Inequalities in Sickness Absence between Finnish and Swedish Speakers in Finland: A Register-Based Study

Jan Saarela, Åbo Akademi University
Kaarina Reini, Åbo Akademi University

Background

One of the aims of the current reform of Finnish social and health care system is to reduce the health gap between different population groups. Finnish- and Swedish-speakers in Finland provide an interesting study setting for observing health inequalities and possible reasons for their existence. Literature shows that Swedish-speakers have a certain health advantage over Finnish-speakers such as lower rates of disability pension and mortality. Here, we examine whether they differ in the receipt of sickness benefit, which is a previously unexplored objective health measure in this context.

Materials and methods

The individual-level data used come from the Finnish longitudinal population register. They cover the period 1987-2011, and consist of five per cent of all Finnish speakers and 20 per cent of all Swedish speakers. To estimate the likelihood of receiving sickness benefit in prime working ages, and account for multiple occurrences at the individual level over the study period, we estimate logistic regression models with generalized estimating equations.

Results

We find that, even when we control for a number of socioeconomic and demographic background factors, Finnish-speaking men are on average 30 per cent more likely to receive sickness benefit than Swedish-speaking. In women, the difference is approximately 15 per cent. We also observe some indication of healthy worker effect. These results corroborate previous research based on other objective health measures, and are expected also from the perspective that sickness absence is a predictor of disability pension and mortality.

Conclusion

Since sickness absence causes substantial costs for the society, these results can be utilised in policy making processes that aim to lower sickness absence rates and thus help in equalising health differences.


Background

The two native ethno-linguistic groups in Finland, Finnish speakers and Swedish speakers, provide an interesting study setting for observing health inequalities and their mechanisms. Several factors are equal for both Finnish- and Swedish-speakers. Health system in terms of health service provision and health finance and related sector, as well government policies and actions to both of the groups are identical. Yet it has established that Swedish speakers have a certain health advantage over Finnish speakers as they perform better on objective health measures such as mortality and disability pension. Surveys indicate that they also have better self-reported health, and there are some evidence of difference in well-being and mental health as well. Swedish speakers tend to experience lower levels of psychological distress and have a lower risk of severe mental disorders.

The explanation for these health inequalities, which generally remain after having controlled for a number of socioeconomic and demographic factors, may partly stem from health related behavior, cultural differences in lifestyle, and variation in protective and non-protective factors such as social networks and social support. The two groups differ also in genetic heritage, although it is not clear whether this difference underlie any health differences.

However, this research literature still has some gaps. We do not know whether Finnish and Swedish speakers differ in terms of sickness absence. Receipt of sickness benefit is an objective measure of poor health that reflects a less severe poor health status than receipt of disability pension. In contrast with survey-based data, it relies upon screened cases by physicians and therefore provide a useful and further nuanced way to study two otherwise equal ethno-linguistic groups with respect to health.

In this study, our aim is therefore to examine whether and how Finnish and Swedish speakers who live in the same coastal area of Finland differ on sickness absence.

Materials and methods

The individual-level data used come from the Finnish longitudinal population register. They cover the period 1987-2011, and consist of five per cent of all Finnish speakers and 20 per cent of all Swedish speakers. To estimate the likelihood of receiving sickness benefit in prime working ages, and account for multiple occurrences at the individual level over the study period, we estimate logistic regression models with generalized estimating equations.

Results

The results corroborate previous research based on other objective health measures and are highly expected from the perspective that sickness absence is a predictor of disability pension and mortality. Although Finnish speakers live in local areas where the probability to be on sick leave in general is lower than elsewhere, they are notably more likely to be on sick leave than Swedish speakers. Even when we control for a number of socioeconomic and demographic background factors, Finnish-speaking men are on average 30 per cent more likely to receive sickness benefit than Swedish-speaking. In women, the difference is approximately 15 per cent. For men the difference is greatest in age group 20-43 years and for women in age group 44-56 years.

Detailed analyses that focus on various interactions that include socioeconomic and demographic confounders reveal that the ethno-linguistic difference in sickness absence is remarkably stable across subgroups of the population. Both within more marginalized groups, such as low educated without a family, and in those that are socially and economically better performing, Swedish speakers are less likely to be on sick leave than Finnish speakers are. The consistency in this pattern suggests that some unobserved mechanisms related to latent health are at play, as also suggested by analyses restricted to people with an undisrupted work history and no history of sickness absence. When we focus on healthy workers of this kind, the ethno-linguistic difference in sickness absence in men is significantly reduced, while it is practically abolished in women.

Conclusions

Sickness absence causes substantial cost to the society. The demographic change and especially the decrease in the working aged population emphasizes the need to reduce sickness absence and lengthen work careers. This study may therefore help in further advancing our knowledge on how to combat these challenges.

Like with disability pension and death risks, the ethno-linguistic difference in sickness absence displays a gendered pattern. Finnish-speaking men in particular are in a notably poorer position as compared to Swedish-speaking men, whereas Finnish-speaking and Swedish-speaking women are more similar with regard to receipt of sickness benefit. Since the difference in sickness absence was strongly dependent on work history and previous sickness spells, future studies in this area may benefit from adopting a life-course perspective that incorporate lengthy follow-ups and setups that study how repeated sickness spells and different health measures associate to one another.

Presented in Session 1174: Health, Wellbeing, and Morbidity