Article Text

Original research
Unemployed and disabled for work: identifying 3-year labour market pathways from the beginning of a sickness absence using sequence and cluster analyses in a register-based longitudinal study in Finland
  1. Riku Perhoniemi1,
  2. Jenni Blomgren1,
  3. Mikko Laaksonen2
  1. 1Social Insurance Institution of Finland, Helsinki, Finland
  2. 2Finnish Centre for Pensions, Helsinki, Finland
  1. Correspondence to Riku Perhoniemi; riku.perhoniemi{at}kela.fi

Abstract

Objectives This study followed the labour market pathways of unemployed persons who started a sickness absence (SA) spell. We aimed to unravel subgroups based on altering labour market states and to identify covariates of these subgroups.

Design Register-based longitudinal study, with nine labour market states and 36-month units.

Setting and participants All Finnish persons aged 18–59 years with an SA in 2016 who were unemployed at the start of the SA spell (N=12 639).

Outcome measures Sequence analysis was used to study transitions between nine labour market states based on monthly register data on permanent and temporary (full and partial) disability pensions (DP), rehabilitation, all-cause SA, unemployment and employment. Individuals were grouped into clusters based on cluster analysis and intersequence distances. Multinomial regression analysis was used to examine covariates of cluster memberships.

Results Six clusters with the following pathway identities were found: (1) recurring unemployment (44%); (2) employment after a short SA (18%); (3) rehabilitation, recurring SA and unemployment (12%); (4) unknown sources of income (11%); (5) permanent DP after a prolonged SA (9%) and (6) temporary DP after a prolonged SA (7%).

Compared with the reference cluster 2, all other clusters were associated with less employment days and having a chronic illness before the SA spell, SA based on a mental disorder and a rejected DP application during the follow-up. In addition, the clusters had some unique covariates.

Conclusions Unemployed persons starting an SA are a heterogeneous group, with different labour market pathways. For many, the combination of unemployment and work disability means low chances for employment or regained work ability during the following years. Unemployed persons with poorer health, long history outside employment, older age, low educational level, a rejected DP application and a mental disorder could benefit from targeted support.

  • EPIDEMIOLOGY
  • Health Equity
  • PUBLIC HEALTH

Data availability statement

No data are available. The data that support the findings of this study are available from Kela, Finnish Centre for Pensions and Statistics Finland but restrictions apply to the availability of these data, which were used under licence for the current study, and so are not publicly available.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

No data are available. The data that support the findings of this study are available from Kela, Finnish Centre for Pensions and Statistics Finland but restrictions apply to the availability of these data, which were used under licence for the current study, and so are not publicly available.

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Footnotes

  • Twitter @perhonir

  • Contributors RP, JB and ML contributed to the planning and conducting the study. RP wrote first and successive drafts of the manuscripts, and conducted the statistical analyzes. JB and ML contributed in writing and revising the manuscript, and advised on statistical modeling. All authors interpreted the results and approved the final version of the manuscript. RP is the guarantor.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. It was funded by the Social Insurance Institution of Finland (Kela).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.