Return to work after first incidence of long-term sickness absence: A 10-year prospective follow-up study identifying labour-market trajectories using sequence analysis

Aims: The study aim was to identify prototypical labour-market trajectories following a first incidence of long-term sickness absence (LTSA), and to assess whether baseline socio-demographic characteristics are associated with the return-to-work (RTW) process and labour-market attachment (LMA). Methods: This prospective study used Norwegian administrative registers with quarterly information on labour-market participation to follow all individuals born 1952-1978 who underwent a first LTSA during the first quarter of 2004 (n =9607) over a 10-year period (2004-2013). Sequence analysis was used to identify prototypical labour-market trajectories and LMA; trajectory membership was examined with multinomial logistic regression. Results: Sequence analysis identified nine labour-market trajectories illustrating the complex RTW process, with multiple states and transitions. Among this sample, 68.2% had a successful return to full-time work, while the remaining trajectories consisted of part-time work, unemployment, recurrence of LTSA, rehabilitation and disability pension (DP). A higher odds ratio (OR) for membership to trajectories of weaker LMA was found for females and older participants, while being married/cohabitating, having children, working in the public sector, and having a higher education, income and occupational class were associated with a lower OR of recurrence, unemployment, rehabilitation and DP trajectories. These results are consistent with three LMA indicators. Conclusions: Sequence analysis revealed prototypical labour-market trajectories and provided a holistic overview of the heterogeneous RTW processes. While the most frequent outcome was successful RTW, several unfavourable labour-market trajectories were identified, with trajectory membership predicted by socio-demographic measures.