Abstract
OBJECTIVES: To investigate whether seafarers in Norway who were declared unfit for service at sea or received a time-limited health certificate had a higher risk of acute somatic hospital admissions compared with those who received a full health certificate. DESIGN: Registry-based cohort study. SETTING: Seafarers in Norway who presented to a seafarer's doctor to obtain a health certificate between 2018 and 2019, as required for work aboard Norwegian vessels. The study was conducted within Norway's publicly funded healthcare system. PARTICIPANTS: Norwegian seafarers aged 18-70 years who underwent medical examinations (n=43 758), including n=5452 females (12.5%). OUTCOME MEASURES: Acute somatic hospital admission within 2 years of medical examination. HRs were estimated using Cox regression models in two separate time periods (0-3 months and 3-24 months), with adjustment for possible confounding from age, gender, level of education and centrality of residence (proximity to healthcare services). RESULTS: The crude risk of acute somatic hospital admissions was higher for individuals who received a declaration of unfitness, as compared with those who received a full health certificate, in both follow-up periods: 0-3 months (HR=5.13, 95% CI: 3.27 to 8.04) and 3-24 months (HR=2.63, 95% CI: 2.07 to 3.34). Similarly, those with time-limited health certificates had a higher risk in both periods: 0-3 months (HR=2.02, 95% CI: 1.39 to 2.93) and 3-24 months (HR=2.45, 95% CI: 2.15 to 2.79). Adjustment of the analyses for socio-demographic factors did not change the effect estimates substantially. CONCLUSION: These findings highlight the importance of comprehensive and continuous health assessments to help prevent adverse health outcomes and ensure safety at sea, particularly among vulnerable subgroups of seafarers.