Introduction Women have higher work disability rates than men, but less is known of changes in this gap over time. We examined gender differences in sickness absence trends focusing on sectoral and occupational gender segregation in the labour market.

Methods We used large representative register data on Finnish wage-earners aged 25–59 and generalised estimation equations based on repeated logistic regression to estimate the annual risk of having any long-term sickness absence.

Results Between 2005 and 2013, the predicted proportion of those with all-cause sickness absence decreased from the initial levels of 10.6 among men and 15.1 among women by 16.7% and 13.6%, respectively. The decreases were particularly large among male and female manual workers and among female upper non-manual employees, and there was further variation between different industrial sectors. Excess decrease among men mainly coincided with the peak of the economic recession in 2009. Widening of the gender gap was not influenced by differential distributional changes by employment factors, sociodemographic factors and previous sickness absence between the employed male and female risk populations, but it was influenced by differential within-group changes in sickness absence at the time of the recession between male- and female-dominated industrial sectors and occupational classes.

Conclusions Widening of the gender gap in sickness absence was largely explained by excess decrease in sickness absence in male-dominated sectors and occupations which were hit especially hard during the recent economic recession. The association may be related to reduced illness behaviour among employees experiencing greater labour market insecurity.