title: Sick-listing adherence: a register study of 1.4 million episodes of sickness benefit 2010-2013 in Sweden.
abstract: BACKGROUND
  This register study aims to increase the knowledge on how common it is that sickness benefit recipients are sick-listed for as long as their physician prescribes in their medical sickness certificate, i.e. sick-listing adherence, or wholly/partly bring return-to-work (RTW) forward, i.e. early RTW.
  
  
  METHODS
  The unit for analysis was an episode of 100% sickness benefit, commenced between 1 January 2010 and 31 December 2013. Completed episodes of sickness benefit and full or partial early RTW was analysed by comparing the prescribed length of sick leave in medical sickness certificates and benefit days disbursed by the sickness insurance system. Probability for a full and partial early RTW was estimated with hazard ratio (HR) using the Cox proportional hazard model.
  
  
  RESULTS
  In total, about 1.4 million episodes of sickness benefit (60% women) were included in the study. The overall sick-listing adherence was 84% for women and 82% for men during the first year of sick leave. Adherence varied between 82 and 87% among women and between 79 and 86% among men with regard to ICD-10 diagnosis chapter. The probability of an early RTW varied between diagnosis chapters, where mental disorders was associated with a lower probability of a full early RTW among women and men (HR 0.52 and HR 0.47) as well as a partial early RTW (HR 0.51 and HR 0.46). Younger age (16-29 years), high educational level and high income was associated with a higher probability of an early RTW, while older age (≥ 50 years), not native-born, low educational level, unemployment and parental leave were associated with a lower probability.
  
  
  CONCLUSIONS
  The study demonstrates that sick-listing adherence is relatively high. Probability of an early RTW differs with regard to diagnosis chapter, demographic, socioeconomic and labour market characteristics of the sickness benefit recipients. Interventions intended to improve the sick-listing process, and to affect the length and degree of sick leave in certain target groups, should include measures targeted at physicians' sick-listing practices. Policies and economic incentives aimed at promoting RTW need to focus on individuals' residual capacity for work.
authors.affiliation: Swedish Social Insurance Inspectorate, Box 202, SE-101 24, Stockholm, Sweden. ola.leijon@inspsf.se.|Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden. ola.leijon@inspsf.se.
authors.forename: Ola
authors.initials: O
authors.lastname: Leijon
authors.affiliation: Swedish Social Insurance Inspectorate, Box 202, SE-101 24, Stockholm, Sweden. malin.josephson@inspsf.se.|Section of Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden. malin.josephson@inspsf.se.
authors.forename: Malin
authors.initials: M
authors.lastname: Josephson
authors.affiliation: Swedish Social Insurance Inspectorate, Box 202, SE-101 24, Stockholm, Sweden. niklas.osterlund@inspsf.se.
authors.forename: Niklas
authors.initials: N
authors.lastname: Österlund
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D016016:Proportional Hazards Models; D062707:Return to Work / Q000706:statistics & numerical data*; D012737:Sex Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013548:Sweden; D013997:Time Factors; D055815:Young Adult