Investigating relationships between sickness absence rate, level of education and immigrant status

Abstract

Introduction: The rate of sickness absence is one of the greatest concerns in the developed countries especially because long-term sickness absence was associated with negative impacts on individual health, increased risk for permanent disability, and exclusion from the labor market. According to previous literature, long-term sickness absence, permanent work disability, and disability pension were found to be higher among immigrants compared to natives. Aim: To investigate if the proportion of immigrants in the municipalities from Västra Götland’s Region has a relationship with the level of sickness absence and if this relation remains unchanged if immigrants’ level of education is considered. Methods: An ecological study design was adopted, using data of 2019 from Statistics Sweden (SCB) and the Swedish Social Insurance Agency (Försäkringskassan). The study is based on the Region Västra Götland from Sweden, and it includes 49 municipalities. The main group of interest is the immigrants’ group who are persons born outside Sweden and have non-Swedish parents. Simple and multiple regression models were utilized to investigate if the proportion of immigrants influences the level of sickness absence and if changes occur when considering immigrants’ level of education. Within the analyses, we controlled for some confounding factors such as sex (proportion of females), age, household size, average income, population density and proportion of divorced persons. Results: There was a statistically significant relationship between sickness absence rate and immigrant status, but there was not found a significant relationship between sickness absence and education. Thus 1 unit increase in proportion immigrants reduces by 1.4% sickness absence while education level is not considered. However, the estimated effect increased to 1.6% when we accounted for education level. Conclusion: Surprisingly, in Region Västra Götland, the high number of immigrants contributes to the decrease of the sickness absence rate. This result could be due to the sickness presenteeism or to the healthy immigrant effect. The statistically insignificant relation of the level of education on the sickness absence rate may indicate a mismatch between education and job of the immigrants, but also a lack of adjustment to the labor market and society.