title: Morbidity and suicide mortality following sick leave in relation to changes of social insurance regulations in Sweden.
abstract: Stricter regulations including time limits for sick leave have been introduced in Sweden in 2008, which might have resulted in higher morbidity in those on longer sick-leave spells after the introduction. This study aimed to examine (i) the association between all-cause and diagnosis-specific sickness absence and sick-leave duration with subsequent morbidity and suicide mortality and (ii) differences in socio-demographics and morbidity in individuals on sickness absence regarding changes of social insurance regulations.
  
  
  
  A population-based prospective study was conducted of two cohorts of individuals who lived in Sweden, aged between 20 and 64 years at 31 December 2005 (n = 4 477 678) and at 31 December 2008 (n = 4 500 400), respectively. Each of the cohorts was followed regarding inpatient healthcare and suicide. Hazard ratios (HR) and 95% confidence intervals were estimated by Cox regression models.
  
  
  
  In the multivariate analyses, all-cause and diagnosis-specific sickness absence and sick-leave duration showed higher HRs for inpatient care and suicide in both cohorts (range of HR:1.10-2.59). HRs of inpatient care and suicide among individuals with mental sickness absence 2009 were reduced more after controlling for morbidity-related covariates, than such sickness absence in 2006. Individuals with mental and somatic sickness absence and sickness absence > 180 days in 2009 had higher HRs of somatic inpatient care than those on sickness absence in 2006.
  
  
  
  Diagnosis-specific sickness absence and long-term sickness absence in 2009 might be associated with more severe morbidity or work incapacity than in 2006 due to the stricter regulations.
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden mo.wang@ki.se.
authors.forename: Mo
authors.initials: M
authors.lastname: Wang
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
authors.affiliation: Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Runeson
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ellenor
authors.initials: E
authors.lastname: Mittendorfer-Rutz
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies; D012723:Sex; D018582:Sick Leave / Q000706:statistics & numerical data*; D012943:Social Security / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult