Sequences of sickness absence, disability pension and unemployment four years before and five years after musculoskeletal diagnosis among Swedish twins.

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To investigate sustainable working life via identification of time-related sequences of sickness absence (SA), disability pension (DP) and unemployment four years before and five years after the first musculoskeletal diagnosis in a Swedish twin cohort. Other aims were to account for familial confounding and to examine the associations between sequences and sociodemographic characteristics. Among 28,474 Swedish twins, the patterns of interruptions of working life four years before the first M00-M99 diagnosis (MSD) and five years after MSD diagnosis were investigated with a sequence analysis in a seven-element state space consisting of sustainable working life, unemployment >90 days, moderate SA/DP (30-179 days), almost full year of SA/DP (180-365 days), full year of SA/DP (⩾ 365 days), death, and old-age pension. The six-cluster solution had the best fit to the data. Five clusters had varying patterns of interruptions of sustainable working life (Clusters 2-6, n = 537-1949 with SA/DP, unemployment, but also accounting death and old-age pension) compared with the largest cluster with primarily sustainable working life (n = 23,316). Age, sex and familial factors affected the likelihood of belonging to the clusters with SA/DP. Most Swedish twins with or without MSD diagnosis have a sustainable working life, although MSD was both prevalent and a strong risk factor for belonging to the clusters with SA/DP. Thus, early prevention of MSD and prevention of recurrent or long sickness absences due to any cause would be merited while paying special attention to women also.