Affiliations: [a] Center for Clinical Research Västmanland, Uppsala University, Västerås, Sweden | [b] Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden | [c] Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Unit, Uppsala University, Uppsala, Sweden
Correspondence:
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Corresponding author: Monica Löfvander, Center for Clinical Research, Hospital of Vastmanland Vasteras, Region Vastmanland, Uppsala University, Sweden, SE-72189 Västerås, Sweden. Tel.: +46 721530440; Fax: +46 2117373; E-mail: Monica.Lofvander@regionvastmanland.se.
Abstract: BACKGROUND: Mortality rates among immigrant patients undergoing rehabilitation for musculoskeletal backache are unknown. OBJECTIVE: To study the association between marital status, severe psychosocial strain, receiving long-term time-limited sickness allowance (TLSA) and all-cause mortality (ACM) in a cohort of immigrants aged 20–45 years with long-standing backache in Sweden. METHODS: We studied 318 patients (92% foreign-born, 76% non-European) of known marital status on sick-leave for musculoskeletal backache. They were followed up for ACM until 2015. Socio-demographic data, TLSA and psychosocial strain, including major depression, severe psychosocial stressors and pessimistic thoughts, were analysed using multiple-imputation Cox regression. RESULTS: Over a mean (standard deviation) follow-up time of 15 (5.0) years, 11 (3.5%) participants died. At baseline, 34% were unmarried, 19% were receiving TLSA, and 71% had ⩾ 1 psychosocial strain component (38% depression; 47% severe stressors; 35% pessimistic thoughts). After concomitant risk factors were adjusted for, being unmarried and receiving TLSA were associated with higher mortality by factors of 6.2 (p= 0.005) and 5.8 (p= 0.006), respectively. Psychosocial strain was only significantly associated with higher mortality in the unadjusted analyses. CONCLUSIONS: Being unmarried and receiving TLSA were associated with significantly higher ACM in this highly marginalized group of immigrant patients.
