The European Journal of Public Health Advance Access published online on March 9, 2008
The European Journal of Public Health, doi:10.1093/eurpub/ckn010
Mortality after long-term sickness absence: prospective cohort study
Sturla Gjesdal1, Peder R. Ringdal2, Kjell Haug3, John G. Maeland3, Stein E. Vollset3 and Kristina Alexanderson4
1 Department of Public Health and Primary Health Care, and Health Economics, University of Bergen, Norway
2 Department of Public Health and Primary Health Care, University of Bergen and National Insurance Services, Hordaland County Office, Bergen, Norway
3 Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
4 Section for Personal Injury Prevention, Karolinska Institute, Stockholm, Sweden
Correspondence: Sturla Gjesdal, ISF UiB, Kalfarveien 31, 5018 Bergen, Norway, tel: +47 55586100/50, fax: +47 55586130, e-mail: sturla.gjesdal{at}isf.uib.no
Received August 27, 2007 , accepted January 23, 2008
Background: The study estimated the excess mortality after long-term sickness absence (LTSA), and identified socio-demographic and diagnostic risk factors of death. Methods: Prospective cohort study during 1994–2003 in a Norwegian county with 256 654 inhabitants aged 16–62 years. A representative sample of 3386 persons with a spell of sickness absence >8 weeks was compared with the total county population with respect to all cause mortality. Comparative mortality figures (CMF) for the total sample and standardized mortality rates for diagnostic groups were calculated. Results: The CMFs were 1.5 (95% CI 1.1–1.9) for the female and 2.0 (95% CI 1.7–2.4) for the male sample. Among women, persons’ sickness certified with cancer contributed with 43% of all deaths and standardized mortality ratios (SMR) was 16.1 (11.2–23.2). The respective figure for the men was 27% and SMR was 8.0 (5.7–11.1). SMR for men with mental diagnoses was 1.7 (95% CI 1.1–2.9) and for ‘other’ (respiratory, neurological, digestive) 1.8 (95% CI 1.3–2.7). Musculoskeletal cases had not elevated SMRs. Cox proportional hazard analysis with musculoskeletal cases as reference adjusted for age and income showed very high hazard ratios (HR) for cases with cancer diagnoses. Among the men, mental and ‘other’ diagnoses had also HR above unity. Conclusion: The study verified findings from Finland and the UK of excess mortality after LTSA, also when compared with the total population of the same age. Among women, cancer cases explained all the excess mortality, whereas other cases outside the musculoskeletal group also contributed among men.
Keywords: diagnoses, mortality, sickness absence