http://informahealthcare.com/dre ISSN 0963-8288 print/ISSN 1464-5165 online Disabil Rehabil, 2015; 37(5): 396–410 ! 2014 Informa UK Ltd. DOI: 10.3109/09638288.2014.923521

RESEARCH PAPER

Sick leave diagnoses and return to work: a Swedish register study Ulrik Lidwall1,2 1

Statistical Analysis Unit, Department for Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden and 2Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Abstract

Keywords

Purpose: To provide a detailed description of return to work (RTW) for different diagnoses. Methods: A sample of 617 611 cases of sick leave with minimum duration of 14 days started in 2009 and 2010 was followed for 450 days. Data on sick leave episodes, diagnosis (ICD-10 codes on 3-digit level) and background factors were retrieved from Swedish National Social Insurance registers. RTW was analysed with Cox proportional hazard regression with separate analyses for women and men. Results: The diseases with the lowest RTW rates were present within malign neoplasms, severe mental disorders and severe cardiovascular diseases. High-RTW rates were present for infectious respiratory diseases, viral infections and less severe cardiovascular diseases. There were distinct differences across diagnoses within all diagnosis chapters. This also holds for mental disorders and musculoskeletal diseases, which are the most common causes of sick leave. The results for women and men across different diseases and disorders were strikingly similar. Conclusions: Systematic use of standard information such as detailed sick listing diagnosis could, at low-additional cost, pinpoint cases at risk for prolonged sick leave. The use of broad diagnosis categories in sick leave research may be questioned since there are distinct differences in RTW within ICD-10 chapters.

Diagnosis, ICD-10, return to work, sick leave History Received 5 July 2013 Revised 25 April 2014 Accepted 8 May 2014 Published online 28 May 2014

ä Implications for Rehabilitation 





Case managers’ systematic use of information on sick leave diagnosis could, at low-additional cost, pinpoint cases at risk for prolonged sick leave. Low return to work rates (RTW) are, in general, found among neoplasms, cardiovascular diseases and mental disorders. Alongside medical rehabilitation measures, vocational rehabilitation measures should be considered at early stages in the rehabilitation process by case managers, in collaboration with medical service providers, and employers or the employment service. In sick leave research, in general, and RTW research, in particular, the application of broad ranging categories of diagnoses has to be reflected on, since there are distinct differences in RTW across diagnoses within the same diagnosis chapter.

Introduction The cost of sick leave and disability in developed countries is high [1]. But still, in the occupational rehabilitation context, firm evidence is lacking regarding factors influencing return to work (RTW) or prolonged sick leave due to any cause [2]. The strongest evidence has been reported for factors such as older age and history of sick leave [3]. Over time, there has been a shift in the RTW literature from medically determined models to focus more on the workplace, cultural, economic and social factors [4]. Nevertheless, the medical reason for the sickness episode seems to be of great importance for the length of sick leave and a more diagnosis-based approach within primary care, which handles the

Address for correspondence: Ulrik Lidwall, Statistical Analysis Unit, Department for Analysis and Forecast, Swedish Social Insurance Agency, SE-103 51 Stockholm, Sweden. Tel: +46-10-1169726; Fax: +46-8-7869580. E-mail: [email protected]

majority of sick leave cases, has been suggested for early screening of individuals at risk for long-term sick leave [5,6]. In Sweden, diagnosis has also been brought to the fore in sick listing, with emphasis put on reduced work ability due to a specific diagnosis. In March 2008, sick-listing guidelines for different illnesses and diseases were introduced, in terms of recommended length of the sick-listing period [7]. In order to facilitate RTW for persons on medically certified sick leave, it is important to recognise factors hindering successful rehabilitation, such as detailed information about diagnosis rather than using broad categories. Earlier studies have, in general, focused either on broad categories of diagnoses due to limited study size [6,8] or on more specific categories such as mental disorders or musculoskeletal diseases, which are the most common causes of prolonged sick leave [9–15]. Even though differences in recovery due to different diseases and disorders are supposedly common knowledge in the medical profession and clinical practice, no thorough description across different diagnoses as regards RTW is at hand. Such information could most

Sick leave diagnoses and RTW

DOI: 10.3109/09638288.2014.923521

certainly be valuable for case managers within the social insurance administration struggling to identify cases in need of closer attention. Swedish sickness insurance The compulsory Swedish sickness insurance scheme potentially covers all Swedish or foreign citizens working in Sweden. Those 16 years or older who have a minimum annual income from work are qualified for sickness cash benefits in case of temporary loss of work ability [16]. The prime requisite for being eligible for sickness cash benefit is that the person in question has a disease or injury that reduces his/her ability to work by at least 25%. Depending on the reduction of work ability, the level of compensation can be 25, 50, 75 or 100%. The first day of sick leave is a qualifying day without compensation and sick pay is thereafter provided by the employer for the first 14 days. A medical certificate from a physician is required from day 8. If the reduction in work ability persists after the end of the sick pay period, the employee receives sickness cash benefit from the national social insurance system [16]. Sweden previously had no official time limit for how long a person could receive sickness cash benefit. However, since July 2008, such compensation has been restricted to 1 year, although it can be prolonged under certain circumstances such as severe illnesses. Another novelty introduced in July 2008 was specific time limits, where the assessment of work ability gradually becomes stricter over time, i.e. after 90 and 180 days of sick leave [16]. Previous studies indicate that both these time limits and the diagnosis-specific sick listing guidelines introduced in 2008, especially the latter, reduced the duration of sick leave periods [17]. The current study was performed under this stricter regime within Swedish sickness insurance, which allows less scope for non-medical factors in the assessment of work ability.

397

Measures Dependent variable The dependent variable, i.e. RTW, was the duration of compensated sick leave until termination measured in days. RTW was defined as regained full work ability according to the judgement of the case manager at the SSIA. This was used as the RTW measure, although these two outcomes are not necessarily coincident. Furthermore, the concept of full work ability is relative. That is, a person previously working full time and on full-time sick leave is supposed to fully return to her/his full-time job, whereas a person previously working part time and on fulltime sick leave (from the part-time job) is supposed to fully return to her/his part-time job. The maximum time for follow-up was 450 days, where longer durations were truncated and events thereafter neglected, i.e. right censored. Terminations within the follow-up time, such as transitions to disability pension, emigration or death, were also right censored. Predictor The predictor was the first primary sick leave diagnosis documented in the case according to WHO’s International Classification of Diseases (ICD-10) on 3-digit level [18]. Every diagnosis, or blocks of diagnoses comprising at least 0.1% of the cases, constitutes a diagnosis category in the study. In most cases, a single diagnosis, such as F10, is the dominant cause of sick leave within the block of diagnoses (F10–F19) and will by itself constitute a category. In some cases, however, the diagnoses are fairly evenly distributed across a block and therefore the block will constitute a category, with F20–F29 as an example. Diagnoses or blocks of diagnoses falling below the 0.1% threshold will constitute a mixed ‘‘other’’ category within each diagnosis chapter. This reduces the problem with lack of power and associations by chance for diseases and disorders with rare occurrences as causes of sick leave.

Aim

Confounders

The aim was to provide an in-depth description of RTW for different diagnoses in medically certified sick leave exceeding 14 days for women and men separately.

Adjustment was made for available variables previously reported to be potentially associated with sick leave, in general [19], or RTW, in particular [2,3,6]. There is a risk of over adjustment but the size of the available data reduces the risk of type II errors. The data used for potential confounding variables, in general, refer to the status at the start of the sick leave spell as recorded in the Swedish social insurance registers. This holds for age, civil status, children and their age, county of residence, country of birth, sickness insurance status (partial sickness benefit, type of sickness benefit, sick leave history and partial disability pension), occupational status (employed, unemployed, etc.) and month of onset of compensated sick leave. Occupation refers to the last known occupation recorded up to November 2008 according to the Swedish occupational register held by Statistics Sweden. The information about occupation is, in general, of high quality for employees, but is missing or of poorer quality for self-employed or unemployed [20]. Occupation is coded according to the Swedish version of the International Standard Classification of Occupations (ISCO88) at the 2-digit level into 27 occupational sub-major groups [21]. Age in years was used as a continuous variable. Civil status was classified in seven categories (married, unmarried, registered partnership, divorced, divorced partnership, widow/widower and surviving partnership). Having custody of children of different ages was also accounted for. Having children in ages below 7 years, in ages 7–12 and ages 13–15 where dichotomised (yes/no). Country of birth was classified in 10 categories (Sweden, Other Nordic countries, EU 27 without Nordic

Methods Cases of sick leave compensated by compulsory Swedish sickness insurance were retrieved from the MiDAS database (Micro Data for Analysis of Social Insurance), with data originating from administrative social insurance registers held by the Swedish Social Insurance Agency (SSIA). Spells for employed individuals with duration below 15 days are in general compensated by the employers and are therefore not recorded in the social insurance registers [16]. A medical certificate from a physician with a diagnosis is required from day 8, so shorter spells lack information about the medical cause. All spells exceeding 14 days with onset between 1st January 2009 and 31st December 2010 were included in the study. Recurrent spells were excluded, so each individual only contributed with one spell in the analysis. In accordance with regulations in Swedish sickness insurance, a recurrence within 5 days after termination of the previous spell is considered to be a continuation of that spell. The total number of sick leave cases was 631 703, with 384 259 for women and 247 444 for men. Cases with missing values for diagnosis were omitted from the analysis. For women 7158 (1.9%) cases and for men 6934 cases (2.8%) were omitted. The final number of cases used in the analysis was 617 611, with 377 101 for women and 240 510 for men.

398

U. Lidwall

countries, other European countries, Africa south of Sahara, Asia without Middle East, Middle East–North Africa–Turkey, North America, South America and Oceania). Partial sick leave was classified in four categories (25, 50, 75 or 100%). Sick leave history was recorded as having had a spell exceeding 14 days or more or not in the year before onset of the current sick leave. Finally, occupational status according to the SSIA was classified into eight categories (employed with sick pay, employed without sick pay, unemployed, self-employed, combination of selfemployment and employment, on parental leave, student with study allowance and finally student with income entitling to sickness cash benefit). Statistical analysis All statistical analyses were performed using SPSS Statistics for Windows (release 20.0.0). The analyses were conducted separately for men and women in order to reveal potential gender specific patterns. Cox proportional hazard regression was used to analyse RTW and to compute 95% confidence intervals. Crude hazard rates were calculated for each diagnosis, and associations were further adjusted for potential confounding factors. Since the term ‘‘hazard’’ implies a negative outcome, the presented hazard rates will be referred to as relative RTW rates as earlier proposed [22]. The proportional hazard assumption was checked graphically and no evidence of violation of this assumption was found. The most common procedure when presenting hazard rates is to choose a particular reference category which constitutes the benchmark. Although the choice of reference category is arbitrary, it bears no importance beyond pedagogic purposes. Here no particular disease has been chosen for reference. Instead each diagnosis category is compared to the unweighted average of all diagnosis categories, normalised to the value one. A relative RTW rate 41 indicates an earlier termination of sick leave and 51 a later termination of sick leave in comparison with the unweighted average of all diagnoses.

Results The distribution of cases of medically certified sick leave by diagnosis among women and men and the corresponding median duration in days are presented in Appendix Table 1. The three most common causes of sick leave exceeding 14 days are, in order, diseases of the musculoskeletal system & connective tissue (ICD-10 chapter XIII, codes M00-M99), mental & behavioural disorders (chapter V, F00-F99) and injury & poisoning (chapter XIX, S00-T98). Poisonings are, in general, rare, but injuries are more common among men than among women, while mental disorders are more common among women. Among women, sick leaves due to pregnancy, childbirth and the puerperium (chapter XV, O00-O99) are also common. The three, by far, most common specific diseases and disorders are, in order, reaction to severe stress and adjustment disorders (F43), dorsalgia (M54) and depressive episode (F32). As regards sick leave duration, the most extensive spells by chapter are found within mental and behavioural disorders with a median duration of 70 days, neoplasms (63 days), diseases of the circulatory system (51 days), pregnancy and childbirth (51 days), musculoskeletal diseases (46 days) and injuries (45 days). The three most extensive specific diseases or disorders are, in order, intracerebral haemorrhage (code I61) with a median duration of 368 days, hyperkinetic disorders (F90, 306 days) and malignant neoplasm of rectum (C20, 239 days). At the other end of the distribution, the shortest sick leaves are found among diseases of the respiratory system (chapter X, J00–99) with a median duration of 21 days. The shortest specific diseases within the respiratory diseases are acute sinusitis (J01), acute tonsillitis (J03), acute

Disabil Rehabil, 2015; 37(5): 396–410

upper respiratory infections (J06), influenza (J11) and unspecified acute lower respiratory infection (J22), all with 19 days as their median duration. In Appendix Tables 2 and 3, relative RTW rates for women and men are presented in detail. Some of these results are summarised in Figures 1, 2 and 3, where diseases or disorders have been chosen on the basis of substantially deviating RTW rates and/or considerably prevalence as cause of sick leave. Since mental and behavioural disorders and musculoskeletal diseases constitute the bulk of sick leave diagnoses, these diagnoses receive special attention with Figures 1 and 2. In Figure 1, relative RTW rates for the mental and behavioural disorders are presented. With the exception of non-organic sleep disorders (F51), mental and behavioural disorders have lower RTW rates for both women and men compared to the unweighted average of all diagnosis categories. The RTW rates are about 0.8 for reaction to severe stress & adjustment disorders (F43) and mental & behavioural disorders due to the use of alcohol (F10). Depressive episode (F32) and anxiety disorders (F41) constitute a middle group with RTW rates about 0.6. Rates about or below 0.4 are found for recurrent depressive disorder (F33), bipolar affective disorder (F31) and schizophrenia (F20–F29). The lowest RTW rates are found for hyperkinetic disorders (F90) with figures below 0.3. In Figure 2, relative RTW rates for diseases of the musculoskeletal system and connective tissue are presented. Some of these diseases have RTW rates above the unweighted average at 1.0. Men

F10 Mental & behavioural disorders due to use of alcohol F20-F29 Schizophrenia, schizotypal & delusional disorders

Women

F31 Bipolar affective disorder F32 Depressive episode F33 Recurrent depressive disorder F41 Anxiety disorders F43 Reaction to severe stress, & adjustment disorders F51 Nonorganic sleep disorders F90 Hyperkinetic disorders

0

0.5

1

1.5

Relative RTW rate

Figure 1. Relative RTW rates for a selection of mental and behavioural disorders (some terms have been truncated; see Appendix Tables 2 and 3 for the correct terms). Men

M16 Coxarthrosis [arthrosis of hip]

Women

M17 Gonarthrosis [arthrosis of knee] M20 Deformities of fingers & toes M23 Internal derangement of knee M25 Other joint disorders M51 Other intervertebral disc disorders M53 Other dorsopathies M54 Dorsalgia M75 Shoulder lesions M77 Other enthesopathies M79 Other soft tissue disorders

0

0.5

1

1.5

Relative RTW rate

Figure 2. Relative RTW rates for a selection of diseases of the musculoskeletal system and connective tissue (some terms have been truncated; see Appendix Tables 2 and 3 for the correct terms).

Sick leave diagnoses and RTW

DOI: 10.3109/09638288.2014.923521

These are other enthesopathies (M77), deformities of fingers and toes (M20), internal derangement of knee (M23), dorsalgia (M54) and for men also other soft tissue disorders (M79). Among women, other soft tissue disorders (M79) have a lower RTW rate in parity with shoulder lesions (M75). Even lower RTW rates are found among other dorsopathies (M53), other intervertebral disc disorders (M51), knee arthrosis (M17) and hip arthrosis (M16). A selection of other physical diseases is presented in Figure 3. High-relative RTW rates are present for infectious respiratory diseases (e.g. J06, J18) and viral infections (B34), and less severe cardiovascular diseases such as varicose veins of lower extremities (I83). Even though the similarities between the sexes in RTW rates across diagnoses outweigh the differences, some differences should be mentioned. Inguinal hernia (K40) is more common among men, and the relative RTW rate is higher compared to among women. Pregnancy-related disorders (O00-O99) are fairly common as a cause of sick leave among women in Sweden, e.g. O26. These sick leaves are, in general, terminated with the birth of the child or shortly thereafter, and are, in general, one to two months in length during the end of pregnancy, see Appendix Table 1. With the exception of multiple gestations (O30) with longer durations, pregnancy-related disorders are at average RTW rate levels among women. However, since previous studies on Swedish data indicate that not all pregnancy-related disorders are categorised within ICD-10 chapter 15 (O00-O99), some overspill to other diagnoses, such as musculoskeletal disorders, could be expected [23]. Among women, malign neoplasm of breast (C50) is the most common neoplasm leading to sick leave with an RTW rate 50% below the average. The most common neoplasm among men is malign neoplasm of prostate (C61) with an average RTW rate among men. I63 Cerebral infarction G35 Multiple sclerosis C50 Malignant neoplasm of breast S32 Fracture of lumbar spine & pelvis J44 Other chronic obstructive PD E10 Insulin-dependent diabetes mellitus S82 Fracture of lower leg, including ankle L40 Psoriasis R52 Pain, not elsewhere classified S42 Fracture of shoulder & upper arm I20 Angina pectoris S52 Fracture of forearm C61 Malignant neoplasm of prostate O26 Maternal care - pregnancy I21 Acute myocardial infarction S83 Knee injuries K51 Ulcerative colitis S62 Fracture at wrist & hand level L20-L30 Dermatitis & eczema R42 Dizziness & giddiness G56 Carpal tunnel syndrome E66 Obesity N80-N98 Disorders of female genital tract N40-N51 Diseases of male genital organs K40 Inguinal hernia T01 Open wounds multiple body regions J18 Pneumonia, organism unspecified B34 Viral infection of unspecified site I83 Varicose veins of lower extremities J06 Acute upper respiratory infections

Men Women

0

0.5

1

1.5

2

2.5

3

3.5

Relative RTW rate

Figure 3. Relative RTW rates for a selection of physical diseases (some terms have been truncated; see Appendix Tables 2 and 3 for the correct terms).

399

Other diseases with low-RTW rates are malign neoplasms in general (Appendix Tables 2 and 3) and severe cardiovascular diseases such as intracerebral haemorrhage (I61) and cerebral infarction (I63). Examples of diseases with lower RTW rates shown in Figure 3 are multiple sclerosis (G35), fracture of lumbar spine & pelvis (S32), other chronic obstructive pulmonary disease (J44), insulin-dependent diabetes mellitus (E10), fractures: lower leg (S82), shoulder-upper arm (S42), forearm (S52), psoriasis (L40), pain not elsewhere classified (R52) and angina pectoris (I20). In general, there are distinct differences in RTW rates across diagnoses within all diagnosis chapters (Appendix Tables 2 and 3).

Discussion Diseases with the lowest RTW rates are found within malign neoplasms, more severe mental disorders, such as schizophrenia and bipolar disorders, and more severe cardiovascular diseases, such as intracerebral haemorrhage and cerebral infarction. HighRTW rates are found within infectious respiratory diseases and viral infections, and less severe cardiovascular diseases such as haemorrhoids and varicose veins of lower extremities. There are distinct differences across diagnoses within all diagnosis chapters, also within mental disorders and musculoskeletal diseases, which are the most common causes of sick leave. With some exceptions, the RTW patterns for women and men across different diseases and disorders are strikingly similar. Even though women have higher sickness absence, this seems to be restricted to short-term sick leave [24] rather than long-term sick leave [3]. In the Swedish context, a recent study found no association between female gender and RTW [6]. Hence, even though the onset of sick leave may differ between women and men, the same ailment seems to hamper RTW to the same degree for both women and men. Earlier studies have shown that mental disorders reduce the chance of RTW [10,25–27]. Most studies on mental disorders focus on common mental disorders such as depression or mood disorders (F30–F39) and anxiety disorders (F40–F43) [10,13]. In these studies, considerably lower RTW rates were reported for depression compared to anxiety and stress-related disorders in line with the current study. Strikingly low-RTW rates were also found for hyperkinetic disorders (F90) in accordance with a recent Norwegian study, where such disorders were specifically linked to reduced work ability and disability pension [28]. This result may also be due to unaccounted comorbid mental conditions which have been reported to prolong sick leave [25]. Malign neoplasms and many musculoskeletal diseases have been reported to lead to prolonged sick leave episodes [29,30], which is in agreement with the present results. However, the current study presents evident exceptions within the musculoskeletal diseases. Comorbidity is, in general, reported to increase sick leave duration [30] and the inability to account for this is a shortcoming in the study. Furthermore, potential changes of diagnosis during the course of the sick leave spell were unaccounted for. Although the register used is a reliable source for the first main sick leave diagnosis, this does not hold for additional diagnosis or changes of diagnosis [31]. In a previous Swedish study of sick leave exceeding 2 months, the diagnoses were recorded through a survey within the SSIA. In these lengthy sick leaves, the diagnosis was identical at both the first and the last medical certificate in 81% of the cases and within the same chapter in 88% of the cases [32]. So even though changes in diagnoses do occur, this is probably not a serious source of bias. More sick leave research is warranted, however, regarding changes of diagnosis through the course of sick leave, comorbidity and sick leave recurrences.

400

U. Lidwall

In this study, full RTW is considered as the outcome. However, in the Nordic countries, partial sick leave is available [33]. In Sweden, partial sick leave is considered as a means to enhance RTW and is often used towards the end of the sick leave period, which also indicates partial RTW [34,35]. In the current analysis, the presence of partial sick leave during the course of the spell was accounted for. Since partial sick leave is more common in very extensive sick leaves [33], the use of full rather than partial RTW as the outcome cannot be considered a serious source of bias. Moreover, RTW was defined as terminating benefits due to regained work ability according to the assessment made by a social insurance officer. Whether the termination of sickness cash benefit coincides with actual work resumption cannot be determined by the current data. However, a previous Swedish study reported that between 10 and 15% of those deemed to have more than 75% work ability after 1 year on paid sick leave ended up in unemployment [31]. These persons have to rely on unemployment benefits, the income of other household members or, as a last resort, social welfare. Hence, in future studies, it would be relevant to discriminate between simply terminating benefits and actual work resumption. From a welfare and health perspective, the latter is often associated with improved health and income, while the former could be associated with the opposite [36]. This study has several major advantages in terms of generalisation. Firstly, the data are, in general, very reliable, though registration errors cannot be entirely ruled out. Secondly, administrative data are not hampered with low-response rates as is often the case with standard survey techniques and relatively few cases had to be omitted due to missing values. And finally, as all spells of sick leave compensated by the compulsory Swedish sickness insurance scheme were included in the study, the validity for the Swedish setting is evident, as well as in comparable societies with similar sickness insurance schemes. However, as shorter spells than 14 days for employees are not covered by the Swedish compulsory sickness insurance, the validity for shortterm sick leave is substantially reduced. Omitting short-term sick leave, which in general is due to more trivial medical conditions, will, on the other hand, enhance the focus of the study to medical conditions associated with more severe consequences for the ability to work. A further strength in the study is that a number of relevant confounders were accounted for in the Cox-regression analysis, e.g. age, occupation and sick leave history. However, the confounders were only measured at the beginning of the spells, and potential changes during the spells were unaccounted for. Another shortcoming is the observational nature of the study, which inherently opens up for the possibility that other potential factors influence the out comes. RTW is probably determined by a complex combination of biomedical conditions, the availability of effective treatment and a mesh of work-related and personal factors. Work-related factors were not addressed in the study, though there is some evidence that such determinants are relevant for RTW [22,37,38]. Controlling for occupation in the analyses reduces the significance of this shortcoming. Even though the literature is scarce, early and multidisciplinary interventions, in general, seem to facilitate RTW for both physical and psychological illnesses [22,37,38]. However, this does not hold for generic interventions targeted without distinction of diagnoses [39]. Hence, early attention directed to the specific illness or disease as the cause of the reduction in work ability is warranted, especially from case managers within the SSIA as the key stakeholder responsible for the coordination of RTW interventions [16]. Detailed information on sick leave diagnosis and its relation to work ability could potentially empower case managers at the SSIA in endorsing treatment

Disabil Rehabil, 2015; 37(5): 396–410

within the healthcare sector and employers to make adjustments in the work situation of the employee. Within the healthcare sector, the results presented in the study clearly pinpoint diseases with a need for closer attention as regards reduced work ability, and lengthy sick leave may itself be considered a risk factor for physical and mental health [40]. In terms of generalisation, the results from the study need to be confirmed by further research in different settings, particularly as regards the sickness insurance system, by, for instance, cross national comparative studies.

Conclusions Systematic use of standard information available in the social insurance administration, such as detailed sick leave diagnosis, could at low-additional cost pinpoint cases at risk for prolonged sick leave. The use of information available to case managers maximises the practical value of the findings in this study. In sick leave research, the use of broad categories of diseases and disorders has to be thoroughly considered, since there are often distinct differences across diagnoses within the same diagnosis chapter according to ICD-10.

Acknowledgements ¨ sterlund and Andrzej Dudziuk The author is grateful to Niklas O who assisted in the preparation of the data.

Declaration of interest The author reports no conflicts of interest.

References 1. OECD. Sickness, disability and work. Breaking the barriers. Paris: Organisation for Economic Co-operation and Development; 2010. 2. Vlasveld MC, van der Feltz-Cornelis CM, Bultmann U, et al. Predicting return to work in workers with all-cause sickness absence greater than 4 weeks: a prospective cohort study. J Occup Rehabil 2012;22:118–26. 3. Dekkers-Sanchez PM, Hoving JL, Sluiter JK, Frings-Dresen MH. Factors associated with long-term sick leave in sick listed employees: a systematic review. Occup Environ Med 2008;65:153–7. 4. Rollin L, Gehanno JF. Research on return to work in European Union countries. Occup Med (Lond) 2012;62:210–15. 5. Shiels C, Gabbay MB. Patient, clinician, and general practice factors in long-term certified sickness. Scand J Public Health 2007;35: 250–6. 6. von Celsing AS, Svardsudd K, Eriksson HG, et al. Determinants for return to work among sickness certified patients in general practice. BMC Public Health 2012;12:1077. 7. Swedish Social Insurance Agency. Det fo¨rsa¨kringsmedicinska beslutssto¨det. Socialstyrelsens och Fo¨rsa¨kringskassans gemensamma la¨gesrapport 2009. (in Swedish [National Insurance Medicine Guidelines for Sick-listing. A Joint Progress Report for 2009 by the National Board of Health and Welfare & the Swedish Social Insurance Agency to the Ministry of Health and Social Affairs]), Dnr: 4363-2010, Stockholm, 2010. 8. Andre´n D. Long-term absenteeism due to sickness in Sweden. How long does it take and what happens after? Eur J Health Econ 2007;8:41–50. 9. Huijs JJ, Koppes LL, Taris TW, Blonk RW. Differences in predictors of return to work among long-term sick-listed employees with different self-reported reasons for sick leave. J Occup Rehabil 2012; 22:301–11. 10. Nielsen MB, Bultmann U, Madsen IE, et al. Health, work, and personal-related predictors of time to return to work among employees with mental health problems. Disabil Rehabil 2012;34: 1311–16. 11. Heijbel B, Josephson M, Jensen I, et al. Return to work expectation predicts work in chronic musculoskeletal and behavioral health disorders: prospective study with clinical implications. J Occup Rehabil 2006;16:173–84.

DOI: 10.3109/09638288.2014.923521

12. Wahlin C, Ekberg K, Persson J, et al. Association between clinical and work-related interventions and return-to-work for patients with musculoskeletal or mental disorders. J Rehabil Med 2012;44: 355–62. 13. Roelen CA, Norder G, Koopmans PC, et al. Employees sick-listed with mental disorders: who returns to work and when? J Occup Rehabil 2012;22:409–17. 14. Hansson T, Jensen I. Swedish Council on Technology Assessment in Health Care (SBU). Chapter 6. Sickness absence due to back and neck disorders. Scand J Public Health 2004;63:109–51. 15. Andersen LL, Clausen T, Mortensen OS, et al. A prospective cohort study on musculoskeletal risk factors for long-term sickness absence among healthcare workers in eldercare. Int Arch Occup Environ Health 2012;85:615–22. 16. Mulder M. Social insurance in figures. Stockholm: Swedish Social Insurance Agency; 2011. 17. Lidwall U. Termination of sickness benefits or transition to disability pension after changes in sickness insurance: a Swedish register study. Disabil Rehabil 2013;35:118–24. 18. National Board of Health and Welfare. Swedish version of international statistical classification of diseases and related health problems, Tenth Revision (ICD-10), Stockholm; 2011. 19. Allebeck P, Mastekaasa A. Swedish Council on Technology Assessment in Health Care (SBU). Chapter 5. Risk factors for sick leave: general studies. Scand J Public Health 2004;63:49–108. ¨ rebro; 20. Statistics Sweden. The Swedish Occupational Register, O 2011. 21. Statistics Sweden. SSYK 96 Standard fo¨r svensk yrkesklassificering ¨ rebro; 1996. [Swedish standard for classification of occupations]. O 1998. 22. Krause N, Dasinger L, Deegan L, et al. Psychosocial job factors and return-to-work after compensated low back injury: a disability phase-specific analysis. Am J Ind Med 2001;40:374–92. 23. Lidwall U. La˚ngtidssjukskrivna – diagnos, yrke, partiell sjukskrivning och a˚terga˚ng i arbete. En ja¨mfo¨relse mellan 2002 och 2003. In Swedish [Long-term sickness absentees—diagnosis, occupation, partial benefits and return to work. A comparison between 2002 and 2003]. RFV Redovisar 2004:7. Stockholm: Riksfo¨rsa¨kringsverket; 2004. 24. Bekker MH, Rutte CG, van Rijswijk K. Sickness absence: a genderfocused review. Psychol Health Med 2009;14:405–18. 25. Knudsen AK, Harvey SB, Mykletun A, et al. Common mental disorders and long-term sickness absence in a general working population. The Hordaland Health Study. Acta Psychiatr Scand 2013;127:287–97. 26. Cornelius LR, van der Klink JJ, Groothoff JW, Brouwer S. Prognostic factors of long term disability due to mental disorders: a systematic review. J Occup Rehabil 2011;21:259–74.

Sick leave diagnoses and RTW

401

27. Gjesdal S, Bratberg E. Diagnosis and duration of sickness absence as predictors for disability pension: results from a three-year, multiregister based and prospective study. Scand J Public Health 2003;31: 246–54. 28. Mordre M, Groholt B, Sandstad B, Myhre AM. The impact of ADHD symptoms and global impairment in childhood on working disability in mid-adulthood: a 28-year follow-up study using official disability pension records in a high-risk in-patient population. BMC Psychiatry 2012;12:174. 29. Shiels C, Gabbay M, Ford F. Patient factors associated with duration of certified sickness absence and transition to long-term incapacity. Br J Gen Pract 2004;54:86–91. 30. Ubalde-Lopez M, Delclos GL, Calvo E, Benavides FG. Influence of new secondary diagnoses on the duration of non-work-related sickness absence episodes. J Occup Environ Med 2013;55:460–4. 31. Lidwall U. La˚ngtidssjukskrivna – demografi, arbete, yrke, diagnos, sjukpenningra¨tt och a˚terga˚ng i arbete 2003, 2005 och 2006. In Swedish [Long-term sickness absentees—demography, employment, occupation, diagnosis, eligibility and return to work 2003, 2005 and 2006]. Redovisar 2007:6. Stockholm: Fo¨rsa¨kringskassan; 2007. 32. Olkiewicz E, Westin M. Riks-LS: en underso¨kning om la˚ngvarig sjukskrivning och rehabilitering. In Swedish [Riks-LS: a survey of long-term sickness absence and rehabilitation]. RFV Redovisar 1995:20. Stockholm: Riksfo¨rsa¨kringsverket; 1995. 33. Kausto J, Miranda H, Martimo KP, Viikari-Juntura E. Partial sick leave-review of its use, effects and feasibility in the Nordic countries. Scand J Work Environ Health 2008;34:239–49. 34. Andren D. Does part-time sick leave help individuals with mental disorders recover lost work capacity? J Occup Rehabil 2014;24: 344–60. 35. Andren D, Svensson M. Part-time sick leave as a treatment method for individuals with musculoskeletal disorders. J Occup Rehabil 2012;22:418–26. 36. Waddell G, Burton AK. Is work good for your health and wellbeing? Norwich: The Stationery Office; 2006. 37. Post M, Krol B, Groothoff J. Work-related determinants of return to work of employees on long-term sickness absence. Disabil Rehabil 2005;27:481–8. 38. Blank L, Peters J, Pickvance S, et al. A systematic review of the factors which predict return to work for people suffering episodes of poor mental health. J Occup Rehabil 2008;18:27–34. 39. Hoefsmit N, Houkes I, Nijhuis FJ. Intervention characteristics that facilitate return to work after sickness absence: a systematic literature review. J Occup Rehabil 2012;22:462–77. 40. Vinga˚rd E, Alexanderson K, Norlund A. Swedish Council on Technology Assessment in Health Care (SBU). Chapter 9. Consequences of being on sick leave. Scand J Public Health 2004; 63:207–15.

402

U. Lidwall

Disabil Rehabil, 2015; 37(5): 396–410

Appendix Table 1. Distribution and median duration (days) by diagnosis among women and men with a medically certified sick leave 414 days with onset 2009–2010. Number of cases Diagnosis ICD-10 (chapter, codes, titles) I A00-B99 Certain infectious & parasitic diseases A09 Other gastroenteritis & colitis of infectious & unspecified origin A46 Erysipelas B27 Infectious mononucleosis B34 Viral infection of unspecified site Other infectious & parasitic diseases II C00-D48 Neoplasms C18 Malignant neoplasm of colon C20 Malignant neoplasm of rectum C34 Malignant neoplasm of bronchus & lung C50 Malignant neoplasm of breast C51-C58 Malignant neoplasms of female genital organs C61 Malignant neoplasm of prostate C81-C96 Malignant neoplasms of lymphoid, haematopoietic & related tissue D10-D36 Benign neoplasms Other neoplasms III D50-D89 Diseases of the blood & blood-forming organs D50 Iron deficiency anaemia Other Diseases of the blood IV E00–90 Endocrine, nutritional & metabolic diseases E05 Thyrotoxicosis [hyperthyroidism] E10 Insulin-dependent diabetes mellitus E11 Non-insulin-dependent diabetes mellitus E66 Obesity Other endocrine diseases V F00-F99 Mental & behavioural disorders F10 Mental & behavioural disorders due to use of alcohol F20-F29 Schizophrenia, schizotypal & delusional disorders F31 Bipolar affective disorder F32 Depressive episode F33 Recurrent depressive disorder F41 Anxiety disorders F43 Reaction to severe stress and adjustment disorders F51 Nonorganic sleep disorders F90 Hyperkinetic disorders Other mental disorders VI G00–99 Diseases of the nervous system G35 Multiple sclerosis G40 Epilepsy G43 Migraine G44 Other headache syndromes G47 Sleep disorders G56 Mononeuropathies of upper limb (Carpal tunnel syndrome) G93 Other disorders of brain Other diseases of the nervous system VII H00-H59 Diseases of the eye & adnexa H33 Retinal detachments & breaks Other diseases of the eye VIII H60-H95 Diseases of the ear & mastoid process H81 Disorders of vestibular function Other diseases of the ear & mastoid process IX I00–99 Diseases of the circulatory system I10 Essential (primary) hypertension I20 Angina pectoris I21 Acute myocardial infarction I26 Pulmonary embolism I48 Atrial fibrillation & flutter I50 Heart failure I61 Intracerebral haemorrhage I63 Cerebral infarction I83 Varicose veins of lower extremities I84 Haemorrhoids Other diseases of the circulatory system

Total

Men

Women

Days

10 312 1445 914 737 2457 4759 27 868 926 729 674 5779 1407 2773 1538 5425 8617 2016 725 1291 11 850 1273 1002 794 5554 3227 1 22 108 1437 1800 3077 37 675 6400 14 707 49 305 1637 758 5312 22 200 1540 705 756 949 609 11 622 702 5317 4716 1327 3389 4931 2044 2887 26 562 2411 1908 4826 824 1276 978 740 2757 2112 980 7750

4694 571 584 448 887 2204 10 218 501 433 307 – – 2773 922 880 4402 550 83 467 3167 165 510 511 1288 693 37 597 1012 950 1133 12 105 2137 4862 12 590 526 370 1912 7569 408 323 112 305 271 3430 223 2497 2486 802 1684 1890 778 1112 16 567 959 1445 3854 501 897 753 491 1828 530 499 4810

5618 874 330 289 1570 2555 17 650 425 296 367 5779 1407 – 616 4545 4215 1466 642 824 8683 1108 492 283 4266 2534 84 511 425 850 1944 25 570 4263 9845 36 715 1111 388 3400 14 631 1132 382 644 644 338 8192 479 2820 2230 525 1705 3041 1266 1775 9995 1452 463 972 323 379 225 249 929 1582 481 2940

24 21 25 25 20 30 62 142 239 209 88 123 48 236 33 85 38 34 41 32 42 50 41 31 32 70 55 170 159 87 136 77 49 39 306 161 40 98 75 38 34 38 35 38 61 31 32 31 28 31 26 51 32 61 47 40 52 124 368 196 20 22 69 (continued )

Sick leave diagnoses and RTW

DOI: 10.3109/09638288.2014.923521

403

Table 1. Continued

Number of cases Diagnosis ICD-10 (chapter, codes, titles) X J00–99 Diseases of the respiratory system J01 Acute sinusitis J03 Acute tonsillitis J06 Acute upper respiratory infections J11 Influenza, virus not identified J15 Bacterial pneumonia, not elsewhere classified J18 Pneumonia, organism unspecified J20 Acute bronchitis J22 Unspecified acute lower respiratory infection J44 Other chronic obstructive pulmonary disease J45 Asthma Other diseases of the respiratory system XI K00–93 Diseases of the digestive system K30 Dyspepsia K35 Acute appendicitis K40 Inguinal hernia K42 Umbilical hernia K43 Ventral hernia K50 Crohn disease [regional enteritis] K51 Ulcerative colitis K56 Paralytic ileus & intestinal obstruction without hernia K57 Diverticular disease of intestine K80 Cholelithiasis K85 Acute pancreatitis Other diseases of the digestive system XII L00–99 Diseases of the skin & subcutaneous tissue L00-L08 Infections of the skin & subcutaneous tissue L20-L30 Dermatitis & eczema L40 Psoriasis Other diseases of the skin XIII M00-M99 Diseases of the musculoskeletal system & connective tissue M05 Seropositive rheumatoid arthritis M06 Other rheumatoid arthritis M13 Other arthritis M16 Coxarthrosis [arthrosis of hip] M17 Gonarthrosis [arthrosis of knee] M18 Arthrosis of first carpometacarpal joint M19 Other arthrosis M20 Acquired deformities of fingers & toes M23 Internal derangement of knee M24 Other specific joint derangements M25 Other joint disorders, not elsewhere classified M35 Other systemic involvement of connective tissue M43 Other deforming dorsopathies M48 Other spondylopathies M50 Cervical disc disorders M51 Other intervertebral disc disorders M53 Other dorsopathies, not elsewhere classified M54 Dorsalgia M65 Synovitis & tenosynovitis M67 Other disorders of synovium & tendon M70 Soft tissue disorders related to use, overuse & pressure M72 Fibroblastic disorders M75 Shoulder lesions M76 Enthesopathies of lower limb, excluding foot M77 Other enthesopathies M79 Other soft tissue disorders, not elsewhere classified M84 Disorders of continuity of bone Other diseases of the musculoskeletal system XIV N00–99 Diseases of the genitourinary system N20 Calculus of kidney & ureter N39 Other disorders of urinary system N40-N51 Diseases of male genital organs N60-N64 Disorders of breast N80-N98 Non-inflammatory disorders of female genital tract Other diseases of the genitourinary system

Total

Men

Women

Days

34 470 2664 891 8117 2051 1137 7607 670 4706 804 1370 4453 24 229 965 1718 4695 764 920 1309 1720 657 994 2670 713 7104 5895 2088 1127 1034 1646 153 149 1614 1126 1376 6106 7393 1396 3263 8430 7365 2064 7162 766 938 1570 1736 5872 5161 39 644 3738 1485 1412 1488 11 541 1094 7589 12 087 763 8970 14 986 843 928 1144 1542 7076 3453

12 085 646 345 2463 726 537 2968 228 1546 342 373 1911 12 955 302 915 4310 501 369 557 862 263 393 810 438 3235 2653 1257 366 438 592 66 100 307 278 553 3221 3563 283 1681 1223 4443 1344 2915 176 394 854 845 3252 1820 18 155 1169 538 627 1002 5754 510 3105 3455 433 4200 2928 488 102 1144 – – 1194

22 385 2018 546 5654 1325 600 4639 442 3160 462 997 2542 11 274 663 803 385 263 551 752 858 394 601 1860 275 3869 3242 831 761 596 1054 87 049 1307 848 823 2885 3830 1113 1582 7207 2922 720 4247 590 544 716 891 2620 3341 21 489 2569 947 785 486 5787 584 4484 8632 330 4770 12 058 355 826 – 1542 7076 2259

21 19 19 19 19 25 21 20 19 43 25 23 28 26 22 24 25 30 44 42 35 26 22 31 30 31 27 32 54 30 46 63 74 41 95 91 92 76 43 36 62 38 78 63 82 102 75 62 35 25 25 28 34 54 42 33 40 63 57 29 30 21 27 25 31 31 (continued )

404

U. Lidwall

Disabil Rehabil, 2015; 37(5): 396–410

Table 1. Continued

Number of cases Diagnosis ICD-10 (chapter, codes, titles)

Total

Men

Women

Days

XV O00-O99 Pregnancy, childbirth & the puerperium O20 Haemorrhage in early pregnancy O21 Excessive vomiting in pregnancy O26 Maternal care for other conditions predominantly related to pregnancy O30 Multiple gestation O47 False labour O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth & the puerperium Other disorders in pregnancy, childbirth & the puerperium XVI P00–96 Certain conditions originating in the perinatal period & XVII Q00–99 Congenital malformations, deformations & chromosomal abnormalities XVIII R00–99 Symptoms, signs & abnormal clinical & laboratory findings, not elsewhere classified R00-R09 Symptoms & signs in the circulatory & respiratory systems R10 Abdominal & pelvic pain R11 Nausea & vomiting R42 Dizziness & giddiness R51 Headache R52 Pain, not elsewhere classified R53 Malaise & fatigue Other symptoms XIX S00-T98 Injury & poisoning S02 Fracture of skull & facial bones S06 Intracranial injury S13 Dislocation, sprain & strain of joints & ligaments at neck level S22 Fracture of rib(s), sternum & thoracic spine S32 Fracture of lumbar spine & pelvis S42 Fracture of shoulder & upper arm S43 Dislocation, sprain & strain of joints & ligaments of shoulder girdle S46 Injury of muscle & tendon at shoulder & upper arm level S52 Fracture of forearm S61 Open wound of wrist & hand S62 Fracture at wrist & hand level S63 Dislocation, sprain & strain of joints & ligaments at wrist-hand level S66 Injury of muscle & tendon at wrist & hand level S72 Fracture of femur S82 Fracture of lower leg, including ankle S83 Dislocation, sprain & strain of joints & ligaments of knee S86 Injury of muscle & tendon at lower leg level S92 Fracture of foot, except ankle S93 Dislocation, sprain & strain of joints & ligaments at ankle-foot level T00 Superficial injuries involving multiple body regions T01 Open wounds involving multiple body regions T03 Dislocations, sprains & strains involving multiple body regions T07 Unspecified multiple injuries T81 Complications of procedures, not elsewhere classified T92 Sequelae of injuries of upper limb Other injury & poisoning XX V01-Y98 External causes of morbidity & mortality XXI Z00-Z99 Factors influencing health status & contact with health services Z54 Convalescence Z73 Problems related to life-management difficulty Other factors influencing health status Total

35 525 861 4435 17 592 904 5502 842

– – – – – – –

35 525 861 4435 17 592 904 5502 842

51 40 46 56 72 52 56

5389 1374

– 393

5389 981

35 32

19 881

6566

13 315

34

2341 3017 812 3185 1587 2466 2352 4121 88 817 659 1581 1601 3867 1509 5409 1961 1076 10 475 1582 7794 2177 1851 1280 10 919 6939 2239 4001 2619 1488 1345 936 1634 697 1035 12 143 314 6408 800 1153 4455 617 611

923 891 86 988 501 875 598 1704 50 166 451 846 656 2544 821 2791 1412 851 3405 1270 5579 1203 1452 715 5376 4004 1754 2273 1409 745 929 489 906 264 599 7422 143 1783 128 319 1336 240 510

1418 2126 726 2197 1086 1591 1754 2417 38 651 208 735 945 1323 688 2618 549 225 7070 312 2215 974 399 565 5543 2935 485 1728 1210 743 416 447 728 433 436 4721 171 4625 672 834 3119 377 101

28 30 35 31 32 43 35 39 45 32 46 67 28 76 56 40 79 47 30 40 41 62 98 66 43 67 43 26 25 23 28 27 35 56 39 35 36 30 52 36 42

Sick leave diagnoses and RTW

DOI: 10.3109/09638288.2014.923521

405

Table 2. RTW rates among women with a medically certified sick leave 414 days, n ¼ 377 101, events ¼ 324 627. Diagnosis ICD-10 (chapter, codes, titles)a I A00-B99 Certain infectious & parasitic diseases A09 Other gastroenteritis & colitis of infectious & unspecified origin A46 Erysipelas B27 Infectious mononucleosis B34 Viral infection of unspecified site Other infectious & parasitic diseases II C00–D48 Neoplasms C18 Malignant neoplasm of colon C20 Malignant neoplasm of rectum C34 Malignant neoplasm of bronchus & lung C50 Malignant neoplasm of breast C51–C58 Malignant neoplasms of female genital organs C81–C96 Malignant neoplasms of lymphoid, haematopoietic & related tissue D10–D36 Benign neoplasms Other neoplasms III D50–D89 Diseases of the blood & blood–forming organs D50 Iron deficiency anaemia Other Diseases of the blood IV E00–90 Endocrine, nutritional & metabolic diseases E05 Thyrotoxicosis [hyperthyroidism] E10 Insulin-dependent diabetes mellitus E11 Non-insulin-dependent diabetes mellitus E66 Obesity Other endocrine diseases V F00–F99 Mental & behavioural disorders F10 Mental & behavioural disorders due to use of alcohol F20–F29 Schizophrenia, schizotypal & delusional disorders F31 Bipolar affective disorder F32 Depressive episode F33 Recurrent depressive disorder F41 Anxiety disorders F43 Reaction to severe stress and adjustment disorders F51 Nonorganic sleep disorders F90 Hyperkinetic disorders Other mental disorders VI G00–99 Diseases of the nervous system G35 Multiple sclerosis G40 Epilepsy G43 Migraine G44 Other headache syndromes G47 Sleep disorders G56 Mononeuropathies of upper limb (Carpal tunnel syndrome) G93 Other disorders of brain Other diseases of the nervous system VII H00–H59 Diseases of the eye & adnexa H33 Retinal detachments & breaks Other diseases of the eye VIIII H60–H95 Diseases of the ear & mastoid process H81 Disorders of vestibular function Other diseases of the ear & mastoid process IX I00–99 Diseases of the circulatory system I10 Essential (primary) hypertension I20 Angina pectoris I21 Acute myocardial infarction I26 Pulmonary embolism I48 Atrial fibrillation & flutter I50 Heart failure I61 Intracerebral haemorrhage I63 Cerebral infarction I83 Varicose veins of lower extremities I84 Haemorrhoids Other diseases of the circulatory system X J00–99 Diseases of the respiratory system J01 Acute sinusitis J03 Acute tonsillitis J06 Acute upper respiratory infections J11 Influenza, virus not identified

Crude (95% CI)

Adjustedb (95% CI)

2.65 1.54 2.76 3.18 1.20

(2.47–2.84) (1.37–1.73) (2.46–3.10) (3.02–3.35) (1.15–1.25)

2.39 1.57 2.29 2.91 1.24

(2.23–2.56) (1.40–1.77) (2.04–2.57) (2.77–3.07) (1.19–1.29)

0.42 0.29 0.30 0.51 0.46 0.28 1.43 0.54

(0.38–0.46) (0.26–0.34) (0.26–0.34) (0.49–0.52) (0.43–0.48) (0.25–0.31) (1.39–1.47) (0.52–0.56)

0.36 0.27 0.25 0.50 0.43 0.28 1.23 0.48

(0.33–0.40) (0.24–0.32) (0.22–0.28) (0.49–0.52) (0.41–0.46) (0.25–0.30) (1.19–1.27) (0.46–0.50)

1.26 (1.17–1.37) 0.92 (0.85–0.98)

1.24 (1.14–1.34) 0.94 (0.88–1.01)

1.02 0.60 0.76 1.83 1.15

(0.96–1.08) (0.54–0.66) (0.66–0.86) (1.77–1.88) (1.10–1.20)

1.03 0.72 0.97 1.51 1.20

(0.97–1.10) (0.65–0.80) (0.85–1.10) (1.47–1.56) (1.15–1.25)

0.78 0.26 0.25 0.54 0.35 0.54 0.77 1.00 0.18 0.31

(0.70–0.86) (0.24–0.29) (0.24–0.27) (0.54–0.54) (0.34–0.36) (0.53–0.55) (0.76–0.78) (0.94–1.06) (0.15–0.21) (0.29–0.32)

0.79 0.32 0.34 0.58 0.43 0.60 0.80 1.08 0.24 0.35

(0.72–0.88) (0.29–0.35) (0.31–0.36) (0.57–0.59) (0.41–0.45) (0.58–0.61) (0.78–0.80) (1.02–1.15) (0.21–0.28) (0.33–0.36)

0.26 0.49 0.85 0.91 0.91 1.44 0.68 0.54

(0.23–0.28) (0.43–0.55) (0.78–0.93) (0.84–0.99) (0.81–1.02) (1.41–1.48) (0.62–0.76) (0.52–0.57)

0.42 0.58 0.95 1.05 0.98 1.25 0.74 0.62

(0.38–0.45) (0.52–0.66) (0.88–1.04) (0.96–1.04) (0.87–1.10) (1.22–1.28) (0.67–0.82) (0.59–0.65)

1.53 (1.40–1.67) 1.14 (1.08–1.20)

1.35 (1.24–1.48) 1.17 (1.12–1.24)

1.15 (1.08–1.22) 1.18 (1.13–1.25)

1.31 (1.23–1.39) 1.39 (1.32–1.46)

1.19 0.67 0.85 0.95 0.66 0.44 0.15 0.27 3.29 3.24 0.56

(1.13–1.26) (0.61–0.75) (0.79–0.90) (0.84–1.06) (0.58–0.74) (0.38–0.52) (0.13–0.19) (0.25–0.30) (3.13–3.47) (2.96–3.56) (0.53–0.58)

1.26 0.81 0.89 0.95 0.74 0.48 0.13 0.26 2.95 2.72 0.59

(1.20–1.33) (0.73–0.90) (0.83–0.95) (0.85–1.06) (0.66–0.84) (0.41–0.56) (0.11–0.16) (0.24–0.28) (2.80–3.11) (2.48–2.98) (0.57–0.62)

3.48 3.81 3.70 3.78

(3.32–3.64) (3.50–4.16) (3.59–3.80) (3.57–4.00)

3.15 3.16 3.42 3.34

(3.00–3.29) (2.90–3.45) (3.33–3.52) (3.16–3.54) (continued )

406

U. Lidwall

Disabil Rehabil, 2015; 37(5): 396–410

Table 2. Continued

Diagnosis ICD-10 (chapter, codes, titles)a

Crude (95% CI)

J15 Bacterial pneumonia, not elsewhere classified J18 Pneumonia, organism unspecified J20 Acute bronchitis J22 Unspecified acute lower respiratory infection J44 Other chronic obstructive pulmonary disease J45 Asthma Other diseases of the respiratory system XI K00–93 Diseases of the digestive system K30 Dyspepsia K35 Acute appendicitis K40 Inguinal hernia K42 Umbilical hernia K43 Ventral hernia K50 Crohn disease [regional enteritis] K51 Ulcerative colitis K56 Paralytic ileus & intestinal obstruction without hernia K57 Diverticular disease of intestine K80 Cholelithiasis K85 Acute pancreatitis Other diseases of the digestive system XII L00–99 Diseases of the skin & subcutaneous tissue L00–L08 Infections of the skin & subcutaneous tissue L20–L30 Dermatitis & eczema L40 Psoriasis Other diseases of the skin XIII M00–M99 Diseases of the musculoskeletal system & connective tissue M05 Seropositive rheumatoid arthritis M06 Other rheumatoid arthritis M13 Other arthritis M16 Coxarthrosis [arthrosis of hip] M17 Gonarthrosis [arthrosis of knee] M18 Arthrosis of first carpometacarpal joint M19 Other arthrosis M20 Acquired deformities of fingers & toes M23 Internal derangement of knee M24 Other specific joint derangements M25 Other joint disorders, not elsewhere classified M35 Other systemic involvement of connective tissue M43 Other deforming dorsopathies M48 Other spondylopathies M50 Cervical disc disorders M51 Other intervertebral disc disorders M53 Other dorsopathies, not elsewhere classified M54 Dorsalgia M65 Synovitis & tenosynovitis M67 Other disorders of synovium & tendon M70 Soft tissue disorders related to use, overuse & pressure M72 Fibroblastic disorders M75 Shoulder lesions M76 Enthesopathies of lower limb, excluding foot M77 Other enthesopathies M79 Other soft tissue disorders, not elsewhere classified M84 Disorders of continuity of bone Other diseases of the musculoskeletal system XIV N00–99 Diseases of the genitourinary system N20 Calculus of kidney & ureter N39 Other disorders of urinary system N60–N64 Disorders of breast N80–N98 Non-inflammatory disorders of female genital tract Other diseases of the genitourinary system XV O00–O99 Pregnancy, childbirth & the puerperium O20 Haemorrhage in early pregnancy O21 Excessive vomiting in pregnancy O26 Maternal care for other conditions predominantly related to pregnancy O30 Multiple gestation O47 False labour O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth & the puerperium Other disorders in pregnancy, childbirth & the puerperium

2.28 2.99 3.29 3.62 0.51 1.40 1.82

(2.10–2.48) (2.90–3.08) (2.98–3.64) (3.48–3.76) (0.45–0.58) (1.30–1.50) (1.00–1.00)

2.05 2.67 3.22 3.34 0.68 1.58 1.83

(1.89–2.23) (2.59–2.76) (2.92–3.55) (3.22–3.47) (0.60–0.76) (1.48–1.70) (1.75–1.90)

1.54 3.04 1.97 2.40 1.62 0.74 1.01 1.12 1.82 2.75 1.54 1.21

(1.42–1.66) (2.84–3.27) (1.79–2.20) (2.12–2.72) (1.49–1.77) (0.68–0.80) (0.94–1.08) (1.01–1.25) (1.68–1.99) (2.63–2.88) (1.36–1.74) (1.17–1.25)

1.48 2.66 1.62 1.97 1.53 0.83 1.02 1.08 1.72 2.38 1.48 1.24

(1.37–1.60) (2.47–2.85) (1.47–1.80) (1.74–2.23) (1.40–1.67) (0.76–0.90) (0.95–1.09) (0.97–1.20) (1.58–1.87) (2.27–2.49) (1.30–1.67) (1.20–1.28)

1.81 1.20 0.54 1.45

(1.68–1.94) (1.12–1.30) (0.49–0.59) (1.36–1.54)

1.61 1.16 0.72 1.42

(1.50–1.73) (1.07–1.25) (0.65–0.79) (1.33–1.51)

0.46 0.43 0.75 0.53 0.59 0.55 0.53 1.34 1.24 0.84 0.82 0.44 0.65 0.49 0.45 0.56 0.56 0.95 1.83 2.21 1.11 1.30 0.82 1.03 1.15 0.61 0.81 0.64

(0.43–0.50) (0.39–0.47) (0.70–0.81) (0.51–0.55) (0.57–0.61) (0.52–0.59) (0.50–0.56) (1.31–1.37) (1.20–1.29) (0.78–0.91) (0.79–0.85) (0.40–0.48) (0.59–0.72) (0.45–0.53) (0.42–0.49) (0.53–0.58) (0.54–0.58) (0.94–0.97) (1.76–1.91) (2.07–2.36) (1.03–1.20) (1.18–1.43) (0.79–0.84) (0.95–1.12) (1.12–1.19) (0.59–0.62) (0.72–0.90) (0.62–0.67)

0.70 0.63 0.86 0.54 0.67 0.59 0.62 1.12 1.15 0.81 0.89 0.58 0.73 0.60 0.56 0.61 0.71 1.04 1.70 1.93 1.18 1.30 0.90 1.05 1.20 0.78 0.84 0.75

(0.66–0.76) (0.57–0.68) (0.80–0.93) (0.52–0.56) (0.65–0.69) (0.55–0.63) (0.58–0.66) (1.10–1.15) (1.11–1.20) (0.75–0.87) (0.86–0.92) (0.53–0.64) (0.67–0.81) (0.56–0.66) (0.51–0.60) (0.58–0.64) (0.69–0.74) (1.03–1.06) (1.63–1.77) (1.80–2.06) (1.09–1.27) (1.18–1.43) (0.87–0.92) (0.96–1.14) (1.16–1.23) (0.76–0.80) (0.75–0.94) (0.73–0.78)

1.48 3.16 2.65 1.84 1.20

(1.33–1.65) (2.95–3.40) (2.52–2.79) (1.79–1.88) (1.14–1.25)

1.29 2.83 2.17 1.53 1.18

(1.16–1.44) (2.64–3.05) (2.06–2.28) (1.49–1.57) (1.13–1.24)

1.13 1.06 1.03 0.89 1.15 1.02

(1.05–1.21) (1.03–1.09) (1.02–1.05) (0.84–0.95) (1.12–1.18) (0.95–1.09)

0.94 0.91 0.93 0.70 0.95 0.90

(0.88–1.01) (0.88–0.94) (0.91–0.94) (0.65–0.74) (0.93–0.98) (0.84–0.96)

1.43 (1.39–1.47)

Adjustedb (95% CI)

1.17 (1.13–1.20) (continued )

Sick leave diagnoses and RTW

DOI: 10.3109/09638288.2014.923521

407

Table 2. Continued

Diagnosis ICD-10 (chapter, codes, titles)a

Crude (95% CI)

Adjustedb (95% CI)

XVI P00–96 Certain conditions originating in the perinatal period & XVII Q00–99 Congenital malformations, deformations & chromosomal abnormalities XVIII R00–99 Symptoms, signs & abnormal clinical & laboratory findings, not elsewhere classified R00–R09 Symptoms & signs in the circulatory & respiratory systems R10 Abdominal & pelvic pain R11 Nausea & vomiting R42 Dizziness & giddiness R51 Headache R52 Pain, not elsewhere classified R53 Malaise & fatigue Other symptoms XIX S00–T98 Injury & poisoning S02 Fracture of skull & facial bones S06 Intracranial injury S13 Dislocation, sprain & strain of joints & ligaments at neck level S22 Fracture of rib(s), sternum & thoracic spine S32 Fracture of lumbar spine & pelvis S42 Fracture of shoulder & upper arm S43 Dislocation, sprain & strain of joints & ligaments of shoulder girdle S46 Injury of muscle & tendon at shoulder & upper arm level S52 Fracture of forearm S61 Open wound of wrist & hand S62 Fracture at wrist & hand level S63 Dislocation, sprain & strain of joints & ligaments at wrist–hand level S66 Injury of muscle & tendon at wrist & hand level S72 Fracture of femur S82 Fracture of lower leg, including ankle S83 Dislocation, sprain & strain of joints & ligaments of knee S86 Injury of muscle & tendon at lower leg level S92 Fracture of foot, except ankle S93 Dislocation, sprain & strain of joints & ligaments at ankle–foot level T00 Superficial injuries involving multiple body regions T01 Open wounds involving multiple body regions T03 Dislocations, sprains & strains involving multiple body regions T07 Unspecified multiple injuries T81 Complications of procedures, not elsewhere classified T92 Sequelae of injuries of upper limb Other injury & poisoning XX V01–Y98 External causes of morbidity & mortality XXI Z00–Z99 Factors influencing health status & contact with health services Z54 Convalescence Z73 Problems related to life-management difficulty Other factors influencing health status

1.13 (1.06–1.21)

1.18 (1.10–1.26)

1.32 1.22 1.20 1.11 1.17 0.62 1.00 0.85

(1.25–1.39) (1.17–1.28) (1.11–1.29) (1.06–1.16) (1.10–1.25) (0.59–0.66) (0.95–1.05) (0.81–0.89)

1.37 1.18 1.05 1.14 1.18 0.72 1.08 0.84

(1.30–1.45) (1.13–1.24) (0.98–1.13) (1.09–1.19) (1.10–1.25) (0.68–0.76) (1.03–1.14) (0.80–0.87)

1.26 0.83 0.50 1.63 0.72 0.81 1.08 0.64 1.04 1.88 1.33 1.31 0.91 0.51 0.80 1.13 0.97 1.20 1.88 1.84 2.43 1.67 1.44 1.37 0.86 1.04 1.06

(1.10–1.46) (0.77–0.90) (0.47–0.54) (1.54–1.73) (0.66–0.78) (0.78–0.85) (0.99–1.18) (0.56–0.74) (1.02–1.07) (1.67–2.10) (1.28–1.39) (1.22–1.39) (0.83–1.01) (0.47–0.56) (0.78–0.82) (1.08–1.17) (0.88–1.06) (1.14–1.26) (1.77–1.99) (1.71–1.98) (2.21–2.68) (1.52–1.83) (1.33–1.55) (1.24–1.51) (0.77–0.94) (1.01–1.08) (0.90–1.25)

1.18 0.86 0.65 1.56 0.70 0.77 1.00 0.65 0.94 1.54 1.14 1.10 0.74 0.53 0.73 1.03 0.86 1.06 1.77 1.76 2.18 1.56 1.37 1.19 0.82 0.94 1.06

(1.02–1.36) (0.80–0.93) (0.60–0.70) (1.47–1.64) (0.64–0.75) (0.74–0.80) (0.91–1.08) (0.57–0.74) (0.91–0.96) (1.38–1.73) (1.09–1.19) (1.04–1.18) (0.67–0.82) (0.48–0.58) (0.71–0.75) (0.99–1.07) (0.79–0.95) (1.01–1.11) (1.67–1.88) (1.63–1.89) (1.98–2.40) (1.41–1.71) (1.27–1.48) (1.08–1.32) (0.74–0.90) (0.80–1.11) (0.90–1.25)

a

1.89 (1.75–2.04) 0.73 (0.68–0.79) 1.26 (1.21–1.30)

1.56 (1.44–1.68) 0.78 (0.73–0.84) 1.19 (1.15–1.24)

Comparison against the unweighted average of all diagnosis categories. Relative RTW rates adjusted for age, civil status, children and their age, county of residence, country of birth, sickness insurance status (partial sickness benefit, type of sickness benefit, sick leave history and partial disability pension), occupation, occupational status (employed, unemployed, etc.) and month of onset of sick leave period.

b

408

U. Lidwall

Disabil Rehabil, 2015; 37(5): 396–410

Table 3. RTW rates among men with a medically certified sick leave 414 days, n ¼ 240 510, events ¼ 215 203. Diagnosis ICD-10 (chapter, codes, titles)a I A00–B99 Certain infectious & parasitic diseases A09 Other gastroenteritis & colitis of infectious & unspecified origin A46 Erysipelas B27 Infectious mononucleosis B34 Viral infection of unspecified site Other infectious & parasitic diseases II C00–D48 Neoplasms C18 Malignant neoplasm of colon C20 Malignant neoplasm of rectum C34 Malignant neoplasm of bronchus & lung C61 Malignant neoplasm of prostate C81–C96 Malignant neoplasms of lymphoid, haematopoietic & related tissue D10–D36 Benign neoplasms Other neoplasms III D50–D89 Diseases of the blood & blood-forming organs D50 Iron deficiency anaemia Other Diseases of the blood IV E00–90 Endocrine, nutritional & metabolic diseases E05 Thyrotoxicosis [hyperthyroidism] E10 Insulin-dependent diabetes mellitus E11 Non-insulin-dependent diabetes mellitus E66 Obesity Other endocrine diseases V F00–F99 Mental & behavioural disorders F10 Mental & behavioural disorders due to use of alcohol F20–F29 Schizophrenia, schizotypal & delusional disorders F31 Bipolar affective disorder F32 Depressive episode F33 Recurrent depressive disorder F41 Anxiety disorders F43 Reaction to severe stress and adjustment disorders F51 Nonorganic sleep disorders F90 Hyperkinetic disorders Other mental disorders VI G00–99 Diseases of the nervous system G35 Multiple sclerosis G40 Epilepsy G43 Migraine G44 Other headache syndromes G47 Sleep disorders G56 Mononeuropathies of upper limb (Carpal tunnel syndrome) G93 Other disorders of brain Other diseases of the nervous system VII H00–H59 Diseases of the eye & adnexa H33 Retinal detachments & breaks Other diseases of the eye VIIII H60–H95 Diseases of the ear & mastoid process H81 Disorders of vestibular function Other diseases of the ear & mastoid process IX I00–99 Diseases of the circulatory system I10 Essential (primary) hypertension I20 Angina pectoris I21 Acute myocardial infarction I26 Pulmonary embolism I48 Atrial fibrillation & flutter I50 Heart failure I61 Intracerebral haemorrhage I63 Cerebral infarction I83 Varicose veins of lower extremities I84 Haemorrhoids Other diseases of the circulatory system X J00–99 Diseases of the respiratory system J01 Acute sinusitis J03 Acute tonsillitis J06 Acute upper respiratory infections J11 Influenza, virus not identified

Crude (95% CI)

Adjustedb (95% CI)

2.67 1.90 2.76 2.96 1.07

(2.45–2.90) (1.75–2.07) (2.52–3.02) (2.77–3.17) (1.03–1.12)

2.27 1.79 2.26 2.62 1.12

(2.09–2.47) (1.64–1.95) (2.06–2.48) (2.45–2.80) (1.07–1.17)

0.46 0.36 0.36 0.96 0.32 0.95 0.50

(0.42–0.51) (0.32–0.40) (0.31–0.40) (0.92–1.00) (0.29–0.34) (0.89–1.02) (0.48–0.51)

0.44 0.35 0.33 0.93 0.32 0.94 0.45

(0.40–0.48) (0.31–0.39) (0.29–0.37) (0.90–0.97) (0.29–0.34) (0.97–1.01) (0.44–0.47)

1.04 (0.83–1.30) 0.67 (0.61–0.74)

1.02 (0.81–1.28) 0.76 (0.69–0.84)

1.08 0.59 0.80 1.66 0.88

(0.92–1.26) (0.53–0.65) (0.73–0.88) (1.57–1.76) (0.81–0.95)

1.18 0.72 0.87 1.47 0.97

(1.01–1.37) (0.65–0.79) (0.79–0.96) (1.39–1.56) (0.90–1.05)

0.75 0.26 0.31 0.53 0.37 0.53 0.78 0.88 0.22 0.31

(0.71–0.81) (0.24–0.28) (0.28–0.33) (0.52–0.54) (0.36–0.39) (0.51–0.55) (0.76–0.79) (0.81–0.96) (0.19–0.25) (0.30–0.33)

0.76 0.32 0.38 0.57 0.45 0.60 0.81 0.95 0.28 0.38

(0.72–0.82) (0.29–0.35) (0.36–0.41) (0.56–0.58) (0.43–0.47) (0.58–0.62) (0.80–0.83) (0.87–1.03) (0.24–0.32) (0.35–0.40)

0.24 0.53 1.04 0.94 0.95 1.35 0.68 0.46

(0.20–0.27) (0.47–0.60) (0.86–1.26) (0.83–1.06) (0.84–1.08) (1.31–1.40) (0.59–0.79) (0.43–0.48)

0.36 0.58 1.21 0.97 1.05 1.21 0.72 0.53

(0.31–0.42) (0.51–0.65) (1.00–1.47) (0.86–1.09) (0.94–1.19) (1.17–1.26) (0.62–0.84) (0.51–0.56)

1.42 (1.32–1.53) 1.07 (1.02–1.12)

1.28 (1.19–1.37) 1.03 (0.98–1.08)

1.15 (1.07–1.24) 1.25 (1.18–1.33)

1.23 (1.14–1.32) 1.48 (1.39–1.57)

1.12 0.78 0.97 1.10 0.74 0.40 0.22 0.31 3.00 2.86 0.61

(1.05–1.19) (0.74–0.82) (0.94–1.01) (1.01–1.20) (0.69–0.79) (0.37–0.44) (0.20–0.25) (0.29–0.33) (2.76–3.28) (2.62–3.12) (0.59–0.63)

1.20 0.83 1.04 1.17 0.83 0.48 0.20 0.31 2.98 2.53 0.65

(1.12–1.28) (0.79–0.88) (1.00–1.07) (1.06–1.28) (0.78–0.90) (0.44–0.52) (0.18–0.23) (0.29–0.33) (2.74–3.25) (2.32–2.76) (0.63–0.67)

3.74 3.86 3.84 4.41

(3.46–4.04) (3.47–4.30) (3.69–4.00) (4.09–4.74)

3.26 3.08 3.49 3.93

(3.01–3.52) (2.78–3.43) (3.35–3.64) (3.65–4.23) (continued )

Sick leave diagnoses and RTW

DOI: 10.3109/09638288.2014.923521

409

Table 3. Continued

Diagnosis ICD-10 (chapter, codes, titles)a

Crude (95% CI)

J15 Bacterial pneumonia, not elsewhere classified J18 Pneumonia, organism unspecified J20 Acute bronchitis J22 Unspecified acute lower respiratory infection J44 Other chronic obstructive pulmonary disease J45 Asthma Other diseases of the respiratory system XI K00–93 Diseases of the digestive system K30 Dyspepsia K35 Acute appendicitis K40 Inguinal hernia K42 Umbilical hernia K43 Ventral hernia K50 Crohn disease [regional enteritis] K51 Ulcerative colitis K56 Paralytic ileus & intestinal obstruction without hernia K57 Diverticular disease of intestine K80 Cholelithiasis K85 Acute pancreatitis Other diseases of the digestive system XII L00–99 Diseases of the skin & subcutaneous tissue L00–L08 Infections of the skin & subcutaneous tissue L20–L30 Dermatitis & eczema L40 Psoriasis Other diseases of the skin XIII M00–M99 Diseases of the musculoskeletal system & connective tissue M05 Seropositive rheumatoid arthritis M06 Other rheumatoid arthritis M13 Other arthritis M16 Coxarthrosis [arthrosis of hip] M17 Gonarthrosis [arthrosis of knee] M18 Arthrosis of first carpometacarpal joint M19 Other arthrosis M20 Acquired deformities of fingers & toes M23 Internal derangement of knee M24 Other specific joint derangements M25 Other joint disorders, not elsewhere classified M35 Other systemic involvement of connective tissue M43 Other deforming dorsopathies M48 Other spondylopathies M50 Cervical disc disorders M51 Other intervertebral disc disorders M53 Other dorsopathies, not elsewhere classified M54 Dorsalgia M65 Synovitis & tenosynovitis M67 Other disorders of synovium & tendon M70 Soft tissue disorders related to use, overuse & pressure M72 Fibroblastic disorders M75 Shoulder lesions M76 Enthesopathies of lower limb, excluding foot M77 Other enthesopathies M79 Other soft tissue disorders, not elsewhere classified M84 Disorders of continuity of bone Other diseases of the musculoskeletal system XIV N00–99 Diseases of the genitourinary system N20 Calculus of kidney & ureter N39 Other disorders of urinary system N40–N51 Diseases of male genital organs Other diseases of the genitourinary system XVI P00–96 Certain conditions originating in the perinatal period & XVII Q00–99 Congenital malformations, deformations & chromosomal abnormalities XVIII R00–99 Symptoms, signs & abnormal clinical & laboratory findings, not elsewhere classified R00–R09 Symptoms & signs in the circulatory & respiratory systems R10 Abdominal & pelvic pain R11 Nausea & vomiting

2.09 2.82 2.48 3.51 0.52 1.04 1.54

(1.92–2.28) (2.71–2.92) (2.16–2.84) (3.33–3.69) (0.46–0.59) (0.93–1.16) (1.47–1.61)

1.87 2.54 2.38 3.20 0.68 1.13 1.52

(1.71–2.04) (2.45–2.64) (2.08–2.73) (3.04–3.37) (0.59–0.77) (1.02–1.26) (1.45–1.60)

1.49 3.45 2.58 2.63 1.74 0.89 0.98 1.33 1.45 2.60 1.17 1.23

(1.32–1.67) (3.23–3.68) (2.50–2.67) (2.40–2.87) (1.57–1.94) (0.82–0.97) (0.92–1.05) (1.17–1.51) (1.31–1.61) (2.42–2.79) (1.06–1.29) (1.19–1.28)

1.34 2.88 2.26 2.18 1.60 0.94 0.99 1.24 1.49 2.38 1.08 1.23

(1.19–1.50) (2.70–3.07) (2.19–2.34) (2.00–2.39) (1.44–1.77) (0.86–1.03) (0.92–1.06) (1.10–1.41) (1.35–1.65) (2.21–2.55) (0.98–1.19) (1.18–1.27)

1.73 1.24 0.62 1.03

(1.64–1.83) (1.11–1.37) (0.56–0.69) (0.95–1.12)

1.51 1.18 0.80 1.17

(1.42–1.59) (1.07–1.32) (0.72–0.89) (1.08–1.28)

0.50 0.57 0.91 0.61 0.64 0.60 0.65 1.35 1.23 0.88 0.94 0.58 0.68 0.59 0.47 0.64 0.54 1.02 1.71 1.93 1.86 1.44 0.79 1.19 1.27 1.04 0.78 0.75

(0.44–0.58) (0.50–0.65) (0.84–1.00) (0.59–0.64) (0.62–0.66) (0.53–0.68) (0.62–0.68) (1.28–1.43) (1.19–1.27) (0.84–0.94) (0.90–0.98) (0.49–0.68) (0.61–0.76) (0.55–0.64) (0.44–0.51) (0.61–0.66) (0.51–0.57) (1.00–1.04) (1.61–1.81) (1.77–2.10) (1.72–2.02) (1.35–1.53) (0.77–0.81) (1.09–1.30) (1.23–1.32) (1.00–1.08) (0.71–0.86) (0.72–0.77)

0.69 0.66 0.97 0.61 0.69 0.64 0.70 1.16 1.09 0.76 0.96 0.69 0.77 0.64 0.53 0.69 0.67 1.10 1.55 1.76 1.86 1.36 0.82 1.08 1.25 1.12 0.70 0.81

(0.61–0.79) (0.58–0.75) (0.89–1.06) (0.58–0.63) (0.66–0.71) (0.57–0.73) (0.67–0.74) (1.10–1.23) (1.06–1.13) (0.72–0.80) (0.93–1.00) (0.59–0.82) (0.70–0.86) (0.60–0.69) (0.49–0.57) (0.67–0.72) (0.64–0.71) (1.09–1.12) (1.46–1.64) (1.61–1.91) (1.72–2.02) (1.27–1.45) (0.80–0.85) (0.99–1.18) (1.21–1.30) (1.08–1.16) (0.64–0.78) (0.78–0.84)

1.59 1.85 1.91 0.68 0.73

(1.45–1.74) (1.51–2.26) (1.80–2.03) (0.64–0.72) (0.66–0.82)

1.43 1.79 1.83 0.80 0.76

(1.31–1.57) (1.46–2.19) (1.72–1.94) (0.75–0.86) (0.68–0.85)

1.24 (1.16–1.33) 1.21 (1.13–1.29) 1.72 (1.38–2.13)

Adjustedb (95% CI)

1.28 (1.20–1.37) 1.17 (1.09–1.25) 1.73 (1.40–2.15) (continued )

410

U. Lidwall

Disabil Rehabil, 2015; 37(5): 396–410

Table 3. Continued

Diagnosis ICD-10 (chapter, codes, titles)a

Crude (95% CI)

R42 Dizziness & giddiness R51 Headache R52 Pain, not elsewhere classified R53 Malaise & fatigue Other symptoms XIX S00–T98 Injury & poisoning S02 Fracture of skull & facial bones S06 Intracranial injury S13 Dislocation, sprain & strain of joints & ligaments at neck level S22 Fracture of rib(s), sternum & thoracic spine S32 Fracture of lumbar spine & pelvis S42 Fracture of shoulder & upper arm S43 Dislocation, sprain & strain of joints & ligaments of shoulder girdle S46 Injury of muscle & tendon at shoulder & upper arm level S52 Fracture of forearm S61 Open wound of wrist & hand S62 Fracture at wrist & hand level S63 Dislocation, sprain & strain of joints & ligaments at wrist–hand level S66 Injury of muscle & tendon at wrist & hand level S72 Fracture of femur S82 Fracture of lower leg, including ankle S83 Dislocation, sprain & strain of joints & ligaments of knee S86 Injury of muscle & tendon at lower leg level S92 Fracture of foot, except ankle S93 Dislocation, sprain & strain of joints & ligaments at ankle–foot level T00 Superficial injuries involving multiple body regions T01 Open wounds involving multiple body regions T03 Dislocations, sprains & strains involving multiple body regions T07 Unspecified multiple injuries T81 Complications of procedures, not elsewhere classified T92 Sequelae of injuries of upper limb Other injury & poisoning XX V01–Y98 External causes of morbidity & mortality XXI Z00–Z99 Factors influencing health status & contact with health services Z54 Convalescence Z73 Problems related to life-management difficulty Other factors influencing health status

1.17 0.91 0.70 0.88 0.79

(1.10–1.25) (0.86–1.03) (0.65–0.75) (0.80–0.95) (0.75–0.84)

1.24 1.02 0.84 0.96 0.79

(1.16–1.32) (0.93–1.12) (0.78–0.90) (0.88–1.04) (0.75–0.83)

1.23 0.58 0.54 1.56 0.62 0.98 1.13 0.70 1.06 1.77 1.30 1.23 0.94 0.56 0.80 1.06 0.88 1.04 1.78 1.97 2.40 1.58 1.53 1.30 0.92 0.98 0.88

(1.12–1.35) (0.54–0.63) (0.49–0.58) (1.49–1.62) (0.57–0.66) (0.94–1.02) (1.07–1.19) (0.65–0.75) (1.02–1.09) (1.67–1.87) (1.26–1.34) (1.16–1.31) (0.89–0.99) (0.51–0.60) (0.78–0.82) (1.03–1.10) (0.84–0.92) (1.00–1.08) (1.69–1.88) (1.83–2.12) (2.25–2.56) (1.45–1.73) (1.43–1.63) (1.15–1.48) (0.85–1.00) (0.96–1.01) (0.74–1.05)

1.11 0.54 0.63 1.46 0.61 0.87 1.00 0.65 0.91 1.44 1.05 1.04 0.76 0.54 0.71 0.90 0.77 0.90 1.56 1.79 2.17 1.41 1.51 1.27 0.86 0.93 0.86

(1.01–1.22) (0.50–0.59) (0.58–0.69) (1.40–1.52) (0.56–0.65) (0.84–0.91) (0.94–1.05) (0.65–0.75) (0.88–0.95) (1.36–1.52) (1.02–1.08) (0.98–1.10) (0.72–0.80) (0.50–0.58) (0.69–0.73) (0.88–0.93) (0.74–0.81) (0.87–0.94) (1.48–1.65) (1.67–1.93) (2.03–2.31) (1.28–1.54) (1.42–1.62) (1.12–1.44) (0.79–0.93) (0.91–0.96) (0.72–1.03)

a

1.58 (1.33–1.88) 0.73 (0.65–0.82) 0.71 (0.67–0.75)

Adjustedb (95% CI)

1.44 (1.21–1.72) 0.75 (0.67–0.84) 0.73 (0.69–0.78)

Comparison against the unweighted average of all diagnosis categories. bRelative RTW rates adjusted for age, civil status, children and their age, county of residence, country of birth, sickness insurance status (partial sickness benefit, type of sickness benefit, sick leave history and partial disability pension), occupation, occupational status (employed, unemployed, etc.) and month of onset of sick leave period.

Copyright of Disability & Rehabilitation is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.