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Sickness absence due to different musculoskeletal diagnoses by occupational class: a register-based study among 1.2 million Finnish employees
  1. Johanna Pekkala1,
  2. Ossi Rahkonen1,
  3. Olli Pietiläinen1,
  4. Eero Lahelma1,
  5. Jenni Blomgren2
  1. 1 Department of Public Health, University of Helsinki, Helsinki, Finland
  2. 2 The Social Insurance Institution of Finland, Helsinki, Finland
  1. Correspondence to Johanna Pekkala, Department of Public Health, University of Helsinki, Helsinki 00014, Finland; johanna.pekkala{at}


Objectives Those in lower occupational classes have an increased risk of sickness absence due to musculoskeletal diseases (MSDs), but studies examining the associations simultaneously across specified diagnostic groups within MSDs are lacking. We examined occupational class differences in the occurrence and length of long-term sickness absence due to different musculoskeletal diagnoses.

Methods A 70% random sample of employed Finns aged 25–64 years old at the end of 2013 was linked to data on sickness absence of over 10 working days obtained from The Social Insurance Institution of Finland and occupational class from Statistics Finland. Sickness absences due to MSDs initiated in 2014 were followed until the end of each episode for female (n=675 636) and male (n=604 715) upper non-manuals, lower non-manuals and manual workers. Negative binomial hurdle models were used to analyse the associations.

Results Within the studied MSDs, the most common causes of absence were back disorders, particularly back pain, and shoulder disorders. Osteoarthritis, disc disorders and rheumatoid arthritis induced the longest episodes of absence. Clear hierarchical class differences were found throughout, but the magnitude of the differences varied across the diagnostic causes. The largest class differences in the occurrence were detected in shoulder disorders and back pain. The class differences in length were greatest in rheumatoid arthritis, disc disorders and, among men, also in hip osteoarthritis.

Conclusions Hierarchical occupational class differences were found across different MSDs, with large differences in back and shoulder disorders. Occupational class and diagnosis should be considered when attempting to reduce sickness absence due to MSDs.

  • sickness absence
  • musculoskeletal
  • public health

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  • Contributors JP had the original idea for the present study. All the authors participated in planning the study. JP and OP conducted the statistical analyses. JP, OR, OP, EL and JB interpreted the results. JP wrote the first draft of the manuscript and all the later versions. OR, OP, EL and JB reviewed and revised the manuscript. All the authors approved the final manuscript for submission to the journal.

  • Funding This study was supported by the Doctoral Programme in Clinical Research at the University of Helsinki, The Social Insurance Institution of Finland (grant 67/26/2014), the University of Helsinki, the Strategic Research Council of the Academy of Finland (grant 293103/2015) and the Academy of Finland (grant 294514/2016).

  • Competing interests None declared.

  • Ethics approval This study used only secondary data obtained from registers. Permission to use the data in the present study has been obtained from The Social Insurance Institution of Finland (Kela) (permission number 59/522/2015). Kela and its Ethics Committee follow Finnish legislation and are committed to the guidelines provided by the Finnish Advisory Board of Research Integrity. According to Finnish law, ethics approval was not required since the present study is based solely on registers.40 Conventions of good scientific practice, data protection and information security were applied in analysing the data and in presenting the results.

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

  • Presented at This study was presented at the 10th European Public Health Conference Sustaining resilient and healthy communities, and the abstract has been published (Pekkala J, Rahkonen O, Pietiläinen O, et al, Sickness absence due to musculoskeletal diagnoses by occupational class in Finland: a register study. Eur J Public Health 2017;27(suppl_3), ckx187.197.).