Publications by authors named "Pia Svedberg"

95 Publications

The predictive role of sickness absence spell durations in associations with inpatient- and specialized outpatient care among a population-based Swedish twin sample.

BMC Health Serv Res 2021 Apr 7;21(1):315. Epub 2021 Apr 7.

Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.

Background: The associations between a sickness absence spell duration and patient care have been rarely studied. An assumption is that associations would differ by spell duration and by the patient care type, inpatient- or specialized outpatient, due to severity of diseases and/or conditions. We aimed to investigate sickness absence spells in various spell durations as a predictor for subsequent inpatient- and specialized outpatient care separately, and to study if familial confounding plays a role in these associations.

Methods: We followed a population-based sample of Swedish twins born 1925-90 with national registers from 2001 for first incident sickness absence spell (days to calculate spell duration categorized into ≤30 days, 31-90 days, 91-180 days and ≥ 181 days), or no sickness absence, and for inpatient- and specialized outpatient care until 2013 (n = 24,975). Cox proportional hazards models were applied for hazard ratios (HR) with 95% confidence intervals (CI) while accounting for covariates and familial confounding.

Results: First incident sickness absence spell across all duration categories was associated with an increased risk of inpatient- (age- and sex adjusted HR 1.28 to 6.05) or specialized outpatient care (HR 1.17-2.50), both in comparison to those without any sickness absence or the shortest sickness absence spell category (1-30 days). The associations remained statistically significant while controlling for covariates or familial confounding.

Conclusions: First incident sickness absence spell increases the risk of inpatient care or specialized outpatient care regardless of the duration of the sickness absence spell. Hence, incident sickness absence spells should be noted and targeted to actions at workplaces as well as in primary and occupational health care.
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http://dx.doi.org/10.1186/s12913-021-06310-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028110PMC
April 2021

Sleep duration and mortality - Influence of age and occupational group in retired individuals.

Sleep Med 2021 Apr 3;80:199-203. Epub 2021 Feb 3.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

The importance of sleep duration for health or mortality attracts much public attention. Prior work indicates that both long and short sleep duration predicts mortality, with optimal sleep duration (lowest risk) at 7 h. However, we believe this may differ between subgroups. This may be the case with, for example, age groups (due to aging), or blue-collar and white-collar worker (due to work exposure). It is also likely that retirement, which permits extension of the time in bed, may confound analyses. The purpose of the present study was to investigate how occupational group (blue-collar/white-collar worker) and age influence the pattern of association between sleep duration and mortality in retired individuals. Retired individuals were selected since it was hypothesized that effects of occupation may accumulate over years and since the transition into retirement may be a confounder. We used a sample of 14 000 individuals from the Swedish Twin Registry, which had provided data on sleep duration and a number of covariates. Cox proportional hazards analysis was applied to data. The results show that occupational group did not influence the association, but showed significant hazard ratios (HR) for long (≥9.5 h) and short (<6.5 h) sleep in both groups (HR > 1.35), with optimal sleep duration (lowest HR) with a wide span (6.5-9.5 h). Age groups in tertiles also showed significant U-shapes, with a wide span (6.5-9.5 h) for the younger 2/3 (54-74 years), but a weaker pattern for the oldest third (≥75 years), for which optimal sleep fell in the 6.5-7.5 h interval. It was concluded that occupational group does not influence the association between sleep duration and mortality in retired individuals, but that age does.
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http://dx.doi.org/10.1016/j.sleep.2021.01.058DOI Listing
April 2021

Childbirth, morbidity, sickness absence and disability pension: a population-based longitudinal cohort study in Sweden.

BMJ Open 2020 11 24;10(11):e037726. Epub 2020 Nov 24.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Objective: To investigate associations of morbidity with subsequent sickness absence (SA) and disability pension (DP) among initially nulliparous women with no, one or several childbirths during follow-up.

Design: Longitudinal register-based cohort study.

Setting: Sweden.

Participants: Nulliparous women, aged 18 to 39 years and living in Sweden on 31 December 2004 and the three preceding years (n=492 504).

Outcome Measures: Annual mean DP and SA days (in SA spells >14 days) in the 3 years before and after inclusion date in 2005.

Methods: Women were categorised into three groups: no childbirth in 2005 nor during the follow-up, first childbirth in 2005 but not during follow-up, and having first childbirth in 2005 and at least one more during follow-up. Microdata were obtained for 3 years before and 3 years after inclusion regarding SA, DP, mortality and morbidity (ie, hospitalisation and specialised outpatient healthcare, also excluding healthcare for pregnancy, childbirth and puerperium). HRs and 95% CIs for SA and DP in year 2 and 3 after childbirth were estimated by Cox regression; excluding those on DP at inclusion.

Results: After controlling for study participants' prior morbidity and sociodemographic characteristics, women with one childbirth had a lower risk of SA and DP than those who remained nulliparous, while women with more than one childbirth had the lowest DP risk. Morbidity after inclusion that was not related to pregnancy, childbirth or the puerperium was associated with a higher risk of future SA and DP, regardless of childbirth group. Furthermore, morbidity both before and after childbirth showed a strong association with SA and DP (HR range: 2.54 to 13.12).

Conclusion: We found a strong positive association between morbidity and both SA and DP among women, regardless of childbirth status. Those who gave birth had lower future SA and DP risk than those who did not.
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http://dx.doi.org/10.1136/bmjopen-2020-037726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689079PMC
November 2020

Health behaviours and psychosocial working conditions as predictors of disability pension due to different diagnoses: a population-based study.

BMC Public Health 2020 Oct 6;20(1):1507. Epub 2020 Oct 6.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.

Background: To investigate whether the clustering of different health behaviours (i.e. physical activity, tobacco use and alcohol consumption) influences the associations between psychosocial working conditions and disability pension due to different diagnoses.

Methods: A population-based sample of 24,987 Swedish twins born before 1958 were followed from national registers for disability pension until 2013. Baseline survey data in 1998-2003 were used to assess health behaviours and psychosocial Job Exposure Matrix for job control, job demands and social support. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI).

Results: During follow-up, 1252 disability pensions due to musculoskeletal disorders (5%), 601 due to mental diagnoses (2%) and 1162 due to other diagnoses (5%) occurred. In the models controlling for covariates, each one-unit increase in job demands was associated with higher (HR 1.16, 95%CI 1.01-1.33) and in job control with lower (HR 0.87, 95%CI 0.80-0.94) risk of disability pension due to musculoskeletal disorders among those with unhealthy behaviours. Among those with healthy behaviours, one-unit increase of social support was associated with a higher risk of disability pension due to mental and due to other diagnoses (HRs 1.29-1.30, 95%CI 1.04-1.63).

Conclusions: Job control and job demands were associated with the risk of disability pension due to musculoskeletal disorders only among those with unhealthy behaviours. Social support was a risk factor for disability pension due to mental or other diagnoses among those with healthy behaviours. Workplaces and occupational health care should acknowledge these simultaneous circumstances in order to prevent disability pension.
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http://dx.doi.org/10.1186/s12889-020-09567-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541297PMC
October 2020

Psychosocial working conditions, pain, mental disorders, and disability pension.

Arch Environ Occup Health 2020 Sep 21:1-8. Epub 2020 Sep 21.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

We aimed to investigate associations between psychosocial working conditions and disability pension (DP), and the role of co-existing pain or common mental disorders (CMDs). Survey data collected 1998-2003 on 25,135 Swedish twins born 1935-1958 were linked with national DP register data until 2013. Psychosocial working conditions, pain and CMDs were analyzed by Cox proportional hazards regression models (hazard ratios with 95% confidence intervals). One unit increase in job demands or control was associated with a higher risk for DP due to musculoskeletal disorders. One unit decrease in job demands predicted lower risk of DP due to mental diagnoses. Co-existing pain or CMD played no role for associations of job demands with DP, but pain influenced the associations with DP due to mental diagnoses. To conclude, psychosocial working conditions play different roles for DP depending on the diagnoses.
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http://dx.doi.org/10.1080/19338244.2020.1816882DOI Listing
September 2020

Adverse outcomes of chronic widespread pain and common mental disorders in individuals with sickness absence - a prospective study of Swedish twins.

BMC Public Health 2020 Aug 27;20(1):1301. Epub 2020 Aug 27.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.

Background: Chronic widespread pain (CWP) and common mental disorders (CMDs) are common public health problems, but little is known about the role of CWP and CMDs on future adverse outcomes among work disabled individuals. The aims of the study were to investigate the associations between CWP and CMDs with subsequent disability pension (DP), long-term unemployment (> 90 days) and all-cause mortality in individuals with sickness absence (SA) and whether the associations were explained by familial factors.

Methods: In this prospective cohort study, 7884 Swedish twins born between 1933 and 1985 were included and baseline data were gathered from a questionnaire in 1998 to 2006. Register data were used for obtaining information regarding demographics, SA, DP, unemployment and mortality. Cox proportional hazards regressions were used to calculate Hazard Ratios (HR) with 95% Confidence Intervals (CI) for the associations between CWP and/or CMDs with DP, unemployment and mortality, while conditional Cox models for twin pairs provided control for familial confounding.

Results: Having either CWP or CMDs among those with a history of SA was associated with a higher risk of DP and all-cause mortality than individuals without CWP and CMDs after controlling for socio-demographic and health factors. Moreover, sick-listed individuals with both CWP and CMDs had a higher risk of DP while those who only had CMDs had a higher risk of long-term unemployment compared to those without CWP and CMDs. The association between CMDs with DP and long-term unemployment was no longer significant when controlling for familial factors.

Conclusions: CMDs was a risk factor for DP, unemployment and mortality among individuals with SA, while CWP seems to be important in relation to future DP and mortality. Familial factors played a role in the associations between CMDs and DP and CMDs and unemployment.
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http://dx.doi.org/10.1186/s12889-020-09407-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457303PMC
August 2020

Sick leave due to back pain, common mental disorders and disability pension: Common genetic liability.

Eur J Pain 2020 11 17;24(10):1892-1901. Epub 2020 Aug 17.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Background: Back pain and common mental disorders are often comorbid and known risk factors for future disability pension. However, the reason for the covariation is not known. The aim was to investigate the common genetic and environmental influences on the covariation between sick leave due to back pain, sick leave due to common mental disorders and disability pension.

Methods: Register data from the Swedish Social Insurance Agency on sick leave due to back pain, common mental disorders and disability pension between 2005 and 2018, in a population-based sample of 56,686 working age twins was used to construct biometric twin models to calculate if the covariation between the traits were due to Additive (A) or Dominant (D) genetic factors, Common environmental factors (C) or unique Environmental factors (E), for women and men.

Results: The phenotypic correlations ranged between 0.17 and 0.25. A common factor common pathway AE model fitted best for both women and men. The latent underlying common factor, that explained the covariation was mostly explained by genetic factors (87% for women and 90% for men). Each trait was also influenced by its own unique genetic and unique environment factors. A higher heritability was found for disability pension than for sick leave.

Conclusions: The covariation between sick leave due to back pain and common mental disorders, and disability pension were mostly explained by common genetic factors, while the unique variation in each trait was influenced by both genetic and environmental factors not shared within the twin pairs.

Significance: A common genetic liability seems to be of importance in the comorbidity of sick leave due to back pain and common mental disorders and the transition to disability pension, both among women and men. However, the proportion in each trait that was explained by genetic factors was somewhat higher for men than for women in all traits. This may be of importance to consider in intervention or prevention efforts.
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http://dx.doi.org/10.1002/ejp.1635DOI Listing
November 2020

Sickness absence and disability pension in relation to first childbirth and in nulliparous women according to occupational groups: a cohort study of 492,504 women in Sweden.

BMC Public Health 2020 May 14;20(1):686. Epub 2020 May 14.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Background: Childbirth has been suggested to increase sickness absence (SA) and disability pension (DP). This may vary by occupation; however, knowledge in this field remains limited. We explored SA and DP in the years before and after childbirth among women in four occupational groups and those without occupation.

Methods: We studied nulliparous women aged 18-39 years, living in Sweden on December 31, 2004 (n = 492,504). Women were categorized into five skill-level based occupational groups and three childbirth groups; no childbirths within 3 years (B0), first childbirth in 2005 with no childbirth within 3 years (B1), and first childbirth in 2005 with at least one more birth within 3 years (B1+). We compared crude and standardized annual mean SA (in spells> 14 days) and DP net days in the 3 years before and 3 years after first childbirth date.

Results: Women in the highest skill level occupations and managers, had less mean SA/DP days during most study years than women in the lowest skill level occupations group. In B1 and B1+, absolute differences in mean SA/DP, particularly in SA, among occupational groups were highest during the year before childbirth. DP was most common in B0, regardless of group and year.

Conclusions: We found that women's mean SA/DP days before and after first childbirth was higher with decreasing skill-level of the occupational group and these differences were most pronounced in the year before childbirth. DP was most common among women not giving birth, regardless of occupational group.
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http://dx.doi.org/10.1186/s12889-020-08730-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227196PMC
May 2020

Night work, mortality, and the link to occupational group and sex.

Scand J Work Environ Health 2020 09 9;46(5):508-515. Epub 2020 Apr 9.

Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden.

Objective Night shifts are associated with several major diseases. Mortality has been studied only to a limited extent, and the association with night shifts remains unclear. The purpose of the present study was to investigate the association between duration of night shift exposure and mortality in a large sample from the Swedish Twin Registry (the SALT cohort). Methods Cox proportional hazards regression models were used to analyze the data (N=42 731) over a follow-up period of 18 years, with years of night shift work as the exposure variable and adjustment for lifestyle factors and age, and stratification on gender and occupational group. Results The hazard ratio (HR) for "ever" night shifts for total mortality was 1.07 [95% confidence interval (CI) 1.01-1.15] but 1.15 (95% CI 1.07-1.25) for longer exposure (>5 years). Also, HR for cause-specific mortality due to cardiovascular disease was significant, with higher HR for longer night shift exposure. Mortality due to cancer was significant for longer exposure only. White-collar workers showed significant HR for longer exposure. In particular, male white-collar workers showed a significant HR, with a highest value for longer exposure [HR 1.28 (95% CI 1.09-1.49)]. Heredity did not influence the results significantly. Conclusions Long duration of exposure to night shift work is associated with increased mortality, particularly in male white-collar workers. The lack of effects of accumulated exposure suggests that the results should be interpreted with caution.
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http://dx.doi.org/10.5271/sjweh.3892DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737802PMC
September 2020

Shared liability to pain, common mental disorders, and long-term work disability differs among women and men.

Pain 2020 05;161(5):1005-1011

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Knowledge of factors involved in the associations between pain, common mental disorders, and future work incapacity is still scarce. The aim of this study was to examine the overlap between genetic and environmental factors contributing to depression/anxiety, pain, and future long-term sickness absence (SA) and disability pension (DP) among women and men. The study sample included 47,995 twins born in Sweden 1935 to 1985. Information on self-reported depression/anxiety and back, neck, and shoulder pain was obtained from surveys conducted 1998 to 2002 and 2004 to 2005. Data on long-term SA (>365 days) and DP due to mental and/or musculoskeletal disorders until 2013 were obtained from the National Social Insurance Agency. Shared genetic and environmental influences on depression/anxiety, pain, and SA/DP were estimated by applying structural equation modeling. The prevalence of depression/anxiety was 27% and 14% among women and men, for pain 24% and 19%, and for SA/DP due to mental and musculoskeletal diagnoses 7% and 4%, respectively. Multivariate biometric analyses revealed different patterns of covariation between the 3 phenotypes among women and men. For women, a latent-shared liability to all 3 phenotypes could be identified, mainly attributable to genetic factors (66%). For men, no shared underlying liability was observed. The variation in SA/DP was explained by genetic factors in common with depression/anxiety by 27% and in common with pain by 9%. Common mental disorders, pain, and SA/DP tend to covariate in different ways among women and men. The results may have clinical implications as strategies preventing SA/DP may be different among women and men.
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http://dx.doi.org/10.1097/j.pain.0000000000001787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170444PMC
May 2020

Health, work and demographic factors associated with a lower risk of work disability and unemployment in employees with lower back, neck and shoulder pain.

BMC Musculoskelet Disord 2019 Dec 26;20(1):622. Epub 2019 Dec 26.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Background: Chronic musculoskeletal pain affects over 20% of the adult population and is one of the most common reasons for sick leave in Sweden. The aim of this study was to investigate which demographic, health and psychosocial work environment factors are of importance for a lower risk of future work disability and unemployment among workers with low back pain (LBP) and/or neck shoulder pain (NSP), and if familial factors influence these associations.

Methods: All 5556 persons that reported having LBP and/or NSP in a web-based questionnaire study in 2004-2006 were included. They were followed up for work disability (sick leave > 90 days or disability pension), and unemployment (> 180 days in a year) until 31 December 2013. Hazard ratios (HR) with 95% confidence intervals were calculated using cox proportional hazard models of the whole sample, adjusting for covariates. In addition, co-twin analyses of outcome discordant twin pairs were conducted to assess the impact of familial confounding on the associations.

Results: Being male, 19-28 years old, having higher education, only NSP, no history of depression or anxiety, good self-rated health, low job demands and high job control were associated with a lower risk of work disability (adjusted HR ranging between 0.29-0.85). No history of anxiety and depression and high job control was associated with a lower risk of unemployment (adjusted HR ranging from 0.53 and 0.67). Familial factors were found to affect the association between education and work disability, but none of the other associations investigated.

Conclusions: Among those with LBP or NSP, good health in terms of mental- and self-rated health, few pain sites, as well as good psychosocial working conditions seem to indicate a lower risk for work disability.
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http://dx.doi.org/10.1186/s12891-019-2999-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6933729PMC
December 2019

A Life Course Study of Genetic and Environmental Influences on Work Incapacity.

Twin Res Hum Genet 2020 02 26;23(1):16-22. Epub 2019 Dec 26.

Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway.

Work incapacity is a major public health challenge and an economic burden to both society and individuals. Understanding the underlying causes is becoming ever more relevant as many countries face an aging workforce. We examined stability and change in genetic and environmental factors influencing work incapacity from age 18 until retirement, and sex differences in these effects. The large population-based sample comprised information from 28,759 twins followed for up to 23 years combined with high-quality national registry data. We measured work incapacity as the total proportion of potential workdays lost due to sickness absence, rehabilitation and disability benefits. Structural equation modeling with twin data indicated moderate genetic influences on work incapacity throughout life in both men and women, with a high degree of genetic stability from young to old adulthood. Environmental influences were mainly age-specific. Our results indicate that largely the same genetic factors influence individual differences in work incapacity throughout young, middle and older adulthood, despite major differences in degree of work incapacity and probable underlying medical causes.
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http://dx.doi.org/10.1017/thg.2019.116DOI Listing
February 2020

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.

PLoS One 2019 13;14(12):e0226198. Epub 2019 Dec 13.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Background: Pregnancy is associated with a temporarily increased sickness absence (SA) risk. This association may vary by the level of occupational gender segregation; however, knowledge in this area is limited. We studied whether trends in SA and disability pension (DP) in the years before and after first childbirth among women with one or more childbirths and with no childbirth during the study period varied by occupational gender segregation.

Methods: We conducted a population-based register study involving nulliparous women aged 18-39 years, living in Sweden in 2002-2004 (n = 364,411). We classified participants in three childbirth groups as: (1) no childbirth in 2005 or in the next 3.75 years, (2) first childbirth in 2005 and no births in the subsequent 3.75 years, and (3) first childbirth in 2005 and at least one additional birth in the subsequent 3.75 years, and into five categories based on the rate of women in their occupations. We compared crude and standardized mean annual net SA and DP days during the three years before and the three years after 2005 across the childbirth and occupational gender segregation categories.

Results: Women in extremely male-dominated occupations had or tended to have somewhat higher mean combined SA and DP days than women in gender-integrated occupations; women in female-dominated occupations had comparable or tended to have slightly higher mean SA and DP days than women in gender-integrated occupations. Except for the year before the first childbirth, women who gave birth, especially those who gave several births, had generally a lower mean combined standardized SA and DP days than nulliparous women. We found no substantial differences in trends in SA and DP around the time of first childbirth according to occupational gender segregation.

Conclusions: Trends in SA and DP around the time of first childbirth did not vary by occupational gender segregation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226198PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910695PMC
April 2020

Life events as predictors for disability pension due to musculoskeletal diagnoses: a cohort study of Finnish twins.

Int Arch Occup Environ Health 2020 05 11;93(4):469-478. Epub 2019 Dec 11.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Purpose: Musculoskeletal diagnoses (MSD) are one of the largest diagnostic groups for disability pensions (DP). This study investigated the associations between life events and DP due to MSD, considering sociodemographic, health, and familial factors.

Methods: The study sample included 18,530 Finnish twins, 24-64 years old at baseline, who responded to a questionnaire in 1981 including a 21-item life event inventory. Information on DP with diagnosis codes (ICD codes: M00-M99) were obtained from the official national pension registers. Life events were divided into family- and work-related events. "Positive change in life" was analyzed separately. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI).

Results: During the follow-up of 23 years, 1273 (7%) individuals were granted DP due to MSD. In discordant pair analysis, family-related events (≥ 4 events) increased (HR 1.63, 95% CI 1.31, 2.03) and the absence of such events decreased (HR 0.68, 95% CI 0.48, 0.95) the risk of DP due to MSD. For work-related events (≥ 3 events), the risk estimates were non-significant when controlling for familial factors. Having had a positive change in life decreased the risk of DP due to MSD (HR 0.79, 95% CI 0.65, 0.96) while controlling for familial confounding, but were non-significant in the full model controlling for various covariates (HR 0.91, 95% CI 0.75, 1.12).

Conclusions: The associations between life events and the risk of DP due to MSD are complex and potentially affected by familial and other confounding factors including sociodemographics and health.
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http://dx.doi.org/10.1007/s00420-019-01505-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118032PMC
May 2020

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

BMJ Open 2019 11 10;9(11):e031889. Epub 2019 Nov 10.

Division of Insurance Medicine, Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Objectives: To 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.

Design: Prospective twin cohort study.

Setting: Sweden.

Participants: Twins 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 Measure: Incident 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.

Results: The 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.

Conclusions: Being 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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http://dx.doi.org/10.1136/bmjopen-2019-031889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858211PMC
November 2019

Associations of sitting time with leisure-time physical inactivity, education, and body mass index change.

Scand J Med Sci Sports 2020 Feb 24;30(2):322-331. Epub 2019 Oct 24.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

We aimed to investigate the associations of long-term leisure-time physical inactivity, body mass index (BMI) change, and education with sitting time in a 35-year follow-up based on self-reports in surveys. Influences of working status in 2011 and familial confounding on the associations were tested. Data were based on the population-based Finnish Twin Cohort of 5232 twins (53-67-year-old, 41% men) with four surveys in 1975-2011. Statistical analyses were performed using linear regression with several covariates. The effect of familial confounding (genetics and shared environment) was analyzed using a co-twin control design which should be interpreted as if familial confounding plays a role, an association should be seen among all individuals but not in discordant twin pairs. Compared to those not at work, those at work had a longer total sitting time/d. For those at work, higher education was associated with more total sitting but with less non-work sitting. Long-term leisure-time physical inactivity was associated with more non-work sitting among those at work, whereas long-term weight gain with more total and non-work sitting regardless of working status. Familial confounding attenuated the associations, except for the association of increasing BMI with total and non-work sitting among women at work. To conclude, total sitting time was longer among those still at work, but it was also influenced by long-term leisure-time physical inactivity, higher education, and an increase of BMI over the years. Public health efforts should be targeted to reduce sedentary behavior by promoting life-long leisure-time physical activity and weight control.
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http://dx.doi.org/10.1111/sms.13575DOI Listing
February 2020

Changes in prescription of antidepressants and disability pension due to back pain, compared with other musculoskeletal and other somatic diagnoses: a cohort study in Sweden.

BMJ Open 2019 09 17;9(9):e029836. Epub 2019 Sep 17.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Objectives: The aim was to investigate differences in the prescription of antidepressants during the transition to disability pension (DP) comparing DP due to back pain with DP due to other musculoskeletal and DP due to other somatic diagnoses.

Design: A population-based cohort study with follow-up 3 years before and after the event. Estimated prevalence and adjusted ORs with 95% CIs for antidepressant prescription were computed for the 7-year window (ie, t-3 to t+3) around the DP by generalised estimating equations for repeated measures.

Setting And Participants: This Swedish population-based nationwide study with registry data included individuals aged 18-64 years, with DP due to back pain (n=2011), DP due to other musculoskeletal (n=3548) or DP due to other somatic diagnoses (n=11 809).

Primary Outcome Measures: Prescription of antidepressants.

Results: Before DP, the prevalence of prescription of antidepressants was stable in DP due to back pain, but increased for the other DP groups. Similarly, the likelihood of prescription increased only marginally before DP due to back pain (ORs from 0.86 at t-3 to 1.10 at t-1), but clearly in DP due to musculoskeletal (from 0.42 to 1.15) and somatic diagnoses (from 0.29 to 0.98). Both prevalence measures and risks remained at the elevated levels after DP.

Conclusions: Pathways to DP due to musculoskeletal and somatic diagnoses seem to be partly driven by adverse mental health, which remains at a higher level after DP. The increasing prescription of antidepressants prior to DP suggests that special attention should be paid to mental health for prevention of DP. The period after DP needs attention to avoid deterioration of mental health.
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http://dx.doi.org/10.1136/bmjopen-2019-029836DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756318PMC
September 2019

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

BMJ Open 2019 09 8;9(9):e031593. Epub 2019 Sep 8.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Objective: Childbirth 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.

Design: Register-based longitudinal cohort study.

Setting: Sweden.

Participants: Three 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 Measures: Sum of SA >14 and DP net days/year.

Methods: We compared crude and standardised mean SA and DP days/year during the 3 years preceding and the 3 years after first childbirth date (Y to Y), 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).

Results: Despite 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: 25.3 (24.9-25.7), 14.5 (13.6-15.5) and 8.5 (7.9-9.2); Y: 27.5 (27.1-27.9), 16.6 (15.5-17.6) and 9.6 (8.9-10.4); Y: 29.2 (28.8-29.6), 31.4 (30.2-32.6) and 22.0 (21.2-22.9); Y: 30.2 (29.8-30.7), 11.2 (10.4-12.1) and 5.5 (5.0-6.1); Y: 31.7 (31.3-32.1), 15.3 (14.2-16.3) and 10.9 (10.3-11.6); Y: 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.

Conclusions: Women 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.
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http://dx.doi.org/10.1136/bmjopen-2019-031593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738681PMC
September 2019

Number of Pain Locations as a Predictor of Cause-Specific Disability Pension in Sweden-Do Common Mental Disorders Play a Role?

J Occup Environ Med 2019 08;61(8):646-652

Finnish Institute of Occupational Health, Työterveyslaitos, Finland (Dr Ropponen), Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Drs Ropponen, Narusyte, Mittendorfer-Rutz, Svedberg).

Objective: The aim of this study was to investigate the associations between number of pain locations, common mental disorders (CMDs), and disability pension (DP).

Methods: Survey data in 1998 to 2003 for 27,165 Swedish twins born in 1935 to 1958 were linked to national DP data until 2013. Pain locations were evaluated for back, low back, sciatica, shoulder, or neck pain, and CMDs for lifetime major depression and 1-month anxiety.

Results: The number of pain locations was associated with DP in a dose-response manner. One pain location had a hazard ratio of 1.50 (95% confidence interval 1.35 to 1.68) and five pain locations hazard ratio 4.67 (95% confidence interval 4.11 to 5.30) for DP. Also, CMDs were associated with DP.

Conclusion: The number of pain locations has a dose-response association with the risk of DP. CMDs predict DP. In strategies to prevent DP, early signs of pain or CMDs should be taken into consideration.
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http://dx.doi.org/10.1097/JOM.0000000000001635DOI Listing
August 2019

The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research.

Eur J Epidemiol 2019 Apr 30;34(4):423-437. Epub 2019 Mar 30.

Clinical Epidemiology Unit, Department of Medicine Stockholm, Karolinska Institutet, Stockholm, Sweden.

Education, income, and occupation are factors known to affect health and disease. In this review we describe the Swedish Longitudinal Integrated Database for Health Insurance and Labour Market Studies (LISA, Longitudinell Integrationsdatabas för Sjukförsäkrings- och Arbetsmarknadsstudier). LISA covers the adult Swedish population aged ≥ 16 years registered on December 31 each year since 1990 (since 2010 individuals aged ≥ 15 years). The database was launched in response to rising levels of sick leave in the country. Participation in Swedish government-administered registers such as LISA is compulsory, and hence selection bias is minimized. The LISA database allows researchers to identify individuals who do not work because of injury, disease, or rehabilitation. It contains data on sick leave and disability pension based on calendar year. LISA also includes information on unemployment benefits, disposable income, social welfare payments, civil status, and migration. During 2000-2017, an average of 97,000 individuals immigrated to Sweden each year. This corresponds to about 1% of the Swedish population (10 million people in 2017). Data on occupation have a completeness of 95%. Income data consist primarily of income from employment, capital, and allowances, including parental allowance. In Sweden, work force participation is around 80% (2017: overall: 79.1%; men 80.3% and women 77.9%). Education data are available in > 98% of all individuals aged 25-64 years, with an estimated accuracy for highest attained level of education of 85%. Some information on civil status, income, education, and employment before 1990 can be obtained through the Population and Housing Census data (FoB, Folk- och bostadsräkningen).
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http://dx.doi.org/10.1007/s10654-019-00511-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451717PMC
April 2019

The role of occupational class on the association between sickness absence and disability pension: A Swedish register-based twin study.

Scand J Work Environ Health 2019 11 20;45(6):622-630. Epub 2019 Mar 20.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Berzeliusväg 3, 171 77 Stockholm, Sweden.

Objectives The aim of this study was to examine the association between long-term sickness absence (LTSA) due to mental disorders and musculoskeletal disorders and all-cause disability pension (DP) among blue- and white-collar workers. A secondary objective was to examine the influence of familial factors on the associations. Methods This was a prospective twin cohort study of 42 984 individuals (21-64 years at baseline), 3017 of whom had a new LTSA spell (>14 days) due to mental or musculoskeletal disorders in 2005-2006. Average follow-up time was 5.4 years. Survey data on occupational class and register data on LTSA and DP were used. Cox proportional hazards regression was applied to calculate hazards ratios (HR) with 95% confidence intervals (CI). Results During follow-up, 989 participants went on disability. LTSA due to mental disorders and musculoskeletal disorders led to similar HR for DP among both white- and blue-collar workers when compared to white-collar workers not on LTSA (reference group). LTSA ≥6 months due to musculoskeletal disorders was associated with a higher risk of DP for white-collar (HR 31.50, 95% CI 20.45-48.52) than blue-collar (HR 17.64, 95% CI 13.08-23.78) workers when compared to the reference group. HR were lower in the discordant twin pair models for LTSA due to mental disorders than in the whole cohort. Conclusions White-collar workers on LTSA due to musculoskeletal disorders are especially vulnerable to all-cause DP. This pattern was not present for LTSA due to mental disorders. Familial factors seem to influence the association between LTSA due to mental disorders and all-cause DP.
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http://dx.doi.org/10.5271/sjweh.3816DOI Listing
November 2019

Associations between adolescent social phobia, sickness absence and unemployment: a prospective study of twins in Sweden.

Eur J Public Health 2019 10;29(5):931-936

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Background: Little is known about adolescent mental health problems, including social phobia, as risk factors for future work incapacity. The aim of this study was to investigate the association between social phobia in adolescence and unemployment and sickness absence (SA) in early adulthood, also evaluating the role of familial factors (genetics and shared environment).

Methods: A sample of 2845 Swedish twins born in 1985-86 in Sweden was followed longitudinally in the population-based and prospective Twin study of CHild and Adolescent Development. Information on twins' social phobia was collected at ages 13-4, 16-7 and 19-20 years. Logistic regression providing odds ratios (OR) with 95% confidence intervals (95% CI) was used to analyze the associations between social phobia, unemployment and SA during the follow-up 2006-12. The influence of familial factors was evaluated by conditional logistic regression.

Results: Presence of social phobia during adolescence was associated with increased odds for unemployment and SA in young adulthood. For unemployment, the highest OR was at the age of 13-4 years (1.58 [95% CI: 1.22-2.06]), and the associations became null after adjusting for familial factors. For SA, the highest OR was at the age of 19-20 years (1.73 [95% CI: 1.13-2.65]), and the estimates changed slightly after adjusting for familial factors.

Conclusions: : Results suggest that social phobia experienced in adolescence contribute to early adulthood unemployment and SA. Familial factors seemed to explain the association between social phobia and unemployment.
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http://dx.doi.org/10.1093/eurpub/ckz033DOI Listing
October 2019

Work-disability in low back pain patients with or without surgery, and the role of social insurance regulation changes in Sweden.

Eur J Public Health 2019 06;29(3):524-530

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Background: The aims were to study the differences in work-disability in patients with low back pain (LBP) in relation to (i) treatment provided (non-surgical or lumber spine surgery (decompression or fusion), and (ii) two time points, i.e. before and after the social insurance regulation changes in the in 2008.

Methods: All non-pensioned individuals, aged 19-60 years, living in Sweden, diagnosed with LBP in 2004-06 or 2008-10 were included (n = 153739). Hazard ratios (HRs) with 95% confidence intervals for long-term sickness absence (>90 days, LTSA) and disability pension (DP) for LBP-patients (non-surgical, decompression, fusion, both surgeries) were estimated by Cox regression compared with the matched references from the general population without LBP (n = 566008).

Results: LBP-patients had a higher risk of subsequent work-disability compared with the references before and after insurance regulation changes. LBP-patients receiving decompression surgery had similar risk for later work-disability as those treated non-surgically. However, following regulation changes, LBP-patients undergoing fusion surgery had higher risk estimates of both LTSA (HR: 3.3) and DP (HR: 4.8) than patients treated non-surgically (HR: LTSA 2.1; DP 2.5) or with decompression (HR: LTSA 2.6; DP 2.1). In the adjusted models, risk estimates mainly attenuated after controlling for previous sickness absence.

Conclusion: Risk for subsequent work-disability among LBP-patients was higher compared with people without LBP and lumbar spine surgery. Discrepancies in risk were explained by the treatment provided previous sickness absence and changes in the social insurance regulations, specifically LBP-patients treated with fusion surgery had an increased risk of subsequent work-disability after changes in regulations.
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http://dx.doi.org/10.1093/eurpub/cky243DOI Listing
June 2019

Time pressure and sleep problems due to thoughts about work as risk factors for future sickness absence.

Int Arch Occup Environ Health 2018 Nov 20;91(8):1051-1059. Epub 2018 Aug 20.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden.

Purpose: This study investigated whether time pressure or sleep problems due to thoughts about work are associated with future sickness absence (SA) among women and men employed in different sectors, also when adjusting for confounders including familial factors (genetics and shared environment).

Methods: The study sample included 16,127 twin individuals (52% women), aged 19-47 years who in 2005 participated in an online survey including questions regarding time pressure, sleep, work and health. Register data on SA (> 14 days) were obtained from the National Social Insurance Agency and individuals were followed from date of survey response until 12/31/2013. Associations between time pressure, sleep problems due to thoughts about work and future SA were investigated using logistic regression analyses to assess odds ratios (OR) with 95% confidence intervals (CI).

Results: In total 5723 (35%) individuals had an incident SA spell during follow-up. Sleep problems due to thoughts about work were associated with SA in the fully adjusted model (OR 1.22, CI 1.10-1.36). Stratified by sector, the highest estimate was found for state employees (OR 1.54, CI 1.11-2.13). Familial factors did not seem to influence the associations. We found no statistically significant associations between time pressure and SA. No sex differences were found.

Conclusions: Results indicated that sleep problems due to thoughts about work is a risk factor for future SA. This follows previous research showing that sleep length and sleep disturbances, regardless of reason, are associated with SA. But, experiences of work-related time pressure seem to have no effect on SA.
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http://dx.doi.org/10.1007/s00420-018-1349-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182313PMC
November 2018

Course and characteristics of work disability 3 years before and after lumbar spine decompression surgery- a national population-based study.

Sci Rep 2018 08 7;8(1):11811. Epub 2018 Aug 7.

Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, Berzeliusv. 3, 171 77, Stockholm, Sweden.

Despite decompression surgery being a widespread intervention for patients with dorsopathies (i.e. back pain) affecting the lumbar spine, the scientific knowledge on patterns and characteristics of work disability before and after the surgery is limited. Sickness absence (SA) and disability pension (DP) were examined three years before and after surgery in 8558 patients aged 25-60 years who underwent lumbar spine decompression surgery in Sweden. They were compared to individuals with diagnosed dorsopathies but no surgery and individuals from the general population as matched comparison groups. According to Group Based Trajectory models, in patients with decompression surgery, 39% had low levels of SA/DP during the entire study period and 15% started with low levels of SA/DP, which increased in the year before, and declined to almost zero in the second year after surgery. Three trajectory groups (12%, 17%, and 18%) started at different levels of SA/DP, which increased in the years before, and declined in the third year after surgery. The trajectory groups in the comparison groups showed lower levels of work disability. Sex, education, and the use of antidepressants and analgesics the year before surgery played an important role to explain the variance of trajectory groups in patients with surgery.
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http://dx.doi.org/10.1038/s41598-018-30211-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081436PMC
August 2018

The association between part-time and temporary employment and sickness absence: a prospective Swedish twin study.

Eur J Public Health 2019 02;29(1):147-153

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Background: Sickness absence (SA) is becoming a major economic problem in many countries. Our aim was to investigate whether type of employment, including temporary employment or part-time employment, is associated with SA while controlling for familial factors (genetic and shared environment). Differences between men and women and across employment sectors were explored.

Methods: This is a prospective twin study based on 21 105 twins born in Sweden 1959-85. The participants completed a survey in 2005 with follow-up of SA (≥15 days), using register data, until end of 2013. The data were analyzed with logistic regression, with results presented as odds ratios (OR) with 95% confidence intervals (CI).

Results: Temporary employment involved higher odds of SA (OR=1.21 95% CI=1.04-1.40) compared to full-time employment. Both part-time workers (OR=0.84 95% CI=0.74-0.95) and the self-employed (OR=0.77 95%CI=0.62-0.94) had lower odds of SA. Stratifying by sex showed lower odds for part-timers (OR=0.82 95% CI=0.73-0.94) and self-employed women (OR=0.65 95% CI=0.47-0.90), but higher odds for men in temporary employment (OR=1.33 95% CI=1.03-1.72). Temporary employees in county councils (OR=1.73 95% CI=1.01-2.99) and municipalities (OR=1.41 95% CI=1.02-1.96) had higher odds while part-timers employed in the private sector had lower odds (OR=0.77 95% CI=0.64-0.93). Familial factors did not confound the association between employment type and SA.

Conclusions: Employment type is associated with SA, with temporary employment involving a higher risk compared to permanent full-time employment while both part-time employment and self-employment involved a lower risk. The associations vary between women and men and across sectors.
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http://dx.doi.org/10.1093/eurpub/cky145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345142PMC
February 2019

Determinants of work disability following lumbar spine decompression surgery.

Scand J Public Health 2019 May 5;47(3):281-292. Epub 2018 Jul 5.

1 Department of Clinical Neuroscience, Karolinska Institutet, Sweden.

Aims: Scientific knowledge about risk factors for work disability in terms of long-term sickness absence and disability pension following lumbar spine decompression surgery remains insufficient. This study aimed to investigate the associations between socio-demographic, work-related, and medical characteristics with subsequent long-term sickness absence (>90 days) and disability pension for individuals who underwent lumbar spine decompression surgery.

Methods: A prospective cohort study of all individuals aged 19-60 years with diagnosed dorsopathies, who underwent lumbar spine decompression surgery 2008-10 in Sweden ( n=7373) was performed. Univariate and multivariate hazard ratios with 95% confidence intervals regarding long-term sickness absence and disability pension with a 3-year follow-up period were estimated by Cox proportional regression.

Results: Low educational level, being a non-European immigrant and preoperative sickness absence were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.8). Female sex was a risk factor for long-term sickness absence (hazard ratios: 1.3) whereas age >44 years and being a Nordic immigrant were risk factors for disability pension (hazard ratios: 1.9-2.6). Medical factors as common mental disorders, other mental disorders, prescribed psychiatric medication and somatic comorbidity were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.4). A simultaneous lumbar fusion surgery and high preoperative pain severity were risk factors for long-term sickness absence (hazard ratios 1.2-1.8).

Conclusions: To prevent long-term work disability after lumbar spine decompression surgery, specific focus is required on older and female patients, those with mental or somatic comorbidities, high levels of preoperative pain or sickness absence, with a simultaneous lumbar fusion surgery, a low educational level or a non-European immigrant background.
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http://dx.doi.org/10.1177/1403494818785055DOI Listing
May 2019

Night work as a risk factor for future cause-specific disability pension: A prospective twin cohort study in Sweden.

Chronobiol Int 2018 02 16;35(2):249-260. Epub 2017 Nov 16.

b Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.

The objectives of the study were to investigate the associations between night work and disability pension (DP) due to all causes, cardiovascular (CVD), mental, and other diagnoses, adjusting for familial confounding. The material of the study included comprehensive survey data on 27 165 Swedish twins born in 1935-1958 that were linked with DP data for the survey period (1998-2003) to 2013. Night work was assessed as years of working nights at least every now and then, and categorized into not at all, 1-10 years and over 10 years. For statistical analyses, Cox proportional hazards regressions were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). The results of the study indicated that over 10 years duration of night work had an age- and sex-adjusted HR of 1.48 (95% CI 1.11-1.98) for DP due to CVD and 1-10 years of night work an HR of 1.28 (95% CI 1.06-1.55) for DP due to mental diagnoses, but attenuated when covariates were adjusted for. Both 1-10 years (HR 1.27, 95% CI 1.17-1.39) and >10 years of night work (HR 1.20, 95% CI 1.08-1.34) were associated with DP due to all causes and other diagnoses. These risks remained after adjusting for covariates. To conclude, even modest exposure in terms of duration of night work is a risk factor for all-cause DP, but also for DP due to mental and other diagnoses. The risk of DP due to CVD seems to be associated with longer (>10 years) periods of night work. All the associations between night work and DP seem to be influenced by various covariates.
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http://dx.doi.org/10.1080/07420528.2017.1399137DOI Listing
February 2018

Adverse outcomes of sick leave due to mental disorders: A prospective study of discordant twin pairs.

Scand J Public Health 2019 Mar 14;47(2):127-136. Epub 2017 Oct 14.

1 Division of Insurance Medicine, Karolinska Institutet, Sweden.

Aims: The aim of this study was to investigate whether sick leave due to different mental disorders increased the risk of reoccurring sick-leave, disability pension and unemployment, taking genetics and shared environment into account.

Methods: This register-based cohort study contains 2202 discordant twin pairs 18-64 years old, where one twin had sick leave due to a mental disorder 2005-2006. The end of the sick-leave spell was the start of follow-up for both twins. The twins were followed up for reoccurring sick-leave, disability pension and unemployment (> 180 days in a year), until December 2012. Analyses were censored for disability pension, death, emigration and old-age pension. Cox proportional hazards models with time-varying covariates were used to calculate hazard ratios with 95% confidence intervals (CI).

Results: Those with sick leave due to mental disorders had a 3.64 (CI: 3.24-4.08) times higher risk of reoccurring sick-leave within the first two years; after that, hazard ratios were attenuated and explained by genetic factors. The first year, they had 12.24 (CI: 8.11-18.46) times the risk of disability pension. The risk was attenuated but remained at 2.75 (CI: 2.07-3.65) after one year. The risk of unemployment was 1.99 (CI: 1.72-2.31) during the whole follow-up period. The risk of unemployment and disability pension was lower for those with stress-related than other mental disorders, this was less clear for recurrent reoccuring sick-leave.

Conclusions: Sick leave due to mental disorders increased the risk of reoccurring sick-leave within two years, disability pension and unemployment, independent of genetics and shared environment.
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http://dx.doi.org/10.1177/1403494817735755DOI Listing
March 2019

Sleep Duration, Mortality, and Heredity-A Prospective Twin Study.

Sleep 2017 10;40(10)

Division of Insurance Medicine, Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Introduction: A number of studies have shown a U-shaped association between sleep duration and mortality. Since sleep duration is partly genetically determined, it seems likely that its association with mortality is also genetically influenced. The purpose of the present study was to investigate the influence on heredity on the association between sleep duration and mortality.

Methods: We used a cohort of 14267 twins from the Swedish Twin Registry.

Results: A Cox proportional hazards regression analysis, adjusted for a number of covariates, confirmed a clear U shape with a hazard ratio (HR) = 1.34 and 95% confidence interval (CI) = 1.15-1.57 for a sleep duration of ≤6.5 hours and HR = 1.18 (CI = 1.07-1.30) for sleep of ≥9.5 hours. Reference value was 7.0 hours. A co-twin analysis of 1942 twins discordant on mortality showed a HR = 2.66 (CI = 1.17-6.04) for long (≥9.5 hours) sleep in monzygotic twins and an HR = 0.66 (CI = 0.20-2.14) for short (<6.5 hours) sleep. In dizygotic twins, no association was significant. The heritability for mortality was 28% for the whole group, while it was 86% for short sleepers and 42% for long sleepers. Thus, the link with mortality for long sleep appears to be more due to environmental factors than to heredity, while heritability dominates among short sleepers.

Conclusions: We found that both long and short sleep were associated with higher total mortality, that the difference in mortality within twin pairs is associated with long sleep, and that short sleep has a higher heritability for mortality, while long sleep is associated with more environmental influences on mortality.
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http://dx.doi.org/10.1093/sleep/zsx135DOI Listing
October 2017