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Background Multiple sclerosis (MS) may affect the individual’s working life. We aimed to 1) investigate the mean levels and distributions of earnings among people with MS (PwMS) before and after MS diagnosis compared to people without an MS diagnosis, and whether such differences in earnings were associated with educational level or occupation and 2) assess the prevalence of sickness absence (SA) and disability pension (DP). Methods Population-based cohort study (10 years prior to 5 years after MS diagnosis) using microdata linked from nationwide Swedish registers of all individuals aged 30-54 with MS diagnosed in 2003-2006 (n = 2553) and references without MS (n = 7584) randomly selected by stratified matching (sex and age). Annual mean earnings, by educational level and type of occupation, were compared with t-tests. Tobit regressions investigated the associations of earnings with individual characteristics. Lastly, the proportions on SA and DP, stratified by educational level and type of occupation, were examined in the diagnosis year and 5 years later. Results Differences in earnings between PwMS and references were observed beginning one year prior to diagnosis and increased with time. PwMS had lower mean earnings for the diagnosis year (difference=SEK 28,000, p-value&amp;lt;0.05), and the difference had more than doubled (p-value&amp;lt;0.05) 5 years later. These differences remained after taking educational level and type of occupation into account. PwMS with university education and/or more qualified occupations had mean earnings most like their respective references’. PwMS had higher prevalence of SA and DP than the references, in both the diagnosis year and 5 years later. Conclusions Earnings of people with MS were lower than references’ already one year before diagnosis, and the gap increased thereafter. Results indicate that educational level and type of occupation are of importance for earnings. Moreover, SA and DP were more common among people with MS. Key messages Our results indicate that working-aged people with MS have less earnings than references already one year before diagnosis and that thereafter this gap in earnings increases with time. Education and occupation were influential in explaining the people with MS’ heterogeneous earnings, with a hierarchal ordering of who maintained similar earnings to their respective peers.

Earnings among people with multiple sclerosis in Sweden, by education and occupation