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

Abstract

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.