However, since longterm sickness absence is much more frequent among women, the total effect is a higher rate of DP among Norwegian women.

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Association of Physical Activity and Cognitive Activity With Disability: A 2-Year Prospective Cohort Study

Physical Therapy ◽

10.1093/ptj/pzaa052 ◽

2020 ◽

Vol 100 (8) ◽

pp. 1289-1295

Author(s):

Satoshi Kurita ◽

Takehiko Doi ◽

Kota Tsutsumimoto ◽

Sho Nakakubo ◽

Minji Kim ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Cohort Study ◽

Proportional Hazards ◽

Physical Therapists ◽

Cognitive Activity ◽

Study Data ◽

Cox Proportional Hazards ◽

Rank Test ◽

Term Care

Abstract Objective Engaging in physical activity (PA) and/or cognitive activity (CA) retains function in older adults, but whether the combination of these activities is associated with disability onset is still unknown. This study aimed to examine the prospective association of PA and/or CA with disability onset in older adults. Methods This was an ongoing prospective community-based cohort study. Data collection was conducted through a health check. An analyzable sample of 2668 participants (mean age = 75.5 years; 51.6% female) were categorized into 4 groups based on quartile 1 (low) and 2 to 4 (high) values of accelerometer-measured moderate-to-vigorous PA and CA scale scores based on the frequency of 6 activities including reading, writing for pleasure, doing crossword puzzles, and playing board games or cards. Disability onset was monitored through long-term care insurance certification for at least 2 years. Results A log-rank test showed significantly lower incidence of disability in the high PA and low CA group and the high PA and high CA group compared with the low PA and low CA group. Cox-proportional hazards models (referring to the low PA and low CA group) showed that only the high PA and high CA group was significantly associated with a lowered hazard ratio for disability onset (0.51; 95% CI = 0.29–0.90) after adjusting for covariates. Conclusions Engaging in both PA and CA is effective for reducing risk of disability onset, but engaging in either PA or CA is not effective. Impact Physical therapists can be guided by this research to design intervention strategies for people at risk of disability.

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Age at Exposure to Parental Suicide and the Subsequent Risk of Suicide in Young People

Crisis ◽

10.1027/0227-5910/a000468 ◽

2018 ◽

Vol 39 (1) ◽

pp. 27-36 ◽

Cited By ~ 5

Author(s):

Kuan-Ying Lee ◽

Chung-Yi Li ◽

Kun-Chia Chang ◽

Tsung-Hsueh Lu ◽

Ying-Yeh Chen

Keyword(s):

Young People ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Birth Registry ◽

Data Set ◽

Parental Suicide ◽

The Impact ◽

Age At Exposure

Abstract. Background: We investigated the age at exposure to parental suicide and the risk of subsequent suicide completion in young people. The impact of parental and offspring sex was also examined. Method: Using a cohort study design, we linked Taiwan's Birth Registry (1978–1997) with Taiwan's Death Registry (1985–2009) and identified 40,249 children who had experienced maternal suicide (n = 14,431), paternal suicide (n = 26,887), or the suicide of both parents (n = 281). Each exposed child was matched to 10 children of the same sex and birth year whose parents were still alive. This yielded a total of 398,081 children for our non-exposed cohort. A Cox proportional hazards model was used to compare the suicide risk of the exposed and non-exposed groups. Results: Compared with the non-exposed group, offspring who were exposed to parental suicide were 3.91 times (95% confidence interval [CI] = 3.10–4.92 more likely to die by suicide after adjusting for baseline characteristics. The risk of suicide seemed to be lower in older male offspring (HR = 3.94, 95% CI = 2.57–6.06), but higher in older female offspring (HR = 5.30, 95% CI = 3.05–9.22). Stratified analyses based on parental sex revealed similar patterns as the combined analysis. Limitations: As only register-based data were used, we were not able to explore the impact of variables not contained in the data set, such as the role of mental illness. Conclusion: Our findings suggest a prominent elevation in the risk of suicide among offspring who lost their parents to suicide. The risk elevation differed according to the sex of the afflicted offspring as well as to their age at exposure.

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