Background In Sweden, approximately 50% of the men and 60% of the women entering retirement pension have had other subsistence than paid employment the years before retirement. Associations between heavy physical workload and musculoskeletal disorders are well-documented. This study investigates the role of heavy physical work for reduced work ability and early exits from the labour market. Socioeconomic position (SEP) is a potential confounder as it both influences the choice of occupation and is a determinant of health and work ability. The aim of this study was to investigate the associations between heavy physical workload, awkward work postures and long-term sickness absence, disability pension and long-term unemployment.

Methods The study is based on the Stockholm Public Health Cohort, a population-based cohort of randomly selected residents in the Stockholm county. A total of 11 041 employed women and men, who answered a baseline questionnaire in 2002, were followed in national registers on sickness absence, disability pension and unemployment until 2010. The questionnaire contained questions on physical workload, work below knees, work above shoulder height and occupation.

Results Heavy physical workload increased the risk of long-term sickness absence (HR 2.21, CI: 95% 1.83–2.68), disability pension (HR 2.06, CI: 95% 1.27–3.35), and long-term unemployment (HR 1.49, CI: 95% 1.15–1.93). Exposure for daily work below knees and above shoulder height were also associated with the three outcomes, with slightly lower hazard ratios. The associations were clearly attenuated after adjustments for SEP.

Conclusions The results imply that heavy physical work contribute to reduced work ability and early exits from labour market manifested in long-term sickness absence, disability pension and long-term unemployment. The effects were partly explained by SEP. However, the associations were probably over-adjusted to some extent as SEP is closely related to occupational exposures, and to high physical workload in particular.