Social differentials in health-related non-employment and poverty : studies on consequences of limiting longstanding illness, musculoskeletal and mental disorders

The overall aim of the thesis is to increase knowledge on social differentials in employment and income consequences among persons with chronic disease. The studies were conducted in Sweden and different policy context during the first decade of the 2000s.

In Study I, cross-sectional survey data were used to compare relative poverty among persons with limiting longstanding illness (LLSI), with and without employment, and healthy employed persons in Sweden, Denmark and the United Kingdom (UK) in 2005 and 2010. Higher rates of relative poverty and risks of relative poverty were found among non- employed persons with LLSI, and most pronounced in the UK. In Sweden relative poverty increased considerably among non-employed persons with LLSI compared to other groups over time indicating an income polarisation most pronounced among men.

In the 5-year follow-up studies, register data from Stockholm County were used to analyse employment consequences following a first time diagnosis of musculoskeletal disorders (MSDs) in 2001 (Study II) and mood and anxiety disorders in 2005 (Study III) among persons employed at baseline, and compare to the general population. Associations between sociodemographic factors and the outcome measures among persons with a disorder were analysed. In Study II, persons with MSDs had a greater drop in employment, especially women with low education. Lower education and being foreign born was associated with an increased risk of non-employment and being granted disability pension for both men and women with MSDs. In Study III, persons with mood and anxiety disorders had higher rates of losing employment compared to the general population, and women had higher rates of not being re-employed. Increased risk of losing employment was found among men with lower income and foreign born men, and among women in the lower educational groups. Low education was associated with an increased risk of not being re-employed among women.

In Study IV, register data from Stockholm County were used to compare employment and income conditions at baseline and over 4 to 5 years between persons with a first time diagnosis of non-affective psychosis in 2005/06 and the general population. Associations between sociodemographic factors, employment status and relative poverty were analysed. Persons with non-affective psychosis had adverse employment and income conditions already prior to diagnosis. Non-employment rates remained high while decreasing in the general population. Disability pension rates doubled and social assistance rates remain high, especially among women with low education and foreign born women. Non-employment was associated with an increased risk of relative poverty as well as being foreign born among women. Disability pension seemed to alleviate the adverse income consequences among persons with non-affective psychosis.

This thesis found adverse employment and income consequences for persons with chronic disease, and social differentials in these. A combination of having chronic disease with impaired work ability, low education and being foreign born may be particularly detrimental to employment chances.

List of scientific papers

I. Falk J, Bruce D, Burström B, Thielen K, Whitehead M, Nylén L: Trends in poverty risks among people with and without limiting-longstanding illness by employment status in Sweden, Denmark, and the United Kingdom during the current economic recession – a comparative study. BMC Public Health 2013 13:925.
https://doi.org/10.1186/1471-2458-13-925

II. Falk J, Burström B, Nylén L. Social differentials in non-employment following hospital admission for musculoskeletal disorders in Sweden, 2001- 2006. Int J Health Serv. 2014, 44(1):155-68.
https://doi.org/10.2190/HS.44.1.i

III. Falk J, Burström B, Dalman C, Jörgensen L, Bruce D, Nylén L: Social differentials in employment consequences after a first time diagnosis of mood and anxiety disorders – a five-year follow-up study in Stockholm County. [Manuscript]

IV. Falk J, Burström B, Dalman C, Jörgensen L, Bruce D, Nylén L: Employment and income among first time cases diagnosed with non-affective psychosis in Stockholm, Sweden – A follow-up study 2004/2005-2010. [Submitted]