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瑞典的国家病假补贴是全球最慷慨的病假补贴之一，雇员病假2～14天由雇主支付相当于雇员本人工资80%的病假工资，病假14天后由社会保险机构支付相当于雇员本人工资80%的病假补贴，病假后450天内最多可申请364天病假补贴。不过，瑞典病假补贴不断超出国家预算，这使乌托邦也不得不考虑对该政策进行调整。那么，乳腺癌诊断后病假和病假补贴是否过多？ 2017年6月20日，美国临床肿瘤学会《临床肿瘤学杂志》正式发表瑞典卡罗林学院的研究报告，对乳腺癌女性与非乳腺癌女性的诊断特定病假和病假补贴进行了比较，并调查了乳腺癌患者疾病与社会人口学因素的相关性。
该人群前瞻队列研究根据2005年首次被诊断为乳腺癌的3547例瑞典女性（年龄20～65岁）以及匹配对照队列（14188人）纵向登记数据，分析了至少5年的每年诊断特定病假发生率和病假补贴率。使用逻辑回归分析乳腺癌女性疾病相关和社会人口学因素与病假和病假补贴的相关性。 结果发现，女性诊断为乳腺癌后第1～5年病假比例递减，分别为71%、40%、30%、22%、19%。相比之下，非乳腺癌女性分别为17%→11%。乳腺癌病假率较高的主要原因确实为乳腺癌，而非心理问题或其他躯体问题。诊断时为晚期癌症、诊断前已病假＞90天、教育程度低、出生于瑞典以外与病假率和病假补贴率较高有相关性（比值比范围：1.40～6.45）。 因此，诊断后第一年，乳腺癌女性病假骤增，随后几年达到非乳腺癌女性水平；然而，即使在第一年，大多数女性并未长时间病假，甚至在高风险人群中，许多女性随后几年未申请病假或病假补贴。关于乳腺癌女性病假和病假补贴水平相对较低的信息，可供患者规划工作时以及医疗专业人员和社会保险官员参考。雇主和职业健康服务部（相当于中国的人力资源和社会保障部）需要参考这些信息适当处理工作场所调整。 J Clin Oncol. 2017 Jun 20;35(18):2044-2052. Sickness Absence and Disability Pension After Breast Cancer Diagnosis: A 5-Year Nationwide Cohort Study. Kvillemo P, Mittendorfer-Rutz E, Branstrom R, Nilsson K, Alexanderson K. Karolinska Institutet, Stockholm, Sweden. PURPOSE: To explore future diagnosis-specific sickness absence and disability pension among women with breast cancer compared with women without breast cancer. Also, to examine associations with disease-related and sociodemographic factors among those with breast cancer. METHODS: Longitudinal register data on 3,547 women living in Sweden (age 20 to 65 years) who were first diagnosed with breast cancer in 2005, and a matched comparison cohort (n = 14,188), were analyzed for the annual prevalence of diagnosis-specific sickness absence and disability pension over 5 years. Logistic regressions were used to explore associations of disease-related and sociodemographic factors with future sickness absence and disability pension among women with breast cancer. RESULTS: Immediately after being diagnosed with breast cancer, the proportion of women with sickness absence was high but decreased continuously from the 1st through 5th year after diagnosis (71%, 40%, 30%, 22%, and 19%, respectively). In comparison, the range for women without breast cancer was 17% to 11%, respectively. The higher prevalence of sickness absence after breast cancer was mainly a result of breast cancer diagnosis, not a mental diagnosis, or other somatic diagnoses. Advanced cancer at diagnosis, > 90 days sickness absence before diagnosis, low education, and being born outside Sweden were associated with higher odds ratios for sickness absence and disability pension (odds ratio range, 1.40 to 6.45). CONCLUSION: The level of sickness absence increased substantially in women with breast cancer during the first year after diagnosis and approached the level of breast cancer-free women in the following years; however, even in the first year, most women were not on sickness absence for a substantial time, and even in high-risk groups, many were not on sickness absence or disability pension in the following years. Information about relatively low future sickness absence and disability pension levels can be used by patients when planning their work, by health care professionals, and by social insurance officers. Employers and Occupational Health Services need this information to adequately handle workplace adjustments. PMID: 28459607 DOI: 10.1200/JCO.2015.66.0613 |
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