Unemployment at a young age and sickness absence, disability pension, death and future unemployment - A register-based study of native Swedish and immigrant young adults

Sammanfattning: Youth unemployment is an increasing burden on societies around the world. This prospective, register-based cohort study examined the relationship between unemployment and sickness absence, disability pension, death and future unemployment among youth in Sweden. A comparison was also made between immigrants and native Swedes. Another aim was to see if Active Labour Market Programs (ALMPs) and attained education moderated the outcomes. The baseline year was 1992, a year of severe economic downturn. The follow-up period was from 1993 to 2007, divided into three 5-year periods. The study group of 199,623 individuals comprised all immigrants born between 1968 and 1972 who immigrated before 1990 (25,607) and a random sample of native Swedes in the same age range (174,016). Individuals with unemployment benefit in 1990-1991, disability pension in 1990-1992 or severe disorders leading to hospitalization in 1990-1992 were excluded in order to minimize selection bias. Those who were unemployed in 1992 had elevated risk, measured as odds ratios, of ≥60 days of sickness absence, disability pension, ≥100 days of unemployment and all, except native Swedish women, had elevated risk of death during follow-up. The risk of future unemployment declined until the last follow-up period, while the elevated risk of future sickness absence was about the same in all three follow-up periods. Higher level of education at baseline decreased the risk of future unemployment. Individuals participating in ALMPs had an increased risk of future unemployment, and immigrant women had an increased risk of sickness absence, compared to non-participating individuals. Attained education between 1993 and 1997 decreased the risk of future unemployment and decreased the risk of sickness absence among immigrants. The risk of both future unemployment and future sickness absence increased with the length of unemployment in 1992. Immigrants had higher risk of unemployment both at baseline and follow-up compared with native Swedes, but followed the pattern of native Swedes when unemployed. The conclusion are that exposure to unemployment are associated with elevated risk of future unemployment, sickness absence, disability pension and death fifteen years after exposure. To a society this will mean substantial costs in the form of increased welfare payments and loss of productivity and tax income. Selection to unemployment by individuals already sick, may explain part of the association between unemployment and the studied outcomes.