Employment status and self-rated health in people with multiple sclerosis in Sweden

In Sweden, many people with multiple sclerosis (PwMS) remain employed due to flexible work and social insurance support. However, as MS progresses, work income declines while reliance on sickness absence (SA) and disability pension (DP) increases. Self-rated health, a holistic measure of physical and mental well-being, is informative in the work context. This study aims to explore factors associated with combined categorical indicators that integrate employment status and self-rated health and examines factors associated with different employment-health states. This population-based study included survey responses from 4329 PwMS linked to national register data. We categorized participants into four employment–health groups based on self-rated health (high vs. low EQ-VAS) and employment status (working vs. receiving SA/DP). Groups comparisons were conducted to describe differences in sociodemographic, clinical, mental health, and work-related characteristics. Multinomial logistic regression was then used to examine factors associated with group membership. Women, older individuals, and those with progressive MS or more visible symptoms were more likely to be receiving SA/DP. Depressive symptoms were more common among participants reporting low self-rated health, regardless of employment status, while disability, fatigue, and reduced work ability were associated with poorer health and reduced labor market participation. Fatigue emerged as a prevalent symptom across all groups, including those still working. Participants working despite low health reported insufficient or absent workplace adjustments, suggesting unmet support needs. Career and educational decisions were also influenced by MS, with many participants reducing working hours or avoiding job changes. Employment status among PwMS did not perfectly reflect individual’s overall well-being, particularly regarding mental health and fatigue. Nevertheless, clear group-level differences between those who were employed and those who were receiving part-time SA/DP underscore the importance of early, tailored interventions.