Is Work Disability More Common among Same-sex than Different-sex Married People?
Received: 26-Apr-2016 / Accepted Date: 12-May-2016 / Published Date: 19-May-2016 DOI: 10.4172/2161-1165.1000242
Abstract
Background: Research has shown that sexual minority individuals have much higher risk of somatic and psychiatric morbidity as compared to heterosexual individuals. However, less is known whether this elevated level of poor health co-occurs with higher rates of work disability. Our aim was thus to examine the association between sexual orientation and risk of work disability.
Methods: Using Sweden’s nationwide registers, we used a cross-sectional design and compared prevalence of work disability, sickness absence and/or disability pension, between same-sex and different-sex married women and men for two years, 1998 and 2008, and calculated odds ratios (OR) with 95% confidence intervals (CI) while adjusting for several confounders.
Results: Higher risk of at least one day of work disability was found among same-sex married women in both 1998 (OR: 1.5, 95% CI: 1.2-1.8) and 2008 (OR: 1.3, 95% CI: 1.2-1.5), as compared to different-sex married women. Same-sex married women also had higher risk of work disability >90 days 1998 (OR: 1.6, 95% CI: 1.2-2.1) and 2008 (OR: 1.5, 95% CI: 1.3-1.7). Also, same-sex married men had higher risks, however somewhat lower in 2008, of at least one day of work disability (OR: 1.6, 95% CI: 1.5-1.8) and >90 days in 2008 (OR: 2.0, 95% CI: 1.7-2.3), as compared to different-sex married men.
Conclusion: This study provides novel results, demonstrating that the previously identified health disparity based on sexual orientation is also reflected in elevated levels of work disability among sexual minority women and men. This finding calls for research to identify the underlying mechanisms leading to this health disparity, and tailored prevention strategies both in clinical settings and on a broader societal level to remedy this health disadvantage.
Keywords: Work disability, LGB; Gay, Marriage, Sick-leave, Disability pension, Register
Introduction
Research has repeatedly shown that lesbian, gay, and bisexual (LGB) individuals experience higher risk for both somatic and psychiatric diseases, as compared to heterosexual individuals [1-7].
In addition, it has been demonstrated that LGB individuals constitute a higher-risk group for health risk behaviors such as smoking, elevated levels of alcohol consumption and substance abuse, as well as higher body-mass index among women [5,7-10].
Also, there are some results of higher disability rates among sexual minority individuals [11-14], which is consistent with pernicious effects of minority stress. However, the prior studies are based on selfreported data and their findings should hence be interpreted in the context of possible misclassifications and recall biases.
Whether these health disparities also entail a higher risk for social consequences of such morbidity in terms of work disability (Sickness Absence (SA) or Disability Pension (DP)) is, however, not investigated.
A recent American study presented disability rates by separating couples into: same-sex-female; same-sex-male, and different-sex married, by using data from the American Community Survey (ACS) Public Use Microdata Sample (PUMS) 2009–2011.
They found same-sex-female couples had higher rates of disability compared to the other three groups. Estimates for individuals in samesex couples also had a greater degree of uncertainty [11].
Sickness absence refers to temporary work incapacity due to health issues. Several studies have investigated risk factors for SA, usually focusing on psychosocial and work environmental factors that may contribute [15-18].
When an individual’s work capacity is permanently reduced due to disease or injury, Disability Pension (DP) can be granted. The risk factors, apart from serious health impairment, for DP are similar to those for SA, i.e., high workload and high psychological stress (often leading to musculoskeletal or mental diagnoses), frequent in-and outpatient care due to mental disorders and use of antidepressants (mental diagnoses), and previous long sick leave spells [19-21].
Sickness absence and DP have also been shown to entail a higher overall mortality risk [22,23].
Even a low number of sick-leave days [23], as well as being granted DP due to diagnoses with low mortality risk [22]; have been associated with a higher risk for premature death.
Sexual orientation-related health disparities have largely been explained by exposure to stress, related to membership in a socially disadvantaged and stigmatized group [24]. Stigma can function at different levels, at the individual level, e.g., self-stigma [25] at an interpersonal level, e.g., victimization [26], and at the structural level e.g., discriminatory legislation [27].
All this combined has been suggested to explain the well documented phenomenon that LGB individuals, as compared to similar heterosexuals, are more likely to report recent psychological distress, suicide ideation, and common stress-related mental disorders such as; depression or anxiety [28-34].
In recent years, extensive changes have been made in Sweden to reduce legislative discrimination against sexual minorities, accompanied with a continuous increase in social acceptance of sexual minorities [35,36].
Although, a cohabitation law for same-sex couples was introduced in 1988 and legislation enabling the legal right for same-sex couples to become registered partners was established already in 1995, the greatest changes regarding legislative discrimination have happened during the past fifteen years.
Several laws protecting LGB individuals against discrimination based on sexual orientation were passed in the beginning of the 21st century, focusing on discrimination in the workplace [11], and in 2003 a new legislation against hate speech towards sexual minorities was introduced [12].
In 2009, gender neutral marriage legislation was adopted [13]. Social acceptance has also increased. For example, the European Social Survey 2002-2014 includes a question assessing public attitudes toward homosexuality [37].
Over time, the proportion of respondents in Sweden that agreed to a statement that ‘Gay men and lesbians should be free to live their own life as they wish’ has continuously increased during the past 15 years, from 82% in 2002 to 87% in 2008 and 92% in 2014. These levels are on a par with those observed in the two countries with the most accepting attitudes pertaining to homosexuality: the Netherlands and Denmark.
The legal differences between the two civil status categories, registered partnership and marriage are minimal. Therefore, we hereafter call both registered partnership and same-sex married “samesex marriage”.
In this study we took advantage of the extensive and high quality nationwide registers in Sweden to compare the prevalence of work disability between same-sex married women and men and differentsex married women and men at two different time points, 1998 and 2008.
The former represents a time when same-sex partnership was newly legalized and many long-term couples changed to an official status. In contrast, 2008 represents a point in time where selection factors into same-sex partnerships are presumed to be closer to achieving a steady state and attitudes toward homosexuals are likely more tolerant.
We hypothesized that same-sex married individuals would have greater risk for work disability, measured as SA and DP, as compared to different-sex married women and men, reflecting the greater risk for social adversity associated with minority sexual orientation.
We also investigated the possibility that reductions in sexual minority stigma during the past decade in Sweden may have led to a decline in sexual orientation-based health disparities and hence in a lowered risk for work disability among sexual minorities.
Data and Methods
Study population
Sweden has invested heavily in nationwide registers of all residents in Sweden. In the present study, we used the unique personal identity number, assigned to each resident in Sweden, to link information from several population-based registers [38].
Because our study focused on work disability, SA and DP, among married individuals, only individuals in working ages 18 to 64 years were eligible for inclusion. Two time periods (1st January-31st December 1998 and 1st January-31st December 2008) were investigated.
Marriage
We included all same-sex marriage individuals and all different-sex married individuals living in Sweden as of 31 December 1998 and 31 December s2008 respectively, from the Longitudinal Integration Database for Health Insurance and Labor Market Studies (LISA), held by Statistics Sweden.
SA and DP public insurance in Sweden
All residents in Sweden, aged 16-64 years, with income from work or unemployment benefits are covered by the same public sickness insurance; providing sick-leave benefits to people who have reduced work capacity due to disease or injury. Among employed individuals, sick pay is, in most cases, paid by the employer during the first 14 days of a sick-leave spell.
Absences from day 15 and onward are then covered by the National Social Insurance (SIA), with a replacement rate of about 80% of lost income up to a certain level. All individuals, also those without work income, can be granted DP if their work capacity is reduced due to disease or injury permanently or for a long time.
The DP covers approximately 65% of the lost income, up to a ceiling amount, and those without previous income get a basic amount. Both SA and DP can be granted for part-time (25, 50, or 75% of ordinary working hours) or full-time.
Outcome measures
Using information obtained from the National Social Insurance Agency’s MiDAS database about SA and DP in the two years, we calculated the number of SIA reimbursed net days of SA and/or DP during each of the two years of interest (1998 and 2008 respectively).
Part-time days were then combined, e.g., two days of half-time SA or DP was counted as one net day. Two types of outcomes for work disability were used; having had at least one day of SA or DP or having had SA or DP for >90 days, during the year studied year.
Covariates
In analyses described below, we adjusted for the following individual level characteristics: sex, age (18-29, 30-39, 40-49, 50-59, 60-64), country of birth (Sweden, other Nordic countries, European Union (EU 25) without the Nordic countries, rest of the world), type of place of residency (based on the H-classification scheme [39] collapsed into the following three categories: larger cities including suburbs (H1-H2), medium sized municipalities including suburbs (H3-H4), or smaller municipalities (H5-H6)), highest attained educational level (compulsory school or less i.e., 9 years or less; senior high school i.e., 10-12 years; college/university i.e., 13 years or more), individual disposable household income, categorized into quartiles, and whether or not the individual was living with children under the age of 18. These variables were extracted from LISA.
We also adjusted for HIV-infection as it has been shown that gay and bisexual men experience higher prevalence of HIV infection than heterosexual men and this may contribute to higher work disability rates, apart from the harmful effects of minority stress.
HIV-infection status was obtained from the National Patient Register if it appeared as a main or contributing diagnosis in 1997 or 1998 and in 2007 or 2008, respectively (ICD-10: B20-B24).
This register is held by the National Board of Health and Welfare and includes all individuals admitted to any psychiatric or general hospital since 1973 and has almost complete coverage [40].
From 2001 and onwards, specialized out-patient care is also recorded in this register and hence included when we extracted information on HIV in 2007 and 2008. In Sweden, health care is publicly funded and accessible to all residents for a low fee, resulting in a low financial barrier to seeking medical care.
Statistical Analysis
We compared same-sex married individuals and different-sex married individuals, in 1998 and in 2008, respectively, for the prevalence of having had at least one day with work disability (SA and/or DP) as well as having had that for more than 90 days.
To do so, we performed logistic regression analyses calculating odds ratios (OR) with 95% confidence intervals (CI) for work disability during 1998 and 2008, respectively.
We adjusted for potential confounders in three sequential models: Model 1) Age, country of birth, Model 2) Confounders adjusted for in model 1 with additional adjustment for: type of place of residency, educational level, net income, and living with children, and, for men only, Model 3) Adjustment for confounders in Model 2 with additional adjustment for HIV-infection.
Although formal test of effect modification by sex did not show a significant difference between women and men, separate analyses for women and men were motivated by extensive previous research showing sex differences in risk exposure, such as health-risk behaviors, among sexual minority individuals compared to heterosexuals [41-43].
Results
We identified 1,287 same-sex married individuals between ages 18 and 64 (whereof 34% women) in 1998 and 4,984 same-sex married individuals (whereof 51% women) in 2008 (Tables 1a and 1b).
Women | Men | |||
---|---|---|---|---|
Same-sex married | Different-sex married | Same-sex married | Different-sex married | |
n (%) | n (%) | n (%) | n (%) | |
N | 441 (34) | 1,243977 (52) | 846 (66) | 1,156240 (48) |
Age in years | ||||
-29 | 46 (10) | 85,428 (7) | 62 (7) | 43,658 (4) |
30-39 | 193 (44) | 290,116 (23) | 280 (33) | 242,864 (21) |
40-49 | 138 (31) | 354,186 (29) | 255 (30) | 338,885 (29) |
50-59 | 63 (14) | 377,784 (30) | 210 (25) | 387,702 (34) |
60-64 | 1(0) | 136,022 (11) | 39 (5) | 142,285 (12) |
Country of birth | ||||
Sweden | 364 (83) | 1,039758 (84) | 640 (76) | 975,100 (84) |
Other Nordic country | 29 (7) | 58,175 (5) | 63 (7) | 42,672 (4) |
EU25 except Northern Europe | 12 (3) | 33,267 (3) | 40 (5) | 31,126 (3) |
Rest of the world | 34 (8) | 111,474 (9) | 101 (12) | 105,507 (9) |
Missing | 2 (1) | 862 (0) | 2 (0) | 989 (0) |
Type of place of residency | ||||
Larger cities | 258 (59) | 421,846 (34) | 630 (75) | 396,377 (34) |
Medium sized municipalities | 115 (26) | 445,196 (36) | 154 (18) | 414,406 (36) |
Smaller municipalities | 68 (15) | 376,494 (30) | 62 (7) | 344,611 (30) |
Educational level | ||||
Low ≤9 years | 62 (14) | 292,185 (24) | 119 (14) | 303,755 (26) |
Medium 10-12 years | 180 (41) | 558,810 (45) | 320 (38) | 502,399 (44) |
High ≥13 years | 194 (44) | 372,245 (30) | 385 (46) | 334,032 (29) |
Missing | 5 (1) | 20,296 (2) | 22 (3) | 15,208 (1) |
Income | ||||
Mean net annual incomea | 256 (109) | 315 (1,193) | 288 (141) | 320 (1238) |
1st quartile (%) | 42 | 26 | 33 | 23,8 |
2nd quartile (%) | 26.8 | 24.8 | 20.7 | 25.2 |
3rd quartile (%) | 21,3 | 24.6 | 21.9 | 25.5 |
4th quartile (%) | 10 | 24.5 | 24.5 | 25.5 |
Living with children <18 years of age | ||||
No | 358 (81) | 473,204 (38) | 840 (99) | 413,477 (36) |
Yes | 83 (19) | 770,329 (62) | 6 (1) | 741,913 (64) |
HIV-infectionb | ||||
No | 840 (99) | 1,155353 (100) | ||
Yes | 6 (1) | 41 (0) |
Table 1a: Demographic characteristics, by sex and sexual orientation in 1998. akSek with standard deviations within parenthesis; bOnly men.
Women | Men | |||
---|---|---|---|---|
Same-sex married | Different-sex married | Same-sex married | Different-sex married | |
n (%) | n (%) | n (%) | n (%) | |
N | 2,566 (51) | 1,195309 (52) | 2,418 (49) | 1,108265 (48) |
Age in years | ||||
-29 | 331 (13) | 80,740 (7) | 134 (6) | 43,766 (4) |
30-39 | 997 (39) | 269,062 (23) | 552 (23) | 225,560 (20) |
40-49 | 787 (31) | 322,275 (27) | 876 (36) | 313,130 (28) |
50-59 | 361 (14) | 332,970 (28) | 623 (26) | 327,526 (30) |
60-64 | 90 (4) | 190,262 (16) | 233 (10) | 198,283 (18) |
Country of birth | ||||
Sweden | 2,152 (84) | 936,165 (78) | 1,706 (71) | 880,601 (80) |
Other Nordic country | 135 (5) | 43,821 (4) | 196 (8) | 32,411 (3) |
EU25 except Northern Europe | 97 (4) | 36,200 (3) | 143 (6) | 33,749 (3) |
Rest of the world | 178 (7) | 177, 870 (15) | 369 (15) | 160,100 (14) |
Missing | 4 (0) | 1,253 (0) | 4 (0) | 1,404 (0) |
Type of place of residency | ||||
Larger cities | 1,500 (59) | 443,147 (37) | 1,641 (68) | 416,132 (38) |
Medium sized municipalities | 722 (28) | 423,149 (35) | 516 (21) | 392,375 (35) |
Smaller municipalities | 344 (13) | 329,013 (28) | 261 (11) | 299, 758 (27) |
Educational level | ||||
Low ≤9 years | 170 (7) | 162,898 (14) | 221 (9) | 191,472 (17) |
Medium 10-12 years | 836 (33) | 522,559 (44) | 892 (37) | 500,095 (45) |
High≥13 years | 1,538 (60) | 493,728 (41) | 1,249 (52) | 402,737 (36) |
Missing | 22 (1) | 18,690 (2) | 56 (2) | 16,379 (2) |
Income | ||||
Mean net annual incomea | 446 (681) | 512 (1,886) | 483 (340) | 517 (2,009) |
1st quartile (%) | 35.3 | 25.7 | 32.1 | 24.2 |
2nd quartile (%) | 29 | 25 | 21.8 | 25 |
3rd quartile (%) | 21.7 | 24.7 | 20.6 | 25.4 |
4th quartile (%) | 14 | 24.6 | 25.5 | 25.4 |
Living with children <18 years of age | ||||
No | 1,562 (61) | 460,781 (39) | 2,347 (97) | 402,214 (36) |
Yes | 1,004 (39) | 734,526 (62) | 71 (3) | 706,048 (64) |
HIV-infectionb | ||||
No | 2,236 (93) | 1, 107818 (100) | ||
Yes | 182 (8) | 447 (0) |
Table 1b: Demographic characteristics, by sex and sexual orientation in 2008. akSek with standard deviations within parenthesis; bOnly men.
For both women and men, being in a same-sex marriage was associated with several individual characteristics. Among married women, this included being younger (p<0.001), living in larger cities (p<0.001), having more years of education (p<0.001), having less mean annual income (p<0.001), and being less likely to live with children (p<0.001).
Among men, same-sex married men, as compared to different-sex married men, were more likely to be younger (p<0.001), born outside of Sweden (p<0.001), live in larger cities (p<0.001), have more years of education (p<0.001), have less mean annual income (p<0.001), be less likely to live with children (p<0.001), and be more likely to have HIVinfection (p<0.001).
Among married women in 1998, same-sex married women had higher risk of having at least one day of work disability (OR: 1.48, 95% CI: 1.19-1.84), as compared to different-sex married women (Table 2a).
n (%) | Model 1* | Model 2** | Model 3*** | |
---|---|---|---|---|
WOMEN | ||||
Any SA/DP | ||||
Different-sex married | 187,180 (15) | 1 (ref) | 1 (ref) | |
Same-sex married | 92 (21) | 1.6 (1.28-1.97) | 1.5 (1.19-1.84) | |
SA/DP >90 days | ||||
Different-sex married | 56,526 (5) | 1 (ref) | 1 (ref) | |
Same-sex married | 29 (7) | 1.7 (1.31-2.33) | 1.6 (1.19-2.13) | |
MEN | ||||
Any SA/DP | ||||
Different-sex married | 111,446 (10) | 1 (ref) | 1 (ref) | 1 (ref) |
Same-sex married | 107 (13) | 1.7 (1.42-2.01) | 2.0 (1.65-2.36) | 2.0 (1.62-2.32) |
SA/DP >90 days | ||||
Different -sex married | 35,170 (3) | 1 (ref) | 1 (ref) | 1 (ref) |
Same-sex married | 43 (5) | 2.2 (1.75-2.71) | 2.6 (2.09-3.26) | 2.6 (2.04-3.19) |
Table 2a: Prevalence of sickness absence (SA) and disability pension (DP) among same-sex married individuals in 1998, as compared to differentsex married individuals, expressed as odds ratios (ORs) with 95% confidence intervals (CI), by sex. * Model 1: Crude, adjusted for age, country of birth. **Model 2: Additional adjustments for: Place of residency, educational level, net income, and living with children. ***Model 3: Additional adjustment for: HIV-infection (men only).
They were also at greater risk of being work disabled for more than 90 days (OR: 1.59, 95% CI: 1.19-2.13), as compared to different-sex married women. Similar differences were found among men. Same-sex married men, as compared to different-sex married men, had higher risk for having had at least one day of work disability (OR: 1.97, 95% CI: 1.65-2.36) as well as for being work disabled for more than 90 days (OR: 2.61, 95% CI: 2.09-3.26).
When additional adjustment was made for HIV-infection, the estimates were only slightly attenuated for same-sex married men (OR: 1.94, 95% CI: 1.62-2.32) for at least one day of work disability and (OR: 2.55, 95% CI: 2.04-3.19) for being work disabled for more than 90 days. Ten years later, in 2008, the work disability prevalence was somewhat lower among married persons in Sweden. Nevertheless, same-sex married women remained at greater risk than different-sex married women for at least one day of work disability (OR: 1.30, 95% CI: 1.15-1.47) and for being work disabled for more than 90 days (OR: 1.48, 95% CI: 1.31-1.66) (Table 2b).
n (%) | Model 1* | Model 2** | Model 3*** | |
---|---|---|---|---|
WOMEN | ||||
Any SA/DP | ||||
Different-sex married | 153,897 (13) | 1 (ref) | 1 (ref) | |
Same-sex married | 403 (16) | 1.3 (1.19-1.43) | 1.3 (1.15-1.47) | |
SA/DP >90 days | ||||
Different-sex married | 47,596 (4) | 1 (ref) | 1 (ref) | |
Same-sex married | 111 (4) | 1.3 (1.15-1.47) | 1.5 (1.31-1.66) | |
MEN | ||||
Any SA/DP | ||||
Different-sex married | 89,829 (8) | 1 (ref) | 1 (ref) | 1 (ref) |
Same-sex married | 208 (9) | 1.4 (1.25-1.56) | 1.6 (1.45-1.83) | 1.5 (1.31-1.66) |
SA/DP >90 days | ||||
Different-sex married | 27,869 (3) | 1 (ref) | 1 (ref) | 1 (ref) |
Same-sex married | 75 (3) | 1.7 (1.48-1.92) | 2.0 (1.74-2.28) | 1.8 (1.52-2.02) |
Table 2b: Prevalence of sickness absence (SA) and disability pension (DP) among same-sex married individuals in 2008, as compared to differentsex married individuals, expressed as odds ratios (ORs) with 95% confidence intervals (CI), by sex. * Model 1: Crude, adjusted for age, country of birth. **Model 2: Additional adjustments for: Place of residency, educational level, net income, and living with children. ***Model 3: Additional adjustment for: HIV-infection (men only).
Again, a similar pattern was observed among men where same-sex married men revealed elevated risks for at least one day of work disability (OR: 1.63, 95% CI: 1.45-1.83).
As well as for being work disabled for more than 90 days (OR: 1.99, 95% CI: 1.74-2.28), as compared to different-sex married men. When additional adjustment was made for HIV-infection (men only) the estimates were only slightly attenuated.
Discussion
Although there is a myriad of studies linking health disadvantages to minority sexual orientation [1,3,4,6], it is still not clear to what extent these health disadvantages and disabilities have psychosocial consequences in terms of work disability. The few prior studies have solely studied “disability” and not work disability, and they have relied upon self-reported data, entailing risk of recall bias and misclassifications [11,14].
In the current study we capitalized on Sweden’s nationwide registers and studied work disability prevalence, measured as SA and DP, among same-sex married women and men, as compared to different-sex married women and men, during two different time points ten years apart; 1998 and 2008.
This study revealed a substantial higher risk of work disability among same-sex married individuals both in 1998 and in 2008, as compared to different-sex married individuals. Same-sex married women had excess risk for at least one day of work disability as well as for being work disabled for more than 90 days. The same was shown for same-sex married men when compared to different-sex married men. When additional adjustment was made for HIV-infection among men, the estimates were only slightly attenuated. However, we could not establish a decrease in the excess risk among same-sex married individuals between the two time points.
As a large body of literature has shown psychological distress to be more prevalent in sexual minority individuals, the higher risk for work disability found in our study is also what we hypothesized.
A recent Swedish study showed that those with psychological stress in relation to daily activities had higher risk of DP [19]. Sexual minority individuals have repeatedly been shown to experience higher rates of everyday stress due to so called minority stress [24], which is in line with our findings of higher risk for work disability.
The concept “minority stress” was first introduced by Meyer [24], and contains prejudice events, expectations of rejection, hiding and concealing of one’s sexual identity, internalized homophobia, and ameliorative coping processes. As stress is a contributing factor in much morbidity [36], it is not a stretch to assume that the excess stress experienced by, at least some, LGB individuals contributes to their higher risk for work disability.
Extensive research has shown that marriage is protective for health and longevity [44-47]. This is theoretically explained by processes related to social selection and social causation [48]. The social selection hypothesis posits that better-adjusted, healthier individuals become and remain married. The social causation hypothesis on the other hand, suggests that something about marriage causes positive changes and/or protects against negative changes in mental or somatic health.
It has been shown that intimate relationships may be especially important for individuals who find themselves outside the norm and often in compromised social positions [49]. One could, therefore, assume that LGB individuals would benefit more than others from being in a stable relationship. Our study contains no data on the sexual orientation of non-married individuals and can thus not test these associations. Future studies are thus warranted.
The prevalence of work disability among different-sex married women and men in Sweden was higher in 1998 than in 2008 (Tables 2a and 2b). In crude numbers the difference in prevalence between different-sex married and same-sex married was less in 2008 as compared to in 1998. In contrast to what we hypothesized, we could however not detect an actual decrease in the excess risk among samesex married individuals between 1998 and 2008.
This despite the increased social acceptance towards sexual minority individuals observed in recent years [37].
When adjusting for all covariates additional adjustment for HIVinfection among men did not affect same-sex married men’s risk of work disability. This was witnessed both in 1998 and in 2008.
Further, our data also replicate the common finding of more elevated morbidity in terms of work disability among women than among men (Tables 2a and 2b). This holds regardless of sexual orientation of the married individuals. Similar sex differences have been reported for the general population in other studies [50].
The strengths of this study include the population-based design, that all, not a sample, were included, the large number of same-sex married individuals, and the use of high-quality and nationwide register data with high completeness and validity. Thus, no selfreported data was used, i.e., eliminating recall bias, and missing data was uncommon. We were able to control for factors related to relationship status and health in our models, particularly socioeconomic position in terms of educational level and disposable household income, but also age, country of birth, type of place of residence, whether children were living in the household, and HIV infection among men.
However, this study also has some limitations that need to be addressed. First, we only included married LGB individuals in this study our results can therefore not be generalized to all LGB people. Second, there may be other cofounding factors that we did not adjust for in these analyses.
As the SA and DP data cover reimbursements from the National Social Insurance Agency, most sick-leave spells lasting less than 15 days were hence not included. However those with recurrent diseases as well as those unemployed, had benefits paid by the Social Insurance Agency from the first or second day of work disability, which means that they might have been overrepresented in the analyses.
In conclusion, this study provides new results that same-sex married women and men have higher risk for work disability as compared to different-sex married women and men. This finding calls for more research regarding the underlying mechanism leading to these observed differences based on sexual orientation, as well as for tailored prevention strategies both in clinical settings and on a broader societal level, directed at same-sex married women and men.
Ethical Approval
The project was approved by the Regional Ethical Review Board in Stockholm, Sweden.
References
- Bostwick WB, Boyd CJ, Hughes TL, McCabe SE (2010) Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. Am J Public Health 100: 468-475.
- Cochran SD, Grella CE, Mays VM (2012) Do substance use norms and perceived drug availability mediate sexual orientation differences in patterns of substance use? Results from the California Quality of Life Survey II. J Stud Alcohol Drugs 73: 675-685.
- Cochran SD, Mays VM (2009) Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey. J AbnormPsychol 118: 647-658.
- Cochran SD, Mays VM (2012) Risk of breast cancer mortality among women cohabiting with same sex partners: findings from the National Health Interview Survey, 1997-2003. Journal of Women's Health 21:528-533.
- Gruskin EP, Greenwood GL, Matevia M, Pollack LM, Bye LL (2007) Disparities in smoking between the lesbian, gay, and bisexual population and the general population in California. Am J Public Health 97: 1496-1502.
- Lick DJ, Durso LE, Johnson KL (2013) Minority Stress and Physical Health Among Sexual Minorities. PerspectPsycholSci 8: 521-548.
- Yancey AK, Cochran SD, Corliss HL, Mays VM (2003) Correlates of overweight and obesity among lesbian and bisexual women. Prev Med 36: 676-683.
- Boehmer U, Miao X, Linkletter C, Clark MA (2012) Adult health behaviors over the life course by sexual orientation. Am J Public Health 102: 292-300.
- Case P, Austin SB, Hunter DJ, Willett WC, Malspeis S, et al. (2006) Disclosure of sexual orientation and behavior in the Nurses' Health Study II: results from a pilot study. J Homosex 51: 13-31.
- Zaritsky E, Dibble SL (2010) Risk factors for reproductive and breast cancers among older lesbians. J Womens Health (Larchmt) 19: 125-131.
- (1999) Law (1999:133) prohibiting employment discrimination based on sexual orientation.
- (2003) Law (2002:800) concerning additions to the provision on hate speech.
- Hooghe M (2012) Is sexual well-being part of subjective well-being? An empirical analysis of Belgian (Flemish) survey data using an extended well-being scale. J Sex Res 49: 264-273.
- Alexanderson K, Norlund A (2004) Swedish Council on Technology Assessment in Health Care (SBU). Chapter 1. Aim, background, key concepts, regulations, and current statistics. Scand J Public Health Suppl 63: 12-30.
- Alexanderson K, Norlund A (2004) Swedish Council on Technology Assessment in Health Care (SBU). Chapter 12. Future need for research. Scand J Public Health Suppl 63: 256-258.
- Allebeck P, Mastekaasa A (2004) Swedish Council on Technology Assessment in Health Care (SBU). Chapter 5. Risk factors for sick leave - general studies. Scand J Public Health Suppl 63: 49-108.
- Steenstra IA, Verbeek JH, Heymans MW, Bongers PM (2005) Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature. Occup Environ Med 62: 851-860.
- Ropponen A, Svedberg P, Koskenvuo M, Silventoinen K, Kaprio J (2014) Physical work load and psychological stress of daily activities as predictors of disability pension due to musculoskeletal disorders. Scand J Public Health 42: 370-376.
- Mittendorfer-Rutz E, Harkanen T, Tiihonen J (2014)Association of socio-demographic factors, sick-leave and health care patterns with the risk of being granted a disability pension among psychiatric outpatients with depression. PloSOne 9:e99869.
- Stapelfeldt C, Vinther Nielsen C, Trolle Andersen N (2014) Sick leave patterns as predictors of disability pension or long-term sick leave: A 6.75-year follow-up study in municipal eldercare workers. Occupational and Environmental Medicine 71:A78.
- Björkenstam C, Alexanderson K, Björkenstam E, Lindholm C, Mittendorfer-Rutz E (2014) Diagnosis-specific disability pension and risk of all-cause and cause-specific mortality--a cohort study of 4.9 million inhabitants in Sweden. BMC Public Health 14: 1247.
- Bjorkenstam E, Weitoft GR, Lindholm C (2014) Associations between number of sick-leave days and future all-cause and cause-specific mortality: a population-based cohort study. BMC Public Health 14:733.
- Meyer IH (2003) Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 129: 674-697.
- Newcomb ME, Mustanski B (2010) Internalized homophobia and internalizing mental health problems: a meta-analytic review. Clinical Psychology Review 30: 1019-1029.
- Balsam KF, Rothblum ED, Beauchaine TP (2005) Victimization over the life span: a comparison of lesbian, gay, bisexual, and heterosexual siblings. J Consult ClinPsychol 73: 477-487.
- Hatzenbuehler ML, McLaughlin KA, Keyes KM (2010) The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: a prospective study. AmericanJournal of Public Health 100:452-459.
- Lewis NM (2009) Mental health in sexual minorities: recent indicators, trends, and their relationships to place in North America and Europe. Health &Place 15:1029-1045.
- Cochran SD, Mays VM, Sullivan JG (2003) Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J Consult ClinPsychol 71: 53-61.
- Frisell T, Lichtenstein P, Rahman Q, Långström N (2010) Psychiatric morbidity associated with same-sex sexual behaviour: influence of minority stress and familial factors. Psychol Med 40: 315-324.
- King M, Semlyen J, Tai SS, Killaspy H, Osborn D, et al. (2008) A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 8: 70.
- Kuyper L, Fokkema T (2011) Minority stress and mental health among Dutch LGBs: examination of differences between sex and sexual orientation. J CounsPsychol 58: 222-233.
- Blosnich JR, Andersen JP (2015) Thursday's child: the role of adverse childhood experiences in explaining mental health disparities among lesbian, gay, and bisexual U.S. adults. Soc Psychiatry PsychiatrEpidemiol 50:335-338.
- Seil KS, Desai MM, Smith MV (2014) Sexual orientation, adult connectedness, substance use, and mental health outcomes among adolescents: findings from the 2009 New York City Youth Risk Behavior Survey. Am J Public Health 104: 1950-1956.
- Hooghe M,Meeusen C (2013) Is Same-Sex Marriage Legislation Related to Attitudes Toward Homosexuality? Trends in Tolerance of Homosexuality in European Countries between 2002 and 2010. Sex Res Soc Policy10:258-268.
- (2015) Norwegian Social Science Data Services. European Social Survey Round 1-7 Data, 2002-2014.
- Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A (2009) The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol 24: 659-667.
- Sweden S (2003)Riketsindelningar: årsboköverregionalaindelningar med koder, postadresser, telefonnummer m m. 2003 [Country classifications: yearbook of regional classifications with codes, postal addresses, phone numbers etc. 2003] Statistics Sween.
- Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, et al. (2011) External review and validation of the Swedish national inpatient register. BMC Public Health 11: 450.
- Austin SB, Ziyadeh N, Fisher LB, Kahn JA, Colditz GA, et al. (2004) Sexual orientation and tobacco use in a cohort study of US adolescent girls and boys. Arch PediatrAdolesc Med 158: 317-322.
- Branstrom R, Hatzenbuehler ML, Pachankis JE (2015) Sexual orientation disparities in physical health: age and gender effects in a population-based study. Social Psychiatry and Psychiatric Epidemiology.
- Trocki KF, Drabble L, Midanik L (2005) Use of heavier drinking contexts among heterosexuals, homosexuals and bisexuals: results from a National Household Probability Survey. J Stud Alcohol 66: 105-110.
- Hughes ME, Waite LJ (2009) Marital biography and health at mid-life. J Health SocBehav 50: 344-358.
- Johnson NJ, Backlund E, Sorlie PD, Loveless CA (2000) Marital status and mortality: the national longitudinal mortality study. Ann Epidemiol 10: 224-238.
- Wade TJ, Pevalin DJ (2004) Marital transitions and mental health. J Health SocBehav 45: 155-170.
- Willitts M1, Benzeval M, Stansfeld S (2004) Partnership history and mental health over time. J Epidemiol Community Health 58: 53-58.
- Horn EE, Xu Y, Beam CR (2013) Accounting for the physical and mental health benefits of entry into marriage: a genetically informed study of selection and causation. JFP 27:30-41.
- Mays VM, Cochran SD (2001) Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health 91: 1869-1876.
- Mittendorfer-Rutz E, Kjeldgard L, Runeson B (2012) Sickness absence due to specific mental diagnoses and all-cause and cause-specific mortality: a cohort study of 4.9 million inhabitants of Sweden. PloSOne 7:e45788.
Citation: Bjorkenstam C, Tinghög P, Cochran S, Andersson G, Alexanderson K, et al. (2016) Is Work Disability More Common among Same-sex than Different-sex Married People?. Epidemiology (Sunnyvale) 6:242. DOI: 10.4172/2161-1165.1000242
Copyright: © 2016 Bjorkenstam C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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