Gender and socio-economic variations in employment among patients with a diagnosed musculoskeletal disorder: a longitudinal record linkage study in Sweden.

OBJECTIVE To establish whether the employment consequences of musculoskeletal disorder vary by gender and socio-economic group in Sweden. METHODS Two linked registers, containing diagnostic and socio-economic data for the 1.8 million residents of Stockholm County, were used to investigate the subsequent employment consequences over 5 yr of having a musculoskeletal disorder requiring hospital admission in 1996. Age-standardized employment rates of all patients with musculoskeletal disorder (n = 2185) were compared with patients employed prior to hospital admission (n = 1286) and with the general population of Stockholm. Odds of leaving employment between 1996-2001 were calculated for men, women and patients from different socio-economic groups. RESULTS Employment rates increased and social differentials narrowed in the general population, while employment declined and social differentials widened among patients with musculoskeletal disorders. These trends were masked when analyses were restricted to individuals employed at baseline. Following hospital admission, the odds of leaving employment increased annually for patients; by 2001, their adjusted odds were over three times greater [odds ratio (OR) = 3.36, 95% confidence interval (CI) 2.89-3.91] than for the general population. Women with musculoskeletal disorders were significantly more likely to leave employment during follow-up than men (OR = 1.95, 95% CI 1.49-2.56). Semi- and unskilled manual workers with musculoskeletal disorders were over three times as likely to leave employment than their professional counterparts (OR = 3.40, 95% CI 2.41-4.81). CONCLUSIONS People with musculoskeletal disorders, particularly women and semi- and unskilled manual workers, are vulnerable to leaving employment. Health and social policies must do more to protect the employment of people with musculoskeletal disorders.