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

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