Occupational differences in the association between alcohol-related disorders and sickness absence: a register-based longitudinal study

Objective The present study aims to investigate the associations between onset of clinically diagnosed alcohol-related disorders and medically certified sickness absence, measured as both the number of sickness absence days and long-term sickness absence (>90 days), and to what extent occupational group modifies these associations. Methods This population-based cohort study used the Swedish Work, Illness and Labor-market Participation (SWIP) cohort, including all individuals employed in Sweden for at least 1 year between 2005 and 2015 (n=2 840 461). Alcohol-related disorders were identified in the National Patient Register, and sickness absence outcomes were obtained from the Social Insurance Register (2006–2020). Register data provided information on occupation, sociodemographic characteristics and individual and parental mental and physical health. Negative binomial models estimated incidence rate ratios (IRR) for sickness absence days, and modified Poisson models estimated risk ratios (RR) for long-term sickness absence. Results Alcohol-related disorders were associated with an increased rate of sickness absence (IRR: 2.10, 95% CI 2.03 to 2.18) and risk of long-term sickness absence (RR: 1.80, 95% CI 1.76 to 1.83) after adjusting for important covariates. Occupational group modified these associations, with alcohol-related disorders associated with between 27.0 and 41.9 additional sickness absence days, with the largest increase observed among managers. Similar occupational differences were observed for long-term sickness absence. Conclusions In Sweden, alcohol-related disorders are strongly associated with sickness absence. The magnitude of these associations differed across occupational groups, suggesting that the occupational consequences of alcohol-related disorders may differ across the labour market.