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Original research article
Trajectories and characteristics of work disability before and after acute myocardial infarction
  1. Mo Wang1,
  2. Marjan Vaez1,
  3. Thomas Ernst Dorner2,
  4. Jari Tiihonen3,
  5. Margaretha Voss1,4,
  6. Torbjörn Ivert5,6,
  7. Ellenor Mittendorfer-Rutz1
  1. 1 Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  2. 2 Department for Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
  3. 3 Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
  4. 4 Department for Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden
  5. 5 Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden
  6. 6 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Mo Wang, Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet Stockholm SE-171 77, Sweden;{at}


Objective Scientific knowledge on work disability in terms of sickness absence and disability pension (SA/DP) among patients with acute myocardial infarction (AMI) is scarce. The study aimed to investigate trajectories of SA/DP among individuals with or without AMI and examined the associations between sociodemographic, morbidity and coronary revascularisation characteristics with such trajectories among patients with AMI.

Methods This is a population-based cohort study of 10 255 individuals aged 30–60 years who had a first AMI during 2008–2010 and were alive 30 days after AMI. Each case was matched by sociodemographics to one control without AMI. Trajectories of annual SA/DP months over a 6-year period for cases and controls were analysed by group-based trajectory modelling. Associations of characteristics with trajectory groups were estimated by Χ2 test and multinomial logistic regression.

Results The majority of patients (59%) had slightly increased annual levels of SA/DP (1 month) at the time of AMI, which returned to no SA/DP 2 years after the event. One group (4%) had increasing SA/DP months preceding and after AMI. Three groups showed constant SA/DP months on low (14%), medium (9%) and high (15%) levels. Sex, unemployment, education, musculoskeletal disorders and prescription of antidepressants were the strongest factors discriminating the SA/DP trajectories (R2 difference=0.02–0.03, p<0.01).

Conclusions The majority of patients with AMI have a good outcome in terms of low levels of work disability within 2 years after AMI. Patterns of SA/DP before AMI, sex, socioeconomic status as well as comorbid musculoskeletal and mental disorders provide crucial clinical information on work disability after AMI.

  • Acute myocardial infarction
  • Sick leave
  • Disability pension
  • Insurance Medicine
  • Trajectory

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  • Contributors All authors contributed to design of the study and the statistical analysis plan. MW was responsible for data management and data analysis. MW and EM-R drafted the manuscript, and all authors were involved in interpretation of the data, critical revision and approval of the final content before submission.

  • Funding This study was funded by the Swedish Research Council dnr 2015-02292.

  • Competing interests None declared.

  • Ethics approval Regional Ethical Review Board of Stockholm, Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.