Trajectories of work absence in England due to a musculoskeletal or mental health condition: an electronic health record cohort study

Purpose To derive common patterns (trajectories) of work absence over time due to a musculoskeletal (MSK) or mental health (MH) condition in an English population and determine associations of these absence trajectories with health and sociodemographic characteristics. Methods This retrospective cohort study used primary care data for 43,130 and 62,355 economically active individuals with an incident work absence (as measured by receipt of fit notes) due to a MSK or MH condition, respectively, between 2016–2018. Latent class growth analysis was used to define trajectories (through issuance of fit notes), and trajectory-covariate association analysis performed through multivariable multinomial logistic regression. Results Five common trajectories of work absence associated with MSK and MH conditions were determined over a one-year follow-up. The two most common trajectories consisted of low absence (a ‘Single’ fit note and ‘Short Term’ absence), whilst the two least common trajectories were characterised by longer-term absence of six months or more (‘Chronic Sustained’ and ‘Chronic Fast Decreasing’), and the fifth by intermittent absence. Individuals associated with the two longer-term absence trajectories were: older, living in the North or Midlands or most deprived areas of England, prescribed opioids, and current smokers. Conclusions This study has highlighted different patterns of sickness absence due to a MSK or MH condition and profiles of individuals associated with longer-term absence. Earlier and more targeted health and work intervention towards these high-risk subgroups, alongside policy interventions to reduce health inequalities, could help alleviate the rising rate of long-term sickness absence and economic inactivity.