Transitions Between Compensated Work Disability, Joblessness, and Self-Sufficiency: A Cohort Study 1997-2010 of Those Jobless in 1995

Abstract

Associations between unemployment, work, and disability have been researched in many studies. The findings are often based on cross-sectional data and single outcomes. The present study analysed multiple outcomes over a period of 15 years among long-term unemployed individuals. Based on all individuals aged 20-40 living in Sweden in 1995, prospective cohort analyses were conducted. Individual annual labour market proximity 1995-2010 was estimated and categorised into three mutually exclusive categories: "Jobless", "Self-sufficient" (i.e. main income from work), or "Disabled". Individuals in the category "Jobless" (n = 638,622) in 1995 constituted the study population. Using autoregressive multinomial logistic regression, transitions between the three states during 1997-2010 were analysed. Socio-economic factors, previous inpatient care, and national unemployment rates in different time periods were included in the regression models. Among those "Jobless" in 1995, 17 % were also "Jobless" in 2010, while 10 % were "Disabled" and 61 % "Self-sufficient". The transitions were stable over time periods for transitions into "Self-sufficient" and "Disabled" but less so for "Jobless". Previous state was the best predictor of subsequent state. "Jobless" individuals with previous morbidity had a higher transition probability into "Disabled" and a lower transition probability into "Self-sufficient". The transition rates into "Self-sufficient" were higher in periods with lower unemployment levels. The study supports the interpretation that return to work was affected both by the individuals' previous health status and by the national unemployment level. Transition from being "Jobless" into "Disability" may be influenced by previous ill health and by negative health effects of being "Jobless".

Keywords: Cohort study; Disability pension; Multi-state; Sick leave; Unemployment; Work.

Fig. 1

Model for transitions between the four states jobless, self-sufficient, disabled, or censored (absorbing state) 1997, 2001, 2005, 2008, and 2010. Entry: all jobless in 1995

Fig. 2

Unemployment rate, incapacity rate, and employment rate in Sweden 1995–2010. Sources The Swedish Social Insurance Agency and www.ekonomifakta.se