Transitioning from sickness absence to disability pension—the impact of poor health behaviours: a prospective Swedish twin cohort study

OBJECTIVES: To investigate the association between three poor health behaviours (current smoker, high consumption of alcohol and low physical activity levels) and the transition to disability pension (DP) among individuals who have recently been sickness absent. Furthermore, we aimed to explore whether having multiple poor health behaviours increased the risk of transitioning from sickness absence (SA) to DP. DESIGN: Prospective twin cohort study. SETTING: Sweden. PARTICIPANTS: Twins aged 20–46 who had participated in a survey and been on SA (>14 days) in the year preceding baseline (date of answering the questionnaire). MAIN OUTCOME MEASURE: Incident DP during the follow-up which ended on 31 December 2012 (mean 5.2 years). A national register with full coverage provided data on DP. RESULTS: The Cox proportional-hazards regression analyses showed that current smokers had a higher risk of transitioning from SA to DP compared with never smokers (HR 1.76; 95% CI 1.08 to 2.84). Alcohol use and lack of physical activity as well as poor health behaviour sum score showed no significant associations. CONCLUSIONS: Being a current smoker influences the transition from SA to DP. Although non-significant, there were indications that more physical activity and fewer poor health behaviours could reduce the risk of exiting the labour market through DP. Improving health behaviours among people on SA could be a valuable tool for preventing the transition to DP.