Abstract
BackgroundGender differences in the prevalence and occupational consequences of musculoskeletal disorders (MSDs) are consistently found in epidemiological studies. The study investigated whether gender differences also exist with respect to chronicity, measured as the rate of transition from sickness absence into permanent disability pension (DP).MethodsProspective national cohort study in Norway including all cases with a spell of sickness absence > eight weeks during 1997 certified with a MSD, 37,942 women and 26,307 men. The cohort was followed-up for five years with chronicity measured as granting of DP as the endpoint. The effect of gender was estimated in the full sample adjusting for sociodemographic factors and diagnostic distribution. Gender specific analyses were performed with the same explanatory variables. Finally, the gender difference was estimated for nine diagnostic subgroups.ResultsThe crude rate of DP was 22% for women and 18% for men. After adjusting for all sociodemographic variables, a slightly higher female risk of DP remained. However, additional adjustment for diagnostic distribution removed the gender difference completely. Having children and working full time decreased the DP risk for both genders, whereas low socioeconomic status increased the risk similarly. There was a different age effect as more women obtained a DP below the age of 50. Increased female risk of chronicity remained for myalgia/fibromyalgia, back disorders and "other/unspecified" after relevant adjustments, whereas men with neck disorders were at higher risk of chronicity.ConclusionsWomen with MSDs had a moderately increased risk of chronicity compared to men, when including MSDs with a traumatic background. Possible explanations are lower income, a higher proportion belonging to diagnostic subgroups with poor prognosis, and a younger age of chronicity among women. When all sociodemographic and diagnostic variables were adjusted for, no gender difference remained, except for some diagnostic subgroups.
Highlights
Gender differences in the prevalence and occupational consequences of musculoskeletal disorders (MSDs) are consistently found in epidemiological studies
When the full sample was analyzed together the risk or hazards ratio (HR) for obtaining disability pension (DP) related to female gender was 1.34 when adjusted only for age
Only after including the diagnostic distribution the gender difference was completely “removed”. In this final model the risk of DP according to diagnostic subgroups is presented after adjustment for all socio-demographic variables
Summary
Gender differences in the prevalence and occupational consequences of musculoskeletal disorders (MSDs) are consistently found in epidemiological studies. Musculoskeletal disorders (MSDs) affect a large proportion of the working population and their quality of life and contribute to increasing healthcare costs, lost work days and higher social insurance expenditures in most welfare states. One of the most worrying aspects of this “epidemic” is the high number of patients in working age that become permanently disabled and dependent of social insurance benefits because of MSD [1,2,3,4,5,6,7]. Studies of sickness absence (SA) and permanent work-disability might outline the functional consequences of MSDs when cause-specific information is present [16]. Within universal social insurance systems, like in Sweden and Norway, population-based studies are feasible, since most women have paid work [7,17,18,19,20]
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