77 Inability to work fulltime, prevalence and associated factors that energy deficit is seen as an important reason to limit the ability to work fulltime [16]. Additionally, some diseases cause limitations in available time to work, for example through part-time psychotherapy in a clinic for mental diseases, or dialysis in kidney disease and thus result in inability to work fulltime. To be able to draw conclusions on which diseases attribute the highest to being assessed with inability to work fulltime, population attributable fractions were calculated. The disease groups with the highest population attributable fraction were neoplasms (5.2%) and diseases of the circulatory system (4.6%). These percentages are relatively low, from which we can conclude that being assessed with an inability to work fulltime is not attributable to one or two specific disease groups. Diseases of the musculoskeletal system, however, showed a highly negative percentage (− 19.3%) indicating being a protective fraction to the outcome. The findings in the present study show that the disease the person has, does seem to be important in terms of their ability to work fulltime, as the association between disease groups and inability to work fulltime varies between disease groups. In addition, there are some diseases associated with long term disability but not with an inability to work fulltime, such as musculoskeletal diseases. These diseases are usually more likely associated with physical work limitations and less likely with energy deficits. Our findings indicate that assessors of inability to work fulltime should be aware that various disease groups have higher odds for inability to work fulltime (i.e. diseases of the blood, neoplasms, diseases of the respiratory system) as well that one of the largest disease groups, diseases of the musculoskeletal system, shows a lower risk of inability to work fulltime in applicants who mostly could not fully resume their original work 2 years after sick leave. Furthermore, the population attributable fractions show that being assessed with inability to work fulltime could not be attributed to one specific disease whereas none of the disease groups showed a high proportion of the outcome. Future studies on the risk of individual diseases on inability to work fulltime could help to identify which applicants are at risk for inability to work fulltime, even earlier than at 2 years after sick leave. Our finding in the total sample, showing a higher risk for inability to work fulltime for multimorbidity, is in line with previous studies [24, 25]. Our findings in the specific disease groups showed that in those disease groups with low risk of inability to work fulltime (such as diseases of the skin and musculoskeletal diseases) multimorbidity increases the risk of inability to work fulltime. Vice versa, in diseases with higher risk of inability to work fulltime (e.g. diseases of the blood and the nervous, respiratory and genitourinary system) multimorbidity lowered the odds for inability to work fulltime. This latter seems counter intuitive, and was therefore discussed with insurance physicians. Insurance physicians indicated that when assessing applicants with severe diseases it is clear that the impact of that disease itself on 4
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