title: Diagnosis-specific sick leave as a long-term predictor of disability pension: a 13-year follow-up of the GAZEL cohort study.
abstract: BACKGROUND
  Factors that increase the risk of labour market exclusion are poorly understood. In this study, we examined the extent to which all-cause and diagnosis-specific sick leave predict subsequent disability pension (DP).
  
  
  METHODS
  Prospective cohort study of 20 434 persons employed by the French national gas and electric company (the GAZEL study). New sick-leave spells >7 days in 1990-1992 were obtained from company records. Follow-up for DP was from 1994 to 2007.
  
  
  RESULTS
  The HR, adjusted for age and occupational position, for DP was 3.5 (95% CI 2.7 to 4.5) in men and 2.6 (95% CI 1.9 to 3.5) in women with one or more sick-leave spells >7 days compared with those with no sick leave. The strongest predictor of DP was sick leave with a psychiatric diagnosis, HR 7.6 (95% CI 5.2 to 10.9) for men and 4.1 (95% CI 2.9 to 5.9) for women. Corresponding HRs for sick leave due to circulatory diagnoses in men and women were 5.6 (95% CI 3.7 to 8.6) and 3.1 (95% CI 1.8 to 5.3), for respiratory diagnoses 3.9 (95% CI 2.6 to 5.8) and 2.6 (95% CI 1.7 to 4.0), and musculoskeletal diagnoses 4.6 (95% CI 3.4 to 6.4) and 3.3 (95% CI 2.2 to 4.8), respectively.
  
  
  CONCLUSIONS
  Sick leave with a psychiatric diagnosis is a major risk factor for subsequent DP, especially among men. Sick leave due to musculoskeletal or circulatory disorders was also a strong predictor of DP. Diagnosis-specific sick leave should be recognised as an early risk marker for future exclusion from the labour market.
authors: Kristina Alexanderson, Division of Insurance Medicine, Department of Clinical Neuroscience, Berzelius väg 3, Karolinska Institutet, SE-171 77 Stockholm, Sweden. kristina.alexanderson@ki.se
authors: K
authors: K
authors: Alexanderson
authors: M
authors: M
authors: Kivimäki
authors: J E
authors: JE
authors: Ferrie
authors: H
authors: H
authors: Westerlund
authors: J
authors: J
authors: Vahtera
authors: A
authors: A
authors: Singh-Manoux
authors: M
authors: M
authors: Melchior
authors: M
authors: M
authors: Zins
authors: M
authors: M
authors: Goldberg
authors: J
authors: J
authors: Head
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018868:Insurance, Disability; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018582:Sick Leave