Abstract
Background
Sickness absence (SA) is a strong predictor of work disability, but little is known about early and short SAs preceding disability pension (DP) applications. Most register-based studies focus on long SAs and granted pensions, leaving rejected applications and short SAs largely unexplored. We describe and visualize SA paths leading to a DP application among Finnish public sector employees, including short SAs, and examine how these paths differ by employee groups and diagnoses.
Methods
We used register data of employees in 21 largest municipal organizations in Finland. The study population comprised 3,037 employees who filed their first-time DP application in 2019–2021. Monthly SA states over 48 months before DP application were calculated, incorporating short absences (<10 days) and longer SA periods. Sequence analysis, clustering and multinomial logistic regression analysis were used to identify different types of paths and their associations with background factors.
Results
Five distinct SA paths to DP application were identified. The most common path was characterized by little SA until one year before application, whereas other paths showed earlier and more sustained accumulation of both short and long absences. The timing and amount of SA differed by age, gender, earnings, occupation, diagnosis, and the decision to the DP application. Rejected applications were more frequent in paths characterized by earlier long SA spells, musculoskeletal disorders were associated with an early, large number of short SA spells.
Conclusions
The goal of extending working lives and reducing disability expenditure highlights the importance of focusing preventive action onto the years leading to a disability pension as well as identifying the paths that lead to permanently losing one’s work ability. This study highlighted five paths to disability pension application and showed that different SA patterns can be identified already four years before the application.
Key messages
• Diverse sickness absence paths lead to disability pension applications, characterized by the amount and timing of both short and long absences, and associations with occupation, age, and diagnosis.
• To better understand paths to disability pension applications, multifaceted long-term data is needed on both short-term and long-term sickness absences and background characteristics.