Differences in predictors of permanent work disability between immigrants and natives: a cohort study of adults with sick leave due to common mental disorders

• Main Authors: Werlen, Laura, Helgesson, Magnus, Mittendorfer-Rutz, Ellenor
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMJ Publishing Group 2017
• Subjects: Epidemiology; Biostatistics and Prevention Institute (EBPI); 610 Medicine & health; Common Mental Disorders; Disability; Insurance; Emigrants and Immigrants; Psychotropic Drugs; Sick Leave; Norway; Iceland
• Online Access: https://www.zora.uzh.ch/id/eprint/143712/; https://www.zora.uzh.ch/id/eprint/143712/1/werlen-differences-e014431.full.pdf; https://doi.org/10.5167/uzh-143712; https://doi.org/10.1136/bmjopen-2016-014431

OBJECTIVES: Immigrants with common mental disorders (CMDs) are reported to have a higher risk of disability pension (DP) compared with native residents; however, the reasons for this are not fully understood. This study aimed to investigate (1) differences in morbidity (3 measures) and socioeconomic status in native Swedes, 'Western' and 'non-Western' immigrants with CMDs and (2) interactions between morbidity and socioeconomic status and immigrant status regarding subsequent DP. DESIGN: The study was a prospective population-based cohort study using national register data. Crude and multivariate HRs with 95% CIs were calculated using the Cox regression (2007-2010). PARTICIPANTS: All individuals aged 18-59 with an incident sick-leave spell due to CMDs during 2006 were included in the study (N=66 097). The study population was divided into 3 groups based on country of birth: (1) Sweden, (2) immigrants from 'Western' countries (EU25, Norway, Iceland, North America and Oceania) and (3) immigrants from 'non-Western' countries (east Europe, Africa, Asia and South America). RESULTS: Particularly, immigrants born in non-Western countries had higher levels of morbidity and lower socioeconomic status than natives (p>0.001). No significant differences in the associations between specialised psychiatric and somatic care with regard to subsequent DP were found between immigrants and native Swedes. Being prescribed more than 1 type of psychiatric medication was associated with higher HRs for DP in immigrants from Western (HR 3.34; CI 2.3 to 4.9) and non-Western countries (3.6; 1.9 to 6.4) than in native Swedes (2.55; 2.3 to 2.8) (pinteraction=0.003). Low education was a marginally stronger predictor for DP in non-Western immigrants than in native Swedes and Western immigrants (pinteraction=0.03). CONCLUSIONS: Morbidity measured by medication, but not by specialised healthcare, was a stronger predictor for DP in immigrants than in native Swedes, warranting scrutiny of differences in care and treatment in immigrants and ...