Childbirth, hospitalisation and sickness absence: a study of female twins

Sickness absence and disability pension three years before and seven years after first childbirth: A Swedish population-based cohort study

AIMS

There is a widely held belief, in Sweden and internationally, that women with children are more likely to be on sickness absence (SA) than their nulliparous counterparts. However, empirical findings in the field are limited and inconsistent. We aimed to explore initially nulliparous women's patterns of SA and disability pension (DP) three years before and seven years after 2009, by later parity.

METHODS

We conducted a longitudinal cohort study of nulliparous women in Sweden on 31 December 2009 (N=426,918). We compared crude and standardized numbers of SA/DP net days in the three years before (Y-3 to Y-1) and the seven years (Y+1 to Y+7) after the date of the first birth in 2010 or 2 July 2010 in the following three groups: (1) women with no childbirth during the seven-year follow-up and an additional nine months (i.e. 7.8 years), (2) women with a first childbirth in 2010 and no additional childbirth during the next 7.8 years, and (3) women with their first childbirth in 2010 and minimum one more during the next 7.8 years.

RESULTS

Women remaining nulliparous had consistently more standardized mean SA/DP days than women giving birth. Compared with women with one birth, women with several births had similar mean numbers of standardized SA/DP days during Y-3 and Y-2, more during Y+1 to Y+3 and fewer during Y+4 to Y+7.

CONCLUSIONS

In contrast to the widely held societal belief, we found that in all years women who gave birth had fewer SA/DP days than those remaining nulliparous.

Women's Health and Working Life: A Scoping Review

Women's health matters for participation in working life. The objective of this study was to explore female physiology in a work-life context and to investigate possible associations between women's health, sickness absence and work ability. A scoping review was conducted to develop a systematic overview of the current research and to identify knowledge gaps. The search strategy was developed through a population, concept and context (PCC) model, and three areas of women's health were identified for investigation in the context of work. A total of 5798 articles were screened by title and abstract and 274 articles were screened by full text; 130 articles were included in the review. The material included research from 19 countries; the majority of the studies used quantitative methods. The results showed an impact on the occupational setting and an association between sickness absence, work ability and all three areas of women's health, but a holistic and overall perspective on female biology in the work context is missing. This review calls for more knowledge on health and work and possible gender differences in this regard. Women's health and working life involve a complex connection that has the potential to develop new knowledge.

Sickness absence in relation to first childbirth in nulliparous women, employed in the education and care branches in the public or private sectors: A Swedish longitudinal cohort study

Background

Pregnancy and childbirth entail increased risks of sickness absence (SA). Many women work in education and care, two branches characterised by high SA levels; it is not known if the link between childbirth and SA in these branches differs between private and public sectors. We examined SA and disability pension (DP) in relation to childbirth among women working in the education and care branches, and if these patterns differed between public and private sectors.

Methods

We performed a Swedish register-based cohort study. Study participants were nulliparous women living in Sweden in December 2004 and employed in education or care (n = 120,013). We compared SA/DP in the three years before and after 2005 among women who had no childbirth during follow-up (B0), had one childbirth in 2005 and no more (B1), and had one childbirth in 2005 and at least one more during follow-up (B1+). Analyses were performed for all and by public or private sector.

Results

Of all studied women, 70% worked in the public sector. Women in B1 and B1+ had, except for the year before childbirth, comparable or lower mean combined SA/DP days than women in the B0 group; women in the B1+ group had, except for the year before childbirth, the lowest mean level of SA/DP. We observed no substantial differences in these patterns between public and private sectors.

Conclusions

Patterns of SA/DP among nulliparous women who did or did not give birth did not differ substantially between public and private sectors among women in the educational and care branches.

Childbirth, morbidity, sickness absence and disability pension: a population-based longitudinal cohort study in Sweden

OBJECTIVE

To investigate associations of morbidity with subsequent sickness absence (SA) and disability pension (DP) among initially nulliparous women with no, one or several childbirths during follow-up.

DESIGN

Longitudinal register-based cohort study.

SETTING

Sweden.

PARTICIPANTS

Nulliparous women, aged 18 to 39 years and living in Sweden on 31 December 2004 and the three preceding years (n=492 504).

OUTCOME MEASURES

Annual mean DP and SA days (in SA spells >14 days) in the 3 years before and after inclusion date in 2005.

METHODS

Women were categorised into three groups: no childbirth in 2005 nor during the follow-up, first childbirth in 2005 but not during follow-up, and having first childbirth in 2005 and at least one more during follow-up. Microdata were obtained for 3 years before and 3 years after inclusion regarding SA, DP, mortality and morbidity (ie, hospitalisation and specialised outpatient healthcare, also excluding healthcare for pregnancy, childbirth and puerperium). HRs and 95% CIs for SA and DP in year 2 and 3 after childbirth were estimated by Cox regression; excluding those on DP at inclusion.

RESULTS

After controlling for study participants' prior morbidity and sociodemographic characteristics, women with one childbirth had a lower risk of SA and DP than those who remained nulliparous, while women with more than one childbirth had the lowest DP risk. Morbidity after inclusion that was not related to pregnancy, childbirth or the puerperium was associated with a higher risk of future SA and DP, regardless of childbirth group. Furthermore, morbidity both before and after childbirth showed a strong association with SA and DP (HR range: 2.54 to 13.12).

CONCLUSION

We found a strong positive association between morbidity and both SA and DP among women, regardless of childbirth status. Those who gave birth had lower future SA and DP risk than those who did not.

Sickness absence and disability pension in relation to first childbirth and in nulliparous women according to occupational groups: a cohort study of 492,504 women in Sweden

Background

Childbirth has been suggested to increase sickness absence (SA) and disability pension (DP). This may vary by occupation; however, knowledge in this field remains limited. We explored SA and DP in the years before and after childbirth among women in four occupational groups and those without occupation.

Methods

We studied nulliparous women aged 18–39 years, living in Sweden on December 31, 2004 (n = 492,504). Women were categorized into five skill-level based occupational groups and three childbirth groups; no childbirths within 3 years (B0), first childbirth in 2005 with no childbirth within 3 years (B1), and first childbirth in 2005 with at least one more birth within 3 years (B1+). We compared crude and standardized annual mean SA (in spells> 14 days) and DP net days in the 3 years before and 3 years after first childbirth date.

Results

Women in the highest skill level occupations and managers, had less mean SA/DP days during most study years than women in the lowest skill level occupations group. In B1 and B1+, absolute differences in mean SA/DP, particularly in SA, among occupational groups were highest during the year before childbirth. DP was most common in B0, regardless of group and year.

Conclusions

We found that women’s mean SA/DP days before and after first childbirth was higher with decreasing skill-level of the occupational group and these differences were most pronounced in the year before childbirth. DP was most common among women not giving birth, regardless of occupational group.

Sickness absence and disability pension before and after first childbirth and in nulliparous women by numerical gender segregation of occupations: A Swedish population-based longitudinal cohort study

Background

Pregnancy is associated with a temporarily increased sickness absence (SA) risk. This association may vary by the level of occupational gender segregation; however, knowledge in this area is limited. We studied whether trends in SA and disability pension (DP) in the years before and after first childbirth among women with one or more childbirths and with no childbirth during the study period varied by occupational gender segregation.

Methods

We conducted a population-based register study involving nulliparous women aged 18–39 years, living in Sweden in 2002–2004 (n = 364,411). We classified participants in three childbirth groups as: (1) no childbirth in 2005 or in the next 3.75 years, (2) first childbirth in 2005 and no births in the subsequent 3.75 years, and (3) first childbirth in 2005 and at least one additional birth in the subsequent 3.75 years, and into five categories based on the rate of women in their occupations. We compared crude and standardized mean annual net SA and DP days during the three years before and the three years after 2005 across the childbirth and occupational gender segregation categories.

Results

Women in extremely male-dominated occupations had or tended to have somewhat higher mean combined SA and DP days than women in gender-integrated occupations; women in female-dominated occupations had comparable or tended to have slightly higher mean SA and DP days than women in gender-integrated occupations. Except for the year before the first childbirth, women who gave birth, especially those who gave several births, had generally a lower mean combined standardized SA and DP days than nulliparous women. We found no substantial differences in trends in SA and DP around the time of first childbirth according to occupational gender segregation.

Conclusions

Trends in SA and DP around the time of first childbirth did not vary by occupational gender segregation.

Sickness absence and disability pension before and after first childbirth and in nulliparous women: longitudinal analyses of three cohorts in Sweden

OBJECTIVE

Childbirth is suggested to be associated with elevated levels of sickness absence (SA) and disability pension (DP). However, detailed knowledge about SA/DP patterns around childbirth is lacking. We aimed to compare SA/DP across different time periods among women according to their childbirth status.

DESIGN

Register-based longitudinal cohort study.

SETTING

Sweden.

PARTICIPANTS

Three population-based cohorts of nulliparous women aged 18-39 years, living in Sweden 31 December 1994, 1999 or 2004 (nearly 500 000/cohort).

PRIMARY AND SECONDARY OUTCOME MEASURES

Sum of SA >14 and DP net days/year.

METHODS

We compared crude and standardised mean SA and DP days/year during the 3 years preceding and the 3 years after first childbirth date (Y_-3 to Y₊₃), among women having (1) their first and only birth during the subsequent 3 years (B1), (2) their first birth and at least another delivery (B1+), and (3) no childbirths during follow-up (B0).

RESULTS

Despite an increase in SA in the year preceding the first childbirth, women in the B1 group, and especially in B1+, tended to have fewer SA/DP days throughout the years than women in the B0 group. For cohort 2005, the mean SA/DP days/year (95% CIs) in the B0, B1 and B1+ groups were for Y_-3: 25.3 (24.9-25.7), 14.5 (13.6-15.5) and 8.5 (7.9-9.2); Y_-2: 27.5 (27.1-27.9), 16.6 (15.5-17.6) and 9.6 (8.9-10.4); Y_-1: 29.2 (28.8-29.6), 31.4 (30.2-32.6) and 22.0 (21.2-22.9); Y₊₁: 30.2 (29.8-30.7), 11.2 (10.4-12.1) and 5.5 (5.0-6.1); Y₊₂: 31.7 (31.3-32.1), 15.3 (14.2-16.3) and 10.9 (10.3-11.6); Y₊₃: 32.3 (31.9-32.7), 18.1 (17.0-19.3) and 12.4 (11.7-13.0), respectively. These patterns were the same in all three cohorts.

CONCLUSIONS

Women with more than one childbirth had fewer SA/DP days/year compared with women with one childbirth or with no births. Women who did not give birth had markedly more DP days than those giving birth, suggesting a health selection into childbirth.

The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research

Education, income, and occupation are factors known to affect health and disease. In this review we describe the Swedish Longitudinal Integrated Database for Health Insurance and Labour Market Studies (LISA, Longitudinell Integrationsdatabas för Sjukförsäkrings- och Arbetsmarknadsstudier). LISA covers the adult Swedish population aged ≥ 16 years registered on December 31 each year since 1990 (since 2010 individuals aged ≥ 15 years). The database was launched in response to rising levels of sick leave in the country. Participation in Swedish government-administered registers such as LISA is compulsory, and hence selection bias is minimized. The LISA database allows researchers to identify individuals who do not work because of injury, disease, or rehabilitation. It contains data on sick leave and disability pension based on calendar year. LISA also includes information on unemployment benefits, disposable income, social welfare payments, civil status, and migration. During 2000–2017, an average of 97,000 individuals immigrated to Sweden each year. This corresponds to about 1% of the Swedish population (10 million people in 2017). Data on occupation have a completeness of 95%. Income data consist primarily of income from employment, capital, and allowances, including parental allowance. In Sweden, work force participation is around 80% (2017: overall: 79.1%; men 80.3% and women 77.9%). Education data are available in > 98% of all individuals aged 25–64 years, with an estimated accuracy for highest attained level of education of 85%. Some information on civil status, income, education, and employment before 1990 can be obtained through the Population and Housing Census data (FoB, Folk- och bostadsräkningen).

A follow-up of the introduction of a maximum entitlement period for receiving sickness benefits in Sweden: A nationwide register-based study

In 2008, Sweden introduced a policy change to limit the number of days for sickness benefits (SB). This study aimed to elucidate the characteristics of those who reached the maximum entitlement period for receiving sickness benefits (MEPSB) and their future main source of income. Methods: All 5,309,759 individuals, aged 20-63 and residents of Sweden in 2009 were followed from July 2008 to July 2010 regarding SB-days and date of MEPSB and then categorised into three groups: I) no SB-days, II) ongoing SB-days, and III) MEPSB. Mean numbers of SB-days 2.5 years before and 2 years after the policy change and main source of income in 2011 were assessed. Associations between sociodemographic factors, occupation and paid work as main source of income were estimated by odds ratio (OR). Results: A total of 0.7% reached MEPSB in 2010. The mean numbers of SB-days before and after the policy change were higher in the MEPSB group than in the other two groups. In the MEPSB group, 14% had their main source of income from paid work in 2011; this was more common among women born in Sweden (OR = 1.29), people living with a partner and children (women OR = 1.29; men OR = 1.48), and those with occupations representing high educational levels. Conclusions: One out of seven individuals with MEPSB in 2010 had their main source of income from paid work in 2011, although they had a long-term SB before and after the policy change. Further research is warranted to address the long-term effects of this policy change.

Days of sick leave and inpatient care at the time of pregnancy and childbirth in relation to maternal age

AIMS

To explore whether older women differ from younger women with respect to sick leave and inpatient care at the time around their first pregnancy and delivery.

METHODS

This was a descriptive population-based cohort study. The study population included all 236,176 nulliparous women registered as living in Sweden who gave birth to their first singleton infant in 2006-2010. Data from nationwide Swedish registers were used. Maternal age was categorized in five-year intervals. Time was calculated in years with the delivery date as the starting point, from two years before and up to three years after delivery. Descriptive statistics were used to calculate mean values and ANOVA tables were used to obtain the 95% confidence intervals of the means. Restriction was used to reduce potential confounding.

RESULTS

Women aged ⩾35 years had a higher annual mean number of sick leave days from two years before to one year after their delivery date compared with younger women. The range for all age categories in the year before the delivery date, including pregnancy, was 15.3-37.4 mean sick leave days. The mean number of inpatient days increased with each age category during the year after the date of delivery in the range 1.4-4.3 days.

CONCLUSIONS

This first explorative study indicates the need for more knowledge on morbidity among older primiparous women. They had a higher number of days with sick leave and hospitalization in the year before and after their delivery date. This might reflect higher health risks during pregnancy and childbirth among older women; however, social factors and reverse causation might also be influential.

Occurrence of sickness absence and disability pension in relation to childbirth: A 16-year follow-up study of 6323 Swedish twins

BACKGROUND

Pregnancy, delivery, and the postpartum period may imply morbidity leading to work incapacity; however, this is seldom studied. This study aimed to compare twin sisters giving or not giving birth regarding occurrence of sickness absence (SA) and disability pension (DP).

METHODS

This population-based cohort study included all 6323 female twins born in Sweden 1959-1990, using register data for 1994-2010 about SA and DP. Average number of SA/DP days/year was calculated in relation to the year of the first delivery, or, if not giving birth, the year when the twin sister gave birth. Twin pairs discordant for delivery were used to investigate the importance of genetic and environmental factors for occurrence of SA and DP.

RESULTS

In all, 52% had a first delivery during 1994-2010. Except for the year of delivery, the average number of SA days/year was similar when comparing women who gave birth to those who did not, while number of DP days was significantly higher in women who did not give birth. Differences between the groups seem attributable to genetic factors. Women who delivered once had higher levels of SA and DP than those who had several deliveries. DP with mental diagnoses was more common among women who had not delivered whereas DP with musculoskeletal diagnoses occurred more often among women who delivered.

CONCLUSIONS

Levels of SA were similar among women who gave birth and who did not. Women not giving birth had significantly higher levels of DP, indicating health selections into childbirth.