Sickness absence and disability pension among individuals injured in a bicycle crash

Bicyclists are the road user group with the highest number of severe injuries, yet little is known about the impact of such injuries on sickness absence (SA) and disability pension (DP). Therefore, the aim was to increase the knowledge on factors associated with SA and DP among individuals of working ages, injured in a bicycle crash. Two register-based studies were conducted, including all individuals of working age and living in Sweden, who in 2010 had in- or specialized out-patient healthcare for injuries sustained in a new bicycle crash. The individuals where categorized by age, sex, crash type, type of injury, and injured body region. Study I, analyzed SA and DP at the time of the crash, the following groups were used: No new SA, Ongoing SA or full-time DP, and New SA spells >14 days. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for New SA spells >14 days, among those at risk of SA. In Study II, weekly SA/DP data for one year before and through three years after the crash date were used in sequence and cluster analyses. Multinomial logistic regression was used to estimate OR and 95% CI for factors associated with each sequence cluster. In Study I, a total of 7643 individuals aged 16-64 years, had specialized healthcare due to a new bicycle crash in 2010, of which the majority (85%) were single-bicycle crashes. Among all, 10% were already on SA or full-time DP at the time of the crash, while 18% had a new SA spell. The most common types of injuries were external injuries (38%) and fractures (37%). The body region most frequently injured was the upper extremities (43%). The OR for New SA was higher for women compared to men (OR 1.40; 95% CI 1.23-1.58) and for higher ages compared to younger (OR 2.50; 2.02-3.09, for ages: 55-64 vs. 25-34). Fractures and internal injuries were the type of injury with the highest OR for New SA compared with external injuries (8.04; 6.62-9.77 and 7.34; 3.67-14.66, respectively). The body regions with the highest ORs for New SA, compared with injuries to the ‘head, face, and neck, not traumatic brain injury’ were injuries to the ‘spine and back’ (3.53; 2.24-5.55) and ‘traumatic brain injury, not concussion’ (2.72; 1.19-6.22). In Study II, including 6353 individuals aged 18-59 years, injured in a bicycle crash 2010, and alive and living in Sweden during the whole follow-up, seven clusters were identified and named: "No SA or DP" (58.2% of all), "Low SA or DP" (7.4%), "Immediate SA" (20.3%), "Episodic SA" (5.9%), "Long-term SA" (1.7%), "Ongoing part-time DP" (1.7%), and "Ongoing full-time DP" (4.8%). Compared to the reference cluster, "No SA or DP", all other clusters were associated with a higher proportion of women, individuals of older age, and individuals who had only high school education (compared to university/college). Further, inpatient healthcare had high OR for all clusters but "Low SA or DP" compared with the cluster “No SA or DP”. There were three clusters with different levels of SA. The clusters "Immediate SA" and "Episodic SA" had higher OR for fractures and injuries to the ‘spine and back’, the clusters "Episodic SA" and “Long-term SA” had higher OR for ‘traumatic brain injury, not concussion’, and the cluster “Long-term SA” had also higher OR for collisions with motor vehicles compared with the cluster “No SA or DP”. Bicycling is an important part of a sustainable transportation system, but is not risk-free. Among individuals of working age who in 2010 had incident in- or specialized out-patient healthcare for injuries sustained in a bicycle crash, 18% had a new SA spell in connection to the crash. Seven clusters of SA and DP sequences were identified displaying that sequence analysis enabled exploration of different characteristics across different patterns of SA and DP following a bicycle crash

Sickness absence and disability pension among injured bicyclists and pedestrians

Background: Active transportation such as walking and bicycling provides an opportunity for individuals to incorporate physical activity into daily life. It has a positive impact on public health and is an important aspect of a sustainable road transport system. However, it also involves some risks. Globally, about a fifth of all fatalities within the road transport system are represented by pedestrians, and bicyclists are the road user group with the highest number of severe injuries in the European Union. Being injured in a road traffic accident may affect the individuals’ work ability and lead to sickness absence (SA) and disability pension (DP). Still, knowledge is lacking on the short- and long-term consequences of road traffic injuries among bicyclists and pedestrians in terms of SA and DP. Therefore, the aim of this thesis was to generate broader and deeper knowledge of SA and DP after a road traffic accident among injured working aged bicyclists and pedestrians. Method: Five nationwide studies using Swedish register data of working-age individuals were conducted. Study I and Study II included all bicyclists injured in a road traffic accident in 2010. Study III and Study IV included all pedestrians injured in a road traffic accident (including fall accidents) in 2010 and 2014-2016, respectively. In Study I - Study IV SA and DP were analysed with logistic regression, sequence analysis, cluster analysis, and multinomial logistic regression. Study V included all working individuals injured in a road traffic accident (pedestrians, bicyclists, car occupants, and other road users) in 2015 and population-based matched references (matched on: sex, year of birth, level of education, country of birth, type of living area) without any traffic-related injury during 2014-2015. Mean SA and DP net days/year for each road traffic group and excess SA and DP net days/year compared with their matched references were calculated. Results: In Study I, 85% of the 7643 injured bicyclists were injured in a single-bicycle crash. Among all, 10% were already on SA or full-time DP, while 18% started a new SA spell (>14 days) in connection with the crash. Women and older individuals had higher OR for new SA. The injury types with the highest ORs for new SA were fractures (8.04; 6.62–9.77) and internal injuries (7.34; 3.67–14.66), compared with external injuries. For the injured bicyclists in Study II, seven clusters of SA and DP were identified: “No SA or DP” (58.2% of the cohort), “Low SA or DP” (7.4%), “Immediate SA” (20.3%), “Episodic SA” (5.9%), “Long-term SA” (1.7%), “Ongoing part-time DP” (1.7%), and “Ongoing full-time DP” (4.8%). Compared to the cluster “No SA or DP”, all other clusters had higher ORs for women and older age groups. The clusters “Immediate SA” and “Episodic SA” had higher ORs for fractures, whereas the cluster “Long-term SA” had higher ORs for traumatic brain injury, not including concussion (18.4; 2.2–155.2). In Study III, 75% of the 5576 injured pedestrians were injured in a fall accident, and half of the falls were related to snow and ice. Among the injured pedestrians, 18.3% were already on SA or full-time DP, and 20% started a new SA spell in connection with the accident. Older individuals had a higher OR for new SA. Fractures were the injury type with the highest OR for new SA when compared with the reference group external injuries (9.58; 7.39-12.43). The injured body region with the highest OR for new SA, was lower leg, ankle, foot, and other leg, compared with the reference group head, face, and neck (4.52; 2.78-7.36). For the injured pedestrians in Study IV, eight clusters of SA patterns were identified. The largest cluster was characterized by no SA or DP (46.7%), four clusters had different SA patterns due to injury diagnoses (immediate (17.9%), episodic (3.9%), later (3.2%), and combined with SA due to other diagnoses (7.0%)). Two clusters had SA due to other diagnoses (short-term (16.6%) and long-term (2.0%)) and one cluster mainly consisted of individuals with DP (2.7%). Compared to the cluster “No SA”, all other clusters were associated with older age, hospitalized at inclusion, and working in health & social care. The clusters “Immediate SA”, “Episodic SA” and “Both SA due to injury and other diagnoses” were also associated with sustaining a fracture. In Study V a third of the individuals injured in a road traffic accident were bicyclists, 31% car occupants, 16% pedestrians, and 19% were other road users (mostly motorcyclists and mopeds). Pedestrians and other road users were the road user groups with the highest mean number of SA days during the first year following the accident (51 and 49 days/year respectively). The matched references had between 8 and 13 SA days/year throughout the study period. The excess SA days/year was elevated for all road user groups the whole study period. Excess SA due to injury diagnoses was 15-35 days/year during the first year following the accident. Excess SA due to diagnoses other than injuries were about eight days/year for pedestrians and car occupants during the whole study period and about zero for the bicyclists. The excess DP was low, although it increased every year for pedestrians and for car occupants; for bicyclists no excess DP was observed. Conclusions: This thesis showed that both among injured bicyclists and pedestrians, about a fifth had new SA in connection with the accident. In addition, both groups had excess SA during the following years after the accident compared to their references. However, bicyclists’ excess SA and DP decreased faster after the accident than the pedestrians’. Fractures were associated with SA in connection with the accident for both pedestrians and bicyclists, and traumatic brain injury was associated with long-term SA for bicyclists

General practitioners' experiences with sickness certification: a comparison of survey data from Sweden and Norway

<p>Abstract</p> <p>Background</p> <p>In most countries with sickness insurance systems, general practitioners (GPs) play a key role in the sickness-absence process. Previous studies have indicated that GPs experience several tasks and situations related to sickness certification consultations as problematic. The fact that the organization of primary health care and social insurance systems differ between countries may influence both GPs' experiences and certification. The aim of the present study was to gain more knowledge of GPs' experiences of sickness certification, by comparing data from Sweden and Norway, regarding frequencies and aspects of sickness certification found to be problematic.</p> <p>Methods</p> <p>Statistical analyses of cross-sectional survey data of sickness certification by GPs in Sweden and Norway. In Sweden, all GPs were included, with 3949 (60.6%) responding. In Norway, a representative sample of GPs was included, with 221 (66.5%) responding.</p> <p>Results</p> <p>Most GPs reported having consultations involving sickness certification at least once a week; 95% of the GPs in Sweden and 99% of the GPs in Norway. A majority found such tasks problematic; 60% of the GPs in Sweden and 53% in Norway. In a logistic regression, having a higher frequency of sickness certification consultations was associated with a higher risk of experiencing them as problematic, in both countries. A higher rate of GPs in Sweden than in Norway reported meeting patients wanting a sickness certification without a medical reason. GPs in Sweden found it more problematic to discuss the advantages and disadvantages of sick leave with patients and to issue a prolongation of a sick-leave period initiated by another physician. GPs in Norway more often worried that patients would go to another physician if they did not issue a certificate, and a higher proportion of Norwegian GPs found it problematic to handle situations where they and their patient disagreed on the need for sick leave.</p> <p>Conclusions</p> <p>The study confirms that many GPs experience sickness absence consultations as problematic. However, there were differences between the two countries in GPs' experiences, which may be linked to differences in social security regulations and the organization of GP services. Possible causes and consequences of national differences should be addressed in future studies.</p

Life satisfaction of women of working age shortly after breast cancer surgery

PURPOSE: To explore, among women of working age, satisfaction with life as a whole and with different life domains, and its associations with social and health variables, shortly after breast cancer surgery. METHODS: This cross-sectional study included 605 women, aged 20–63 years, who had had breast cancer surgery with no distant metastasis, pre-surgical chemotherapy, or previous breast cancer. Associations between LiSat-11 and demographic and social factors as well as health- and treatment-related variables were analysed by multivariable logistic regression. RESULTS: Compared with Swedish reference levels, the women were, after breast cancer surgery, less satisfied with life, particularly sexual life. Women working shortly after breast cancer surgery were more often satisfied with life in provision domains compared with the reference population. Although most included variables showed associations with satisfaction, after adjustment for all significantly associated variables, only six variables—having children, being in work, having emotional and informational social support, and having good physical and emotional functioning—were positively associated with satisfaction with life as a whole. The odds ratios for satisfaction were higher in most life domains if the woman had social support and good emotional and cognitive functioning. CONCLUSIONS: One month after breast cancer surgery, satisfaction with different life domains was associated primarily with social support and health-related functioning. However, this soon after surgery, treatment-related variables showed no significant associations with life satisfaction. These results are useful for planning interventions to enhance e.g. social support and emotional as well as cognitive functioning

Sickness absence and disability pension after road traffic accidents, a nationwide register-based study comparing different road user groups with matched references

Background: Being injured in a road traffic accident may affect individuals’ functional ability and in turn lead to sickness absence (SA) and disability pension (DP). Knowledge regarding long-term consequences in terms of SA and DP following a road traffic accident is lacking, especially comparing different groups of road users and compared to the general population. The aim was to estimate excess diagnosis-specific SA and DP among individuals of different road user groups injured in a road traffic accident compared to matched references without such injury. Methods: A nationwide register-based study, including all working individuals aged 20–59 years and living in Sweden who in 2015 had in- or specialized outpatient healthcare after a new traffic-related injury (n = 20 177) and population-based matched references (matched on: sex, age, level of education, country of birth, living in cities) without any traffic-related injury during 2014–2015 (n = 100 885). Diagnosis-specific (injury and other diagnoses) SA and DP were assessed during 5 years: 1 year before and 4 years following the accident. Mean SA and DP net days/year for each road user group and mean differences of (excess) SA and DP net days/year compared with their matched references were calculated with independent t-tests with bootstrapped 95% confidence intervals (CIs). Results: A third of all injured road users were bicyclists, 31% were car occupants, 16% were pedestrians (including fall accidents), and 19% were other and unspecified accidents. Pedestrians and other road users were the groups with the highest mean number of SA days during the first year following the accident (51 and 49 days/year respectively). The matched references had between 8 and 13 SA days/year throughout the study period. The excess SA days/year were elevated for all road user groups all five studied years. Excess SA due to injury diagnoses was 15–35 days/year during the first year following the accident. Excess SA due to diagnoses other than injuries were about eight days/year during the whole study period for pedestrians and car occupants and about zero for the bicyclists. The excess DP was low, although it increased every year after the accident for pedestrians and car occupants; for bicyclists no excess DP was seen. Conclusion: Higher levels of SA due to injury diagnoses were seen among all road user groups during the first year after the accident compared to their references. Pedestrians and car occupants had more excess SA due to other diagnoses and more excess DP four years after the accident than bicyclists and other road users

Psychiatric diagnoses and risk of suicidal behaviour in young disability pensioners : prospective cohort studies of all 19-23 year olds in Sweden in 1995, 2000, and 2005, respectively.

OBJECTIVE: Increasing rates of disability pension (DP) have been observed among young adults. We studied specific psychiatric DP diagnoses and subsequent risk of suicidal behaviour in a series of three cohorts of young adult in Sweden. METHOD: In a nationwide register study, we included all young adults who in 1995, 2000, and 2005, respectively, were 19-23 years old and lived in Sweden (n≈500,000 per cohort). Rates of DP and specific psychiatric DP diagnoses were recorded in each cohort. Hazard ratios (HRs) and 95% confidence intervals (CIs) for suicidal behaviour during the following five years, with the corresponding age group as reference, were calculated by Cox proportional hazard regression, adjusted for demographic variables and previous own and parental suicidal behaviour. RESULTS: The overall proportion with DP in this age group increased from 0.92% in 1995 to 2.29% in 2005, with particularly large increases in psychiatric diagnoses such as hyperkinetic disorders, pervasive developmental disorders, and depression/anxiety. The overall proportion of young disability pensioners attempting suicide during the five-year follow-up increased from 2.21% in the 1995 cohort to 3.81% in the 2005 cohort. Within most psychiatric DP diagnoses, the risk of attempted suicide did not change significantly over time, whereas suicide attempts increased in the reference group. Accordingly, the HRs for suicide attempt decreased in some psychiatric DP diagnoses. The highest adjusted HRs were observed for depression/anxiety (16.41; CI: 9.06 to 29.74) and schizophrenia (9.37; 6.13 to 14.31) in the 1995 cohort. The rate of suicide among young disability pensioners during follow-up ranged from 0.19% in 1995 to 0.37% in 2005, mainly occurring in individuals with psychiatric diagnoses. CONCLUSION: Suicidal behaviour has become more prevalent among young disability pensioners, which co-occurred with an increased tendency to grant DP in psychiatric diagnoses with a known high risk of suicidal behaviour. Preventive measures are warranted

Sjukskrivningsmönster före och efter att ha drabbats av lätt hjärnskada vid en vägtrafikolycka

Rapporten är framtagen med ekonomiskt bidrag från Trafikverket, Skyltfonden. Ståndpunkter och slutsatser i rapporten reflekterar författaren och överensstämmer inte med nödvändighet med Trafikverkets ståndpunkter och slutsatser inom rapportens ämnesområden. Studien, för vilket medel beviljats, syftar till att kartlägga sjukfrånvaro före och efter en vägtrafikolycka där den skadade personen ådragit sig en lätt traumatisk hjärnskada.  Vi har hanterat data från Socialstyrelsen, Statistiska centralbyrån och Försäkringskassan och etablerat en analysdatabas för projektet. Analysdatabasen inkluderar personer som skadats i vägtrafikolycka under åren 2014 till 2016 och innehåller 6073 individer och som vårdats för hjärnskakning i samband med skadetillfället, i slutenvård eller specialiserad öppenvård. Analys av data är avslutade, både deskriptiva analyser och oddskvoter med hjälp av logistisk regression och 95 % konfidensintervall har genomförts. Manus för submittering till vetenskaplig tidskrift för referentgranskning är under arbete och beräknas skickas in i mars 2022.  Projektplanen har i stort sett följts. För att säkerställa tillräcklig statistisk styrka valde vi att utöka inklusionen till en tre-årsperiod, istället för ett enstaka år. Studien bidrar med ny kunskap om lätta traumatiska hjärnskador i vägtrafikolyckor och dess påverkan på sjukfrånvaro, på såväl kort som lång sikt. Kunskapen kan användas som underlag för ställningstagande till olika preventiva insatser, avseende trafikmiljö, fordon, och vårdinsatser.  Totalt drabbades 6073 individer i arbetsför ålder av en lätt traumatisk hjärnskada/hjärnskakning i samband med vägtrafikolycka under åren 2014 till 2016. Det var en förhållandevis jämn fördelning mellan könen (kvinnor 52 %). Majoriteten av de drabbade var födda i Sverige (85 %). De flesta (81 %) hade högre utbildningsnivå än grundskola. Närmare en tredjedel (31 %) vårdades inom slutenvård till följd av olyckan. Av samtliga skadade erhöll 12 procent ny SA till följd av olyckan. Tio procent av de skadade hade redan en pågående sjukskrivning eller sjukersättning (SE)

Suicidalt beteende bland unga med aktivitetsersättning

I denna studie analyserades samband mellan att ha aktivitetsersättning i tidig vuxen ålder och suicidalt beteende, samt hur sådana samband utvecklats över tid. Vi använde individdata från rikstäckande register och utgick från tre kohorter: samtliga unga vuxna som var 19-23 år och folkbokförda i Sverige år 1995, 2000 respektive 2005. Risken för suicidförsök och suicid under de efterföljande fem åren studerades för varje kohort. I samtliga kohorter förelåg en kraftig överrisk för såväl suicidförsök som suicid hos unga med aktivitetsersättning. Från 1995 till 2005 mer än fördubblades antalet unga med aktivitetsersättning, medan antalet suicidförsök och suicidförsök i denna grupp fyrdubblades. Det finns ett påtagligt behov av regelbunden uppföljning av unga med aktivitetsersättning, för att säkerställa att de får rätt insatser

Sjukskrivningsmönster före och efter att ha drabbats av lätt hjärnskada vid en vägtrafikolycka

Rapporten är framtagen med ekonomiskt bidrag från Trafikverket, Skyltfonden. Ståndpunkter och slutsatser i rapporten reflekterar författaren och överensstämmer inte med nödvändighet med Trafikverkets ståndpunkter och slutsatser inom rapportens ämnesområden. Studien, för vilket medel beviljats, syftar till att kartlägga sjukfrånvaro före och efter en vägtrafikolycka där den skadade personen ådragit sig en lätt traumatisk hjärnskada.  Vi har hanterat data från Socialstyrelsen, Statistiska centralbyrån och Försäkringskassan och etablerat en analysdatabas för projektet. Analysdatabasen inkluderar personer som skadats i vägtrafikolycka under åren 2014 till 2016 och innehåller 6073 individer och som vårdats för hjärnskakning i samband med skadetillfället, i slutenvård eller specialiserad öppenvård. Analys av data är avslutade, både deskriptiva analyser och oddskvoter med hjälp av logistisk regression och 95 % konfidensintervall har genomförts. Manus för submittering till vetenskaplig tidskrift för referentgranskning är under arbete och beräknas skickas in i mars 2022.  Projektplanen har i stort sett följts. För att säkerställa tillräcklig statistisk styrka valde vi att utöka inklusionen till en tre-årsperiod, istället för ett enstaka år. Studien bidrar med ny kunskap om lätta traumatiska hjärnskador i vägtrafikolyckor och dess påverkan på sjukfrånvaro, på såväl kort som lång sikt. Kunskapen kan användas som underlag för ställningstagande till olika preventiva insatser, avseende trafikmiljö, fordon, och vårdinsatser.  Totalt drabbades 6073 individer i arbetsför ålder av en lätt traumatisk hjärnskada/hjärnskakning i samband med vägtrafikolycka under åren 2014 till 2016. Det var en förhållandevis jämn fördelning mellan könen (kvinnor 52 %). Majoriteten av de drabbade var födda i Sverige (85 %). De flesta (81 %) hade högre utbildningsnivå än grundskola. Närmare en tredjedel (31 %) vårdades inom slutenvård till följd av olyckan. Av samtliga skadade erhöll 12 procent ny SA till följd av olyckan. Tio procent av de skadade hade redan en pågående sjukskrivning eller sjukersättning (SE)

I vilken utsträckning leder cykelolyckor till sjukskrivning och sjuk- eller aktivitetsersättning?

Denna slutrapport är framtagen med ekonomiskt stöd från Trafikverkets skyltfond. Ståndpunkter, slutsatser och arbetsmetoder i rapporten reflekterar författaren och överensstämmer inte med nödvändighet med Trafikverkets ståndpunkter, slutsatser och arbetsmetoder inom rapportens ämnesområde. Cykling har ökat under senare år, även om det i stort är positivt skadas nu fler personer i cykelolyckor än i bilolyckor i svenska tätorter. Mer kunskap behövs om sådana skador, om vilka som skadas och om konsekvenserna av skadorna. Sådan kunskap behövs för att kunna genomföra riktade preventiva åtgärder. Detta tvärvetenskapliga projekt har genomförts i syfte att få en bredare och djupare kunskap om hur vanligt det är att cykelolyckor leder till så alvarliga skador att den skadade blir sjukskriven, långtidssjukskriven eller får sjuk- eller aktivitetsersättning, samt om detta skiljer sig åt uppdelat på ålder, kön, olyckstyp, diagnos mm. Projektet sker i samarbete mellan Karolinska Institutet, Folksam och Göteborgs Universitet/Chalmers tekniska högskola. Data från flera rikstäckande register användes; Socialstyrelsens Patientregister (öppen- och slutenvård), Dödsorsaksregistret, SCB:s Lisa register och Försäkringskassans MiDASregister. Två populationsbaserade studier har genomförts och inkluderar de personer i arbetsföra åldrar (16 – 64 år) som sökt vård, antingen specialiserad öppenvård eller via inläggning på sjukhus, för en ny cykelolycka. I den första delstudien inkluderas samtliga de 7643 personer i arbetsför ålder som fått sådan specialiserad vård på grund av en ny cykelolycka under 2010. Vi fann att 18 % av dem fick en ny sjukskrivning i samband med olyckan, och att frakturer var den vanligaste skadan bland dem med sådan ny sjukskrivning. Dessutom fann vi att 10 % redan vid olyckstillfället var sjukskrivna eller hade sjuk- eller aktivitetsersättning. I den andra delstudien inkluderas samtliga de 22 045 personer i arbetsför ålder som under de tre åren 2009-2011 haft specialiserad sjukvård i samband med en ny cykelolycka och som då inte redan var sjukskrivna eller hade sjuk- eller aktivitetsersättning. Tjugo procent fick en ny sjukskrivning i samband med olyckan; för 5 % av dem blev sjukskrivningsfallet 180 dagar eller längre. Sjukskrivning var något vanligare för kvinnor än män, 23 % av kvinnorna jämfört med 18 % av männen blev sjukskrivna. Även i de långa sjukskrivningsfallen var frakturer en vanligt förekommande skada, liksom hjärn- och ryggmärgsskadediagnoser. Slutsatser: Bland de olika typerna av skador i samband med en cykelolycka var frakturer, framför allt skador på skuldra/överarm och på ben vanliga och ledde också i många fall till långa sjukskrivningar. Personer som drabbades av huvudskador fick vanligen längst sjukfrånvaro. Här skulle användning av cykelhjälm inte endast betydligt kunna minska risken för allvarlig skada utan även för långvarig sjukfrånvaro. Skador av axlar, armar och ben, kroppsdelar som fortfarande är oskyddade vid cykling och där det idag inte finns några riktade preventiva åtgärder, kräver ytterligare fokus