Gender differences in disability after sickness absence with musculoskeletal disorders: five-year prospective study of 37,942 women and 26,307 men

<p>Abstract</p> <p>Background</p> <p>Gender 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).</p> <p>Methods</p> <p>Prospective 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.</p> <p>Results</p> <p>The 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.</p> <p>Conclusions</p> <p>Women 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.</p

Self-assessment of health before and after a myocardial infarction

Self-evaluated health represents an important aspect of quality of life that may influence the rehabilitation process after a major illness. However, health is a multi-dimensional concept and relatively little is known about the determinants of, and the interrelationships between the separate aspects of health. In a prospective longitudinal study of myocaridal infarction (MI) patients, two indices of self-evaluated health, maximal physical ability (MPA) and perceived global health (PGH), were used. On the average, both ratings were clearly reduced compared with pre-MI levels even as long as 3-5 yr after the MI. Females and older patients indicated lower MPA before and after the MI, whereas PGH was not related to any sociodemographic variable. The severity of the MI appeared to be of relatively limited importance for self-evaluated health. Heart-related symptoms before and after the MI were more strongly related to lower MPA, whereas non-cardiac health problems and psychological distress more clearly influenced PGH. However, initial illness perceptions were of some importance for both health perceptions. The data suggest that to some extent self-evaluated health can be influenced by educational or psychological support in order to faccilitate readaptation and recovery after a MI.myocardial infarction self-evaluated health quality of life rehabilitation