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      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

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          Abstract

          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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          Most cited references30

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          A quality study of a medical birth registry.

          A quality control study was made of the Swedish Medical Birth Registry. This registry used one mode of data collection during 1973-1981 and another from 1982 onwards. The number of errors in the register was checked by comparing register information with a sample of the original medical records, and the variability in the use of diagnoses between hospitals was studied. Different types of errors were identified and quantified and the efficiency of the two methods of data collection evaluated.
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            Psychosocial work factors and sickness absence in 31 countries in Europe.

            The studies on the associations between psychosocial work factors and sickness absence have rarely included a large number of factors and European data. The objective was to examine the associations between a large set of psychosocial work factors following well-known and emergent concepts and sickness absence in Europe. The study population consisted of 14,881 male and 14,799 female workers in 31 countries from the 2005 European Working Conditions Survey. Psychosocial work factors included the following: decision latitude, psychological demands, social support, physical violence, sexual harassment, discrimination, bullying, long working hours, shift and night work, job insecurity, job promotion and work-life imbalance. Covariates were as follows: age, occupation, economic activity, employee/self-employed status and physical, chemical, biological and biomechanical exposures. Statistical analysis was performed using multilevel negative binomial hurdle models to study the occurrence and duration of sickness absence. In the models, including all psychosocial work factors together and adjustment for covariates, high psychological demands, discrimination, bullying, low-job promotion and work-life imbalance for both genders and physical violence for women were observed as risk factors of the occurrence of sickness absence. Bullying and shift work increased the duration of absence among women. Bullying had the strongest association with sickness absence. Various psychosocial work factors were found to be associated with sickness absence. A less conservative analysis exploring each factor separately provided a still higher number of risk factors. Preventive measures should take psychosocial work environment more comprehensively into account to reduce sickness absence and improve health at work at European level.
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              Social inequalities in health: a proper concern of epidemiology

              Social inequalities are a proper concern of epidemiology. Epidemiological thinking and modes of analysis are central, but epidemiological research is one among many areas of study that provide the evidence for understanding the causes of social inequalities in health and what can be done to reduce them. Understanding the causes of health inequalities requires insights from social, behavioral and biological sciences, and a chain of reasoning that examines how the accumulation of positive and negative influences over the life course leads to health inequalities in adult life. Evidence that the social gradient in health can be reduced should make us optimistic that reducing health inequalities is a realistic goal for all societies.
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                Author and article information

                Contributors
                charlotte.bjorkenstam@neuro.uu.se
                krisztina.laszlo@ki.se
                cecilia.orellana@ki.se
                ulrik.lidwall@forsakringkassan.se
                pls@psychology.su.se
                margaretha.voss@gmail.com
                pia.svedberg@ki.se
                kristina.alexanderson@ki.se
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                14 May 2020
                14 May 2020
                2020
                : 20
                : 686
                Affiliations
                [1 ]GRID grid.4714.6, ISNI 0000 0004 1937 0626, Division of Insurance Medicine, Department of Clinical Neuroscience, , Karolinska Institutet, ; Stockholm, Sweden
                [2 ]GRID grid.4714.6, ISNI 0000 0004 1937 0626, Department of Global Public Health, , Karolinska Institutet, ; Stockholm, Sweden
                [3 ]GRID grid.4714.6, ISNI 0000 0004 1937 0626, Unit of Occupational Medicine, , Institute of Environmental Medicine, Karolinska Institutet, ; Stockholm, Sweden
                [4 ]Department for Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden
                [5 ]GRID grid.10548.38, ISNI 0000 0004 1936 9377, Department of Psychology, , Stockholm University, ; Stockholm, Sweden
                Author information
                http://orcid.org/0000-0002-4695-477X
                Article
                8730
                10.1186/s12889-020-08730-5
                7227196
                32410599
                4182b0b4-0bba-4a6e-a2c0-b895082bcd72
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 27 January 2020
                : 17 April 2020
                Funding
                Funded by: AFA Försäkring (SE)
                Award ID: 160318
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Public health
                sick leave,child birth,occupation,disability pension
                Public health
                sick leave, child birth, occupation, disability pension

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