Prediction of future labour market outcome in a cohort of long-term sick-listed Danes

Abstract

Background: Targeted interventions for the long-term sick-listed may prevent permanent exclusion from the labour force. We aimed to develop a prediction method for identifying high risk groups for continued or recurrent long-term sickness absence, unemployment, or disability among persons on long-term sick leave.

Methods: We obtained individual characteristics and follow-up data from the Danish Register of Sickness Absence Compensation Benefits and Social Transfer Payments (RSS) during 2004 to 2010 for 189,279 Danes who experienced a period of long-term sickness absence (4+ weeks). In a learning data set, statistical prediction methods were built using logistic regression and a discrete event simulation approach for a one year prediction horizon. Personalized risk profiles were obtained for five outcomes: employment, unemployment, recurrent sickness absence, continuous long-term sickness absence, and early retirement from the labour market. Predictor variables included gender, age, socio-economic position, job type, chronic disease status, history of sickness absence, and prior history of unemployment. Separate models were built for times of economic growth (2005-2007) and times of recession (2008-2010). The accuracy of the prediction models was assessed with analyses of Receiver Operating Characteristic (ROC) curves and the Brier score in an independent validation data set.

Results: In comparison with a null model which ignored the predictor variables, logistic regression achieved only moderate prediction accuracy for the five outcome states. Results obtained with discrete event simulation were comparable with logistic regression.

Conclusions: Only moderate prediction accuracy could be achieved using the selected information from the Danish register RSS. Other variables need to be included in order to establish a prediction method which provides more accurate risk profiles for long-term sick-listed persons.

Figure 1

The overall study design for both the training data set and the validation data set.

Figure 2

Multi-state model, the twenty transitions between the six states: sickness absence (SA), work (W), unemployment (U), disability pension (D), temporary out (TO) and the initial long-term sick-listing state (LTS). All individuals start in the LTS-state (marked “Start”).

Figure 3

ROC-curves for the Work-state in the economic growth period. The figure shows the ROC-curves of the Logistic prediction method, the DES prediction approach and a reference line representing the Null-model.