Development of income following sickness absence from the workplace or long-term unemployment, and among individuals with multiple sclerosis

Sammanfattning: The overall aim of this thesis was to gain knowledge of how reduced work capacity due to morbidity is associated with subsequent individual economic outcomes and how different components of the Swedish welfare system were used to cover individual economic loss. This was investigated in four empirical studies using population-based Swedish register data for individuals in working ages in the time period 1995 to 2011. The four studies were based on the Longitudinal Integration Database for Health Insurance and Labour Market Studies (LISA), linked with register data from the Swedish Social Insurance Agency and the National Board of Health and Welfare. In Study I, transitions between three labour market states over a period of 15 years among individuals who initially (1995) had no or limited income from work were studied. This state was defined as “jobless” and consisted mostly of individuals on long-term unemployment. The three studied states were; 1) “Jobless” (i.e., the inclusion criteria), 2) “Self-sufficient” (main income from work), and 3) “Disabled” (main income from the Swedish sickness insurance system). Fifteen years later, more than half of the study population were mainly self-sufficient (i.e., their main income was from work) whereas a smaller proportion were dependent on benefits from the unemployment office or sickness insurance benefits. The results indicated a health selection in transitions from “jobless” to other states. Those with low morbidity were subsequently to a higher degree in paid work compared to those with high morbidity, who were more likely to be unemployed or on sickness insurance benefits. Transitions into paid work were higher in a period with decreasing nationwide unemployment. Finally, although socio-demographic characteristics, such as health status and nationwide unemployment were all significant factors, the individual’s preceding state was the best predictor of his/her subsequent labour market position. In Study II, associations between being on compensated sickness absence (SA), with different diagnoses and different durations of absence, and the subsequent levels of individual disposable income were investigated. Compared to the reference group without a previous SA spell, those with a previous spell of SA had lower subsequent disposable income, 2–6 years after a SA spell. The differences were most pronounced for persons diagnosed with a mental diagnosis and for persons with longer spells of SA. In Study III, incomes from work and from different social compensation systems were analysed among individuals with Multiple Sclerosis (MS), including the relation of these to the time following the initial MS diagnosis. Comparisons with a sample of individuals drawn from the general population without MS were then conducted, regarding sources and levels of income in the year 2010. The results indicated that MS patients were overrepresented, in relative and absolute terms, regarding health-related benefits and that they had lower levels of earnings. This was more pronounced the longer the elapsed time since the MS diagnosis. However, the welfare system provided considerable financial compensation. MS patients’ earnings from ten years prior to and up to five years after the time of the first diagnosis were analysed separately in Study IV. The results showed increasing heterogeneity in the levels of earnings from one year before diagnosis until five years after diagnosis (end of study). The largest differences between the individuals with MS and the reference group – i.e., individuals without MS - were found for persons with lower levels of education and in less qualified types of occupations. Individuals with MS were also overrepresented in the usage of Swedish sickness insurance, measured as the prevalence of insurance for temporary sickness absence from work and disability pension. In summary, transitions from long-term unemployment into work were found to be negatively correlated to previous severe health problems. Further, compared with the alternative of not being on compensated sick leave, compensated SA was associated with a worse individual financial situation up to five years after the initial spell of absence. This was especially the case for persons whose SA was due to a mental diagnosis. For persons with a MS diagnosis and depending on the time elapsed since the initial diagnosis, the degree of the self-sufficiency of earnings from work varied greatly. With time an increasingly larger number received increased support from sickness insurance, i.e., sickness compensation for temporary sick leave and disability pension. Furthermore, a socio-economic gradient was identified among the MS patients. The earnings of individuals with MS with lower levels of education and employed in manual occupations were affected more negatively than those with higher levels of education and in white-collar occupations.