Abstract
BackgroundChronic musculoskeletal pain affects over 20% of the adult population and is one of the most common reasons for sick leave in Sweden. The aim of this study was to investigate which demographic, health and psychosocial work environment factors are of importance for a lower risk of future work disability and unemployment among workers with low back pain (LBP) and/or neck shoulder pain (NSP), and if familial factors influence these associations.MethodsAll 5556 persons that reported having LBP and/or NSP in a web-based questionnaire study in 2004–2006 were included. They were followed up for work disability (sick leave > 90 days or disability pension), and unemployment (> 180 days in a year) until 31 December 2013. Hazard ratios (HR) with 95% confidence intervals were calculated using cox proportional hazard models of the whole sample, adjusting for covariates. In addition, co-twin analyses of outcome discordant twin pairs were conducted to assess the impact of familial confounding on the associations.ResultsBeing male, 19–28 years old, having higher education, only NSP, no history of depression or anxiety, good self-rated health, low job demands and high job control were associated with a lower risk of work disability (adjusted HR ranging between 0.29–0.85). No history of anxiety and depression and high job control was associated with a lower risk of unemployment (adjusted HR ranging from 0.53 and 0.67). Familial factors were found to affect the association between education and work disability, but none of the other associations investigated.ConclusionsAmong those with LBP or NSP, good health in terms of mental- and self-rated health, few pain sites, as well as good psychosocial working conditions seem to indicate a lower risk for work disability.
Highlights
We found that 13.7% had incident sick leave (> 90 days) or disability pension and 10.8% were unemployed for more than 90 days in a year during follow-up (Table 1)
Demographics Women had a higher risk of sick leave/disability pension compared to men (Table 2), for unemployment there were no significant sex difference (Table 3)
The youngest age group had lower risk of sick leave/ disability pension compared to the oldest age group (Table 2), the youngest age group had a higher risk of unemployment compared to the oldest age group (Table 3)
Summary
Chronic musculoskeletal pain affects over 20% of the adult population and is one of the most common reasons for sick leave in Sweden. In Sweden it is estimated that 5% of the population have back pain that prevents them from their normal daily activities [2] and back pain is one of the most common reasons for sick Among those with back pain, psychosocial and workrelated factors have been shown to affect the risk of sick. Having comorbidity of back pain and common mental disorders, such as depression and anxiety, increases the risk of disability pension 15–20 fold [9]. This is a cause of concern as in Europe, up to one third of persons with chronic pain conditions, most frequently back pain, have been diagnosed with depression [10, 11]. Previous research has pointed out the importance of considering employment as an outcome when studying back pain, and that other factors than pain related seem to influence the increased risk of unemployment among those with back pain such as depression [12, 13]
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