Sickness absence with musculoskeletal or mental diagnoses, transition into disability pension and all-cause mortality: A 9-year prospective cohort study

Aims: Increased early mortality indicates poor health. This study assessed mortality among men and women after long-term sickness absence (LTSA) with musculoskeletal or mental diagnoses. A special focus was on possible differences in mortality among women and men who obtained disability pension (DP) as compared to those who did not. Methods: This was a 9-year prospective cohort study in Hordaland County, Norway, including 1417 women and 1075 men aged 16-62 years with a spell of LTSA 48 weeks, and with a musculoskeletal or mental diagnosis. The endpoint was death from all causes. Age-standardised mortality rates for those who obtained DP and those who did not were calculated and compared. Cox proportional hazards analysis was used to assess DP status and other possible predictors of premature death. All analyses were stratified for gender. Results: Overall, 36% obtained a DP and 3.2% died. Among the men, 7.2% with mental diagnoses and 4.4% with musculoskeletal sick-leave diagnoses died. Among the women, 1.9% died in both groups. Among the men, 5.6% of the DP recipients died, as compared to 4.6% among those without DP. The respective figures for the women were 2.9% and 1.3%. Male gender, increasing age and low income among men increased the mortality risk significantly. After adjustments for these variables, the hazard ratios associated with DP were 2.9 (95% confidence interval (CI) 1.2-7.0) for women and 2.3 (95% CI 1.2-4.5) for men. Conclusions: When monitoring those on LTSA, one should be aware of the high mortality among those who obtain DP and male workers with low income, and preventive actions should be considered.