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      Sickness absence in relation to first childbirth in nulliparous women, employed in the education and care branches in the public or private sectors: A Swedish longitudinal cohort study

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          Abstract

          Background

          Pregnancy and childbirth entail increased risks of sickness absence (SA). Many women work in education and care, two branches characterised by high SA levels; it is not known if the link between childbirth and SA in these branches differs between private and public sectors. We examined SA and disability pension (DP) in relation to childbirth among women working in the education and care branches, and if these patterns differed between public and private sectors.

          Methods

          We performed a Swedish register-based cohort study. Study participants were nulliparous women living in Sweden in December 2004 and employed in education or care (n = 120,013). We compared SA/DP in the three years before and after 2005 among women who had no childbirth during follow-up (B0), had one childbirth in 2005 and no more (B1), and had one childbirth in 2005 and at least one more during follow-up (B1+). Analyses were performed for all and by public or private sector.

          Results

          Of all studied women, 70% worked in the public sector. Women in B1 and B1+ had, except for the year before childbirth, comparable or lower mean combined SA/DP days than women in the B0 group; women in the B1+ group had, except for the year before childbirth, the lowest mean level of SA/DP. We observed no substantial differences in these patterns between public and private sectors.

          Conclusions

          Patterns of SA/DP among nulliparous women who did or did not give birth did not differ substantially between public and private sectors among women in the educational and care branches.

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          Most cited references39

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          External review and validation of the Swedish national inpatient register

          Background The Swedish National Inpatient Register (IPR), also called the Hospital Discharge Register, is a principal source of data for numerous research projects. The IPR is part of the National Patient Register. The Swedish IPR was launched in 1964 (psychiatric diagnoses from 1973) but complete coverage did not begin until 1987. Currently, more than 99% of all somatic (including surgery) and psychiatric hospital discharges are registered in the IPR. A previous validation of the IPR by the National Board of Health and Welfare showed that 85-95% of all diagnoses in the IPR are valid. The current paper describes the history, structure, coverage and quality of the Swedish IPR. Methods and results In January 2010, we searched the medical databases, Medline and HighWire, using the search algorithm "validat* (inpatient or hospital discharge) Sweden". We also contacted 218 members of the Swedish Society of Epidemiology and an additional 201 medical researchers to identify papers that had validated the IPR. In total, 132 papers were reviewed. The positive predictive value (PPV) was found to differ between diagnoses in the IPR, but is generally 85-95%. Conclusions In conclusion, the validity of the Swedish IPR is high for many but not all diagnoses. The long follow-up makes the register particularly suitable for large-scale population-based research, but for certain research areas the use of other health registers, such as the Swedish Cancer Register, may be more suitable.
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            The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research

            Swedish health care and national health registers are dependent on the presence of a unique identifier. This paper describes the Swedish personal identity number (PIN) and explores ethical issues of its use in medical research. A ten-digit-PIN is maintained by the National Tax Board for all individuals that have resided in Sweden since 1947. Until January 2008, an estimated 75,638 individuals have changed PIN. The most common reasons for change of PIN are incorrect recording of date of birth or sex among immigrants or newborns. Although uncommon, change of sex always leads to change of PIN since the PIN is sex-specific. The most common reasons for re-use of PIN (n = 15,887), is when immigrants are assigned a PIN that has previously been assigned to someone else. This is sometimes necessary since there is a shortage of certain PIN combinations referring to dates of birth in the 1950s and 1960s. Several ethical issues can be raised pro and con the use of PIN in medical research. The Swedish PIN is a useful tool for linkages between medical registers and allows for virtually 100% coverage of the Swedish health care system. We suggest that matching of registers through PIN and matching of national health registers without the explicit approval of the individual patient is to the benefit for both the individual patient and for society.
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              The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research

              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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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – original draft
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                15 September 2022
                2022
                : 17
                : 9
                : e0274603
                Affiliations
                [1 ] Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
                [2 ] Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
                [3 ] Department of Psychology, Stockholm University, Stockholm, Sweden
                [4 ] Department for Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden
                National Cheng Kung University College of Medicine, TAIWAN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-4695-477X
                Article
                PONE-D-21-34259
                10.1371/journal.pone.0274603
                9477323
                f4d2ffd3-da43-4324-8e6a-902191600115
                © 2022 László et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 26 October 2021
                : 31 August 2022
                Page count
                Figures: 2, Tables: 2, Pages: 13
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100002706, AFA Försäkring;
                Award ID: 160318
                Award Recipient :
                KA; grant no.160318; AFA Insurance Foundation; https://www.afaforsakring.se/ The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
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                Europe
                European Union
                Sweden
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                Custom metadata
                Data cannot be shared publicly because of legal restrictions. Data may be available from the Swedish National Board of Health and Welfare ( registerservice@ 123456socialstyrelsen.se ), Statistics Sweden( Mikrodata.individ@ 123456scb.se ) and the Swedish Social Insurance Agency ( statistikenheten@ 123456forsakringskassan.se ) for researchers who meet the criteria for access to confidential data.

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