The role of sickness absence diagnosis for the risk of future inpatient- or specialized outpatient care in a Swedish population-based twin sample

Abstract

Background: Studies of consequences of sickness absence such as health and well-being have been rare whereas risk factors for sickness absence have been studied extensively. This study assumed the consequences of sickness absence would differ by diagnostic group or by patient care type. The aim was to investigate sickness absence due to various diagnosis groups as a predictor for subsequent inpatient- and specialized outpatient care while controlling for familial confounding.

Methods: We utilized the register data of 69,552 twin individuals between 16 and 80 years of age (48% women). The first incident sickness absence spell, from baseline year 2005, including diagnosis of sickness absence was our primary exposure of interest and we followed them until the first incident inpatient- and specialized outpatient care episode with main diagnosis code or until 31.12.2013.

Results: A total of 7464 incident sickness absence spells took place (11%), 42% had inpatient care and 83% specialized outpatient care (mean follow-up time 3.2 years, SD 3.1 years). All the main sickness absence diagnosis groups were associated with increased risk of future care in comparison to no sickness absence. Controlling for confounders attenuated the associations in magnitude but with retaining direction, and we could not confirm an effect of familial factors.

Conclusions: Sickness absence predicts both inpatient- and specialized outpatient care and the association is universal across diagnosis groups. The lower survival time and incidence rates of inpatient than specialized outpatient care point towards severity of diseases assumption. This finding was also universal across sickness absence diagnosis groups.

Keywords: Diagnosis; Health care; ICD-10; Longitudinal; Population-based; Sick leave; Twins.

Fig. 1

Flow chart of the study sample

Fig. 2

Kaplan-Meier Survival curves across SA diagnosis categories for inpatient care (log-rank test for equality of survivor functions p<0.001)

Fig. 3

Kaplan-Meier Survival curves across SA diagnosis categories for specialized outpatient care (log-rank test for equality of survivor functions p<0.001)