Social determinants of disability pension: a 10-year follow-up of 62 000 people in a Norwegian county population

Cohort Profile: the HUNT Study, Norway

The HUNT Study includes large total population-based cohorts from the 1980ies, covering 125 000 Norwegian participants; HUNT1 (1984-86), HUNT2 (1995-97) and HUNT3 (2006-08). The study was primarily set up to address arterial hypertension, diabetes, screening of tuberculosis, and quality of life. However, the scope has expanded over time. In the latest survey a state of the art biobank was established, with availability of biomaterial for decades ahead. The three population based surveys now contribute to important knowledge regarding health related lifestyle, prevalence and incidence of somatic and mental illness and disease, health determinants, and associations between disease phenotypes and genotypes. Every citizen of Nord-Trøndelag County in Norway being 20 years or older, have been invited to all the surveys for adults. Participants may be linked in families and followed up longitudinally between the surveys and in several national health- and other registers covering the total population. The HUNT Study includes data from questionnaires, interviews, clinical measurements and biological samples (blood and urine). The questionnaires included questions on socioeconomic conditions, health related behaviours, symptoms, illnesses and diseases. Data from the HUNT Study are available for researchers who satisfy some basic requirements (www.ntnu.edu/hunt), whether affiliated in Norway or abroad.

Working conditions as risk factors for disability retirement: a longitudinal register linkage study

BACKGROUND

Early retirement due to disability is a public health and work environment problem that shortens working careers. Transition to disability retirement is based on ill-health, but working conditions are also of relevance. We examined the contributions of work arrangements, physical working conditions and psychosocial working conditions to subsequent disability retirement.

METHODS

The data were derived from the Helsinki Health Study cohort on employees of the City of Helsinki, Finland. Information on working conditions was obtained from the baseline surveys conducted in 2000, 2001 and 2002. These data were linked with register data on disability retirement and their main diagnoses obtained from the Finnish Centre for Pensions. Follow up by the end of 2008 yielded 525 disability retirement events. The analysed data included 6525 participants and 525 disability retirement events. Hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated from Cox regression analysis.

RESULTS

Several working conditions showed own associations with disability retirement before adjustment. After adjustment for all working conditions, the primary risk factors for all-cause disability retirement were physical workload among women (HR 2.02, 95% CI 1.57-2.59) and men (HR 2.00, 95% CI 1.18-3.38), and low job control among women (HR 1.60, 95% CI 1.29-1.99). In addition, for disability retirement due to musculoskeletal causes, the risk factors were physical workload and low job control. For disability retirement due to mental causes the risk factors were computer work and low job control. Furthermore, occupational class was a risk factor for disability retirement due to all causes and musculoskeletal diseases.

CONCLUSIONS

Among various working conditions, those that are physically demanding and those that imply low job control are potential risk factors for disability retirement. Improving the physical working environment and enhancing control over one's job is likely to help prevent early retirement due to disability.

Can high psychological job demands, low decision latitude, and high job strain predict disability pensions? A 12-year follow-up of middle-aged Swedish workers

OBJECTIVES

The aim of this study was to investigate whether job strain, psychological demands, and decision latitude are independent determinants of disability pension rates over a 12-year follow-up period.

METHODS

We studied 3,181 men and 3,359 women, all middle-aged and working at least 30 h per week, recruited from the general population of Malmö, Sweden, in 1992. The participation rate was 41 %. Baseline data include sociodemographics, the Job Content Questionnaire, lifestyle, and health-related variables. Disability pension information was obtained through record linkage from the National Health Insurance Register.

RESULTS

Nearly 20 % of the women and 15 % of the men were granted a disability pension during the follow-up period. The highest quartile of psychological job demands and the lowest quartile of decision latitude were associated with disability pensions when controlling for age, socioeconomic position, and health risk behaviours. In the final model, with adjustment also for health indicators and stress from outside the workplace, the hazard ratios for high strain jobs (i.e. high psychological demands in combination with low decision latitude) were 1.5 in men (95 % CI, 1.04-2.0) and 1.7 in women (95 % CI, 1.3-2.2). Stratifying for health at baseline showed that high strain tended to affect healthy but not unhealthy men, while this pattern was reversed in women.

CONCLUSIONS

High psychological demands, low decision latitude, and job strain were all confirmed as independent risk factors for subsequent disability pensions. In order to increase chances of individuals remaining in the work force, interventions against these adverse psychosocial factors appear worthwhile.

A cohort study of permanently reduced work ability in breast cancer patients

PURPOSE

The aims of this cohort study were to explore various longitudinal aspects of employment and disability pension due to permanently reduced work ability among women with breast cancer and to investigate the impact of breast cancer on income.

PATIENTS AND METHODS

In a national register-based controlled cohort study from Norway, 1,548 women diagnosed with breast cancer (all stages) between 1992 and 1996 at the age 45-54 years and 1,548 cancer-free women matched for age, municipality and civil status were followed for up to 14 years. Medical data from the Cancer Registry of Norway were linked with longitudinal data on employment, social security benefits and socio-demography collected from other national official registries.

RESULTS

Compared to cancer-free controls, breast cancer patients were significantly more likely to receive disability pension (hazard ratio (HR) 2.7, 95% CI 2.3-3.2) after adjustment for unmatched socio-demographic variables (education, income and children <18 years in the household). Adjusted HR in breast cancer stage I patients was 1.8 (95% CI 1.5-2.3) and 3.0 (95% CI 2.4-3.8) in stage II/III patients compared to controls. The risk increased with mastectomy compared to breast-conserving surgery (HR 1.5, 95% CI 1.2-1.9). At the end of the observation period, employment rates were higher in non-disabled patients than in non-disabled controls (82% vs. 77%, p = 0.008). Working breast cancer patients experienced a temporary negative effect on employment income.

CONCLUSION

A considerable proportion of women with breast cancer will over time experience permanently reduced work ability and become disability pension holders. In case of reduced work ability in breast cancer survivors, medical personel caring for them should consider and discuss with them rehabilitation and workplace adjustment in order to prevent early disability pension.

Unemployment and disability pension--an 18-year follow-up study of a 40-year-old population in a Norwegian county

Background

This study explored the association of unemployment and an increased risk of receiving disability pension, and the possibility that this risk is attributed to municipality-specific characteristics.

Methods

A cohort of 7,985 40-42 year olds was followed for 18 years in national registers, identifying new episodes of unemployment and cases of disability pension. The association between an unemployment period and disability pension in the subsequent year was estimated using discrete time multilevel logistic regressions and clustering individuals by municipality. The association between unemployment and disability pension was adjusted for age in the follow up-period, sex, baseline health status, health behaviour and education level. A conditional intra-class correlation coefficient (ICC) was estimated as a measure of inter-municipality variance.

Results

In the follow-up period, 2784 (35%) of the participants were granted disability pension. The crude odds ratio for receiving disability pension after unemployment (adjusted for age in follow-up period and sex only) was 1.42 (95% CI 1.1-1.8). Adjusting for baseline health indicators reduced the odds ratio of unemployment to 1.33 (CI 1.1-1.7). A fully adjusted model, including education level, further reduced the odds ratio of unemployment to 1.25 (CI 1.00-1.6). The ICC of the municipality level was approximately 2%.

Conclusions

Becoming unemployed increased the risk of receiving subsequent disability pension. However, adjusting for baseline health status, health behaviour and education attenuated this impact considerably. The multilevel analysis indicated that a minor, yet statistically significant, proportion of the risk of disability pension can be attributed to the municipality of residence.

Educational inequalities in disability pensioning - the impact of illness and occupational, psychosocial, and behavioural factors: The Nord-Trøndelag Health Study (HUNT)

AIMS

Socioeconomic inequalities in disability pensioning are well established, but we know little about the causes. The main aim of this study was to disentangle educational inequalities in disability pensioning in Norwegian women and men.

METHODS

The baseline data consisted of 32,948 participants in the Norwegian Nord-Trøndelag Health Study (1995-97), 25-66 years old, without disability pension, and in paid work. Additional analyses were made for housewives and unemployed/laid-off persons. Information on the occurrence of disability pension was obtained from the National Insurance Administration database up to 2008. Data analyses were performed using Cox regression.

RESULTS

We found considerable educational inequalities in disability pensioning, and the incidence proportion by 2008 was higher in women (25-49 years 11%, 50-66 years 30%) than men (25-49 years 6%, 50-66 years 24%). Long-standing limiting illness and occupational, psychosocial, and behavioural factors were not sufficient to explain the educational inequalities: young men with primary education had a hazard ratio of 3.1 (95% CI 2.3-4.3) compared to young men with tertiary education. The corresponding numbers for young women were 2.7 (2.1-3.1). We found small educational inequalities in the oldest women in paid work and no inequalities in the oldest unemployed/laid-off women and housewives.

CONCLUSIONS

Illness and occupational, psychosocial, and behavioural factors explained some of the educational inequalities in disability pensioning. However, considerable inequalities remain after accounting for these factors. The higher incidence of disability pensioning in women than men and the small or non-existing educational inequalities in the oldest women calls for a gender perspective in future research.

Interrelationships between education, occupational social class, and income as determinants of disability retirement

AIMS

The association between a low socioeconomic position and disability retirement is established in the literature, but the interrelationships between various subdomains of socioeconomic position are poorly understood. We examined the independent and interdependent effects of education, social class, and income on disability retirement.

METHODS

Using nationally representative register data we followed up over 260,000 Finns aged 30-63 at the end of 1995 for disability retirement from 1996 to 2004. Cox regression analysis was used to calculate hazard ratios (HR) and relative indices of inequality (RII).

RESULTS

Each socioeconomic indicator had a linear negative association with disability retirement. The socioeconomic gradients were stronger in the younger age groups. The effect of education was largely mediated through succeeding social class. Social class was largely explained by preceding education, but was only moderately mediated through income. Income was largely explained by education, and even further by social class. The independent effects of education, social class, and income on disability retirement as measured by the RII were 1.74 (95% CI 1.60-1.90), 1.95 (1.78-2.15), and 1.35 (1.25-1.47) for men and 1.76 (1.61-1.92), 2.14 (1.95-2.34), and 1.14 (1.05-1.24) for women.

CONCLUSIONS

The effects of socioeconomic position on disability retirement may not be fully captured if the pathways between the various subdomains are disregarded. Our results suggest that efforts to delay and prevent disability retirement should focus on lifestyle and cognitive factors associated with education, as well as on factors associated with social class such as working conditions and power resources.

Long-term effects of poor health on employment: the significance of life stage and educational level

Previous research has found the employment consequences of poor health to be of increased magnitude in low qualified groups. The purpose of this study is to investigate if this relationship varies within different stages of the life course when focusing on long term associations with non-employment. An expectation of the article is that stronger effects of poor health may be found in young adults compared to middle aged people. The article considers two possible explanations: normative change and life stage resources. Using three-wave panel data from the Norwegian county of Nord-Trøndelag, the HUNT study allows the study of respondents over two decades. Two narrow cohorts have been selected for comparison, and health was measured by self-reported longstanding limiting illness. For the analyses, cross tabulations, logistic regression, and fixed effects logistic regression techniques are used. The article concludes in favour of the resource explanation; young adulthood is a critical period in relation to long term employment consequences of poor health, and especially so among people with fewer educational resources. Cohort differences in the employment consequences of poor health are not likely to be caused by poorer work ethics among younger cohorts.

Self-rated health as a predictor of disability retirement--the contribution of ill-health and working conditions

Objective

Self-rated health is a generic health indicator predicting mortality, many diseases, and need for care. We examined self-rated health as a predictor of subsequent disability retirement, and ill-health and working conditions as potential explanations for the association.

Methods

Self-rated health and the covariates were obtained from the Helsinki Health Study baseline mail surveys in 2000–2002 conducted among municipal employees aged 40–60 years (n = 6525). Data for disability retirement events (n = 625) along with diagnoses were linked from the Finnish Centre for Pensions, with a follow-up by the end of 2010. Hazard ratios (HR) and their 95% confidence intervals (CI) were calculated using competing risks models.

Results

Less than good self-rated health predicted disability retirement due to all causes among both women (HR = 4.60, 95% CI = 3.84–5.51) and men (HR = 3.83, 95% CI = 2.64–5.56), as well as due to musculoskeletal diseases (HR = 5.17, 95% CI = 4.02–6.66) and mental disorders (HR = 4.80, 95% CI = 3.50–6.59) among women and men pooled. Ill-health and physical working conditions partly explained the found associations, which nevertheless remained after the adjustments. Among the measures of ill-health limiting long-standing illness explained the association most in all-cause disability retirement and disability retirements due to musculoskeletal diseases, whereas common mental disorders explained the association most in disability retirements due to mental health disorders. Among working conditions physical work load and hazardous exposures at work explained the association most, although much less than ill-health.

Conclusions

Self-rated health is a strong predictor of disability retirement. This can be partly explained by ill-health and working conditions. Poor self-rated health provides a useful marker for increased risk of work disability and subsequent disability retirement.

Socioeconomic determinants of disability in Chile

BACKGROUND

Disability is a worldwide public health priority. A shift from a biomedical perspective of dysfunction to a broader social understanding of disability has been proposed. Among many different social factors described in the past, socioeconomic position remains as a key multidimensional determinant of health. The study goal was to analyze the relationship between disability and different domains of socioeconomic position in Chile.

METHODS

Cross-sectional analysis of an anonymized population-based survey conducted in Chile in 2006. Any disability (dichotomous variable) and 6 different types of disability were analyzed on the bases of their relationship with income quintiles, occupational status, educational level, and material living standards (quality of the housing, overcrowding rate and sanitary conditions). Confounding and interaction effects were explored using R statistical program.

RESULTS

Income, education, occupation, and material measures of socioeconomic position, along with some sociodemographic characteristics of the population, were independently associated with the chance of being disabled in Chile. Interestingly, classic measures of socioeconomic position (income, education, and occupation) were consistently associated with any disability in Chile, whereas material living conditions were partially confounded by these classic measures. In addition to this, each type of disability showed a particular pattern of related social determinants, which also varied by age group.

CONCLUSIONS

This study contributed to the understanding of disability in Chile and how different domains of socioeconomic position might be associated with this prevalent condition. Disability remains a complex multidimensional public health problem in Chile that requires the inclusion of a wide range of risk factors, of which socioeconomic position is particularly relevant.

Reverse causality in the association between whiplash and symptoms of anxiety and depression: the HUNT study

STUDY DESIGN

Longitudinal population-based cohort study.

OBJECTIVE

The aim of this study was to examine the possibility of reverse causality, that is, if symptoms of anxiety and depression are associated with incident self-reported whiplash injury. The clinical relevance of self-reported whiplash injury was evaluated by its association with subsequent disability pension award.

SUMMARY OF BACKGROUND DATA

Whiplash is associated with an increased level of anxiety and depressive symptoms. This increase in psychological distress is generally understood as the consequence of the accident and related whiplash.

METHODS

Longitudinal data from the HUNT study was used. Baseline measures of symptoms of anxiety and depression were used in prediction of incident whiplash injury self-reported at follow-up 11 years later. Incident disability pension award was obtained from a comprehensive national registry during 2-year follow-up after self-reported whiplash injury.

RESULTS

Case-level symptom load of anxiety and depression at baseline increased the likelihood of reporting incident whiplash at follow-up (odds ratio [OR] = 1.60, 95% confidence interval = 1.22-2.11). Self-reported whiplash increased the chances of a subsequent disability pension award (OR = 6.54), even in the absence of neck pain (OR = 3.48).

CONCLUSION

This is the first published study with a prewhiplash prospective evaluation of psychological status. Our findings are in conflict with previous research suggesting whiplash to be the cause of associated psychological symptoms rather than their consequence. Self-reported whiplash injury was clinically relevant as it independently increased subsequent disability pension award. The strength of this effect, even in the absence of neck pain, suggests the ascertainment of this diagnostic label, or factors associated with this, are important predictors of disability.

Disability pension by occupational class--the impact of work-related factors: the Hordaland Health Study Cohort

BACKGROUND

The social gradient in disability pension is well recognized, however mechanisms accounting for the gradient are largely unknown. The aim of this study was to examine the association between occupational class and subsequent disability pension among middle-aged men and women, and to what extent work-related factors accounted for the association.

METHODS

A subsample (N = 7031) of the population-based Hordaland Health Study (HUSK) conducted in 1997-99, provided self-reported information on health and work-related factors, and were grouped in four strata by Erikson, Goldthorpe and Portocareros occupational class scheme. The authors obtained follow-up data on disability pension by linking the health survey to national registries of benefit (FD-trygd). They employed Cox regression analysis and adjusted for gender, health (medical conditions, mental health, self-perceived health, somatic symptoms) and work-related factors (working hours, years in current occupation, physical demands, job demands, job control).

RESULTS

A strong gradient in disability pension by occupational class was found. In the fully adjusted model the risk (hazard ratio) ranged from 1.41 (95% CI 0.84 to 2.33) in the routine non-manual class, 1.87 (95% CI 1.07 to 3.27) in the skilled manual class and 2.12 (95% CI 1.14 to 3.95) in the unskilled manual class, employing the administrator and professional class as reference. In the gender and health-adjusted model work-related factors mediated the impact of occupational class on subsequent disability pension with 5% in the routine non-manual class, 26% in the skilled manual class and 24% in the unskilled manual class. The impact of job control and physical demands was modest, and mainly seen among skilled and unskilled manual workers.

CONCLUSIONS

Workers in the skilled and unskilled manual classes had a substantial unexplained risk of disability pension. Work-related factors only had a moderate impact on the disability risk. Literature indicates an accumulation of hazards in the manual classes. This should be taken into account when interpreting the gradient in disability pension.

Disability, sickness, and unemployment benefits among long-term sickness absentees five years before, during, and after a multidisciplinary medical assessment

AIM

The aim was to describe how a multidisciplinary medical assessment changed the distribution of long-term sickness absentees between three different forms of social security support during a period of eleven years.

METHODS

The study group (n = 1002) consisted of persons on long-term sickness absence who were referred to a multidisciplinary medical assessment by the Social Insurance Office in Stockholm, Sweden between 1998 and 2007. Register data from the years 1993-2008 were linked to the study group. A calculation was provided for the number of days per person and year on unemployment benefits, sickness benefits, and disability pension, five years before, during, and five years after the assessment. Also, differences in the average number of days per person and year were calculated with one-way analysis of variance.

RESULTS

The number of days on sickness benefits increased up to the time of multidisciplinary medical assessment, from 69 to 218 days on average. After the assessment there was a decrease in the average number of days on sickness benefits, from 218 to 16 days. Before the assessment the number of days on disability pension was 21, but this increased after the assessment from 104 days to an average of 272 days five years after the assessment. There were age differences regarding number of compensated days, and these were particularly pronounced for disability days after the assessment. Further, there were significant differences between types of diagnosis in relation to average days on disability pension after the assessment.

CONCLUSION

The study shows that after a multidisciplinary medical assessment there is a rapid increase in disability pension and a dramatic decrease in sickness benefits. The results indicate that for a large number of persons, a Social Insurance Office referral to an assessment does not improve their chances of returning to work, but rather seems to justify disability pension.

Future risk for disability pension among people with sickness absence due to otoaudiological diagnoses: a population-based cohort study with a 12-year follow-up

Hearing difficulties is a growing public health problem and more knowledge of consequences of those difficulties in working life is warranted.

AIMS

To study the future risk of being granted a disability pension (DP) among people with sickness absence with an otoaudiological diagnoses (OAD) compared to other sickness absentees.

METHODS

A population-based prospective cohort study of all 40,786 people in a Swedish county who in 1985 were aged 16-64 and had a new sick-leave spell >7 days. Those were followed for 12 years with regard to DP. Hazard ratios (HR) + 95% confidence intervals (CI) of being granted DP was calculated among those with sick leave due to OAD compared to people with sickness absence with other diagnoses.

RESULTS

In 1985, 515 people had a new sick-leave spell with an OAD. Twelve years later, 36% of those had been granted DP, compared to 24% of all other sickness absentees. Their HR for DP was 1.42 (95% CI 1.23-1.64) adjusting for gender and age. Compared to men, women with an OAD had a HR of DP of 1.24 (95% CI 0.90-1.71), when adjusted for age. The HR for DP regarding those aged>45 years and sickness absent with OAD was 2.63 (95% CI 1.95-3.55) compared to the sickness absentees with OAD below 45 years of age, adjusted for gender.

CONCLUSIONS

The risk for future DP was more than 40% higher among those initially on sickness absence due to OAD than among other sickness absentees.

Health problems account for a small part of the association between socioeconomic status and disability pension award. Results from the Hordaland Health Study

BACKGROUND

Low socioeconomic status is a known risk factor for disability pension, and is also associated with health problems. To what degree health problems can explain the increased risk of disability pension award associated with low socioeconomic status is not known.

METHODS

Information on 15,067 participants in the Hordaland Health Study was linked to a comprehensive national registry on disability pension awards. Level of education was used as a proxy for socioeconomic status. Logistic regression analyses were employed to examine the association between socioeconomic status and rates of disability pension award, before and after adjusting for a wide range of somatic and mental health factors. The proportion of the difference in disability pension between socioeconomic groups explained by health was then calculated.

RESULTS

Unadjusted odds ratios for disability pension was 4.60 (95% CI: 3.34-6.33) for the group with elementary school only (9 years of education) and 2.03 (95% CI 1.49-2.77) for the group with high school (12 years of education) when compared to the group with higher education (more than 12 years). When adjusting for somatic and mental health, odds ratios were reduced to 3.87 (2.73-5.47) and 1.81 (1.31-2.52). This corresponds to health explaining only a marginal proportion of the increased level of disability pension in the groups with lower socioeconomic status.

CONCLUSION

There is a socioeconomic gradient in disability pension similar to the well known socioeconomic gradient in health. However, health accounts for little of the socioeconomic gradient in disability pension. Future studies of socioeconomic gradients in disability pension should focus on explanatory factors beyond health.

Coping with multiple sclerosis: a 5-year follow-up study

OBJECTIVES

To examine how coping styles among patients with multiple sclerosis (MS) change over time and how patients' coping styles after 5 years are associated with disability pension.

MATERIALS AND METHODS

Seventy-six MS patients and 94 healthy controls were included in this study. The patients were examined at baseline and 5 years later. This included a neurological examination and information on disability pension and a questionnaire assessing coping (the COPE scale). Controls were registered at baseline only.

RESULTS

Compared to healthy controls, MS patients were more passive in coping with disease related distress. This was even more pronounced 5 years later. Disability pensioned patients employed more social support, venting of emotions and behavioural disengagement at follow-up.

CONCLUSION

This study shows that patients with MS employ coping styles that may be inadequate and this is not improved by adaption over time. Although patients also use strategies to enhance their lives, these findings suggest that there may be a potential for improving the lives of patients with MS through interventions that may enhance adequate coping with the disease.

Social support as a predictor of disability pension: the Finnish Health 2000 study

OBJECTIVE

Social support at work and in private life was examined as a predictor of disability pension in the population-based Finnish Health 2000 study.

METHODS

Social support was measured in a nationally representative sample comprising of 3414 employees aged 30 to 64 years. Disability pensions extracted from the registers of the Finnish Centre for Pensions were followed up across 6 years.

RESULTS

Low social support from supervisors was associated with disability pension with an odds ratio of 1.70 (95% confidence interval, 1.21 to 2.38) when adjusted with sociodemographic and health behavior variables. After adjustment for baseline perceived health, the associations between supervisor support and disability pension strongly attenuated.

CONCLUSIONS

Low social support from supervisors predicts forthcoming work disability but the relationship is affected by self-reported nonoptimal health at baseline.

Education and disability pension: a stronger association than previously found

INTRODUCTION

Although the Norwegian Welfare Law includes rigorous medical criteria for granting disability pensions, several non-medical factors have been shown to be associated with and possible causal factors of pensioning.

OBJECTIVES

We analysed the relationship between disability pension and detailed information on educational attainment in different diagnostic groups.

METHODS

All ethnic Norwegians aged 18-66 years and alive on 31 December 2003 (n = 2,522,430) were included. Age, sex, the receipt of a disability pension on 31 December 2003, and the diagnosis on the medical certificate were taken from a national social security file. The file also included six levels of education: primary school, low-level secondary school, secondary school, low-level university, university, and research level.

RESULTS

We found a dramatic increase in the prevalence of persons granted disability pension with decreasing years of education across all levels of education. The disparities were much stronger than those seen for other health-related parameters and were especially strong for those with musculoskeletal diagnoses. The disability pension is more a consequence of health problems than a proxy for health status. The demonstrated relationship between education and disability pension may be partly explained by exclusion from the work force because of health-related work problems.

CONCLUSIONS

To facilitate a more inclusive working life, attention should be focused on the work place's capacity to include people with different levels of competence and functioning rather than on the health problems of the employees.

Common mental disorders and disability pension award: seven year follow-up of the HUSK study

OBJECTIVE

Rates of disability pension (DP) awards remain high in most developed countries. We aimed to estimate the impact of anxiety and depression on DPs awarded both for mental and for physical diagnoses and to estimate the relative contribution of sub case-level anxiety and depression compared with case-level symptom loads.

METHODS

Information from a large cohort study on mental and physical health in individuals aged 40-46 (N=15,288) was linked to a comprehensive national database of disability benefits. Case-level and sub case-level anxiety and depression were defined as scores on the Hospital Anxiety and Depression Scale of >or=8 and 5-7, respectively. The outcome was incident award of a DP (including ICD-10 diagnosis) during 1-7-year follow-up.

RESULTS

DP awards for all diagnoses were predicted both from case-level anxiety [HR 1.90 (95% CI 1.50-2.41)], case-level depression [HR 2.44 (95% CI 1.65-3.59] and comorbid anxiety and depression [HR 4.92 (95% CI 3.94-6.15)] at baseline. These effects were only partly accounted for by adjusting for baseline somatic symptoms and diagnoses. Anxiety and depression also predicted awards for physical diagnoses [HR 3.26 (95% CI 2.46-4.32)]. The population attributable fractions (PAF) of sub case-level anxiety and depression symptom loads were comparable to those from case-level symptom loads (PAF anxiety 0.07 versus 0.11, PAF depression 0.05 versus 0.06).

CONCLUSION

The long-term occupational impact of symptoms of anxiety and depression is currently being underestimated. Sub case-level symptom loads of anxiety and depression make an important and previously unmeasured contribution to DP awards.

Stressful psychosocial factors and symptoms of gastroesophageal reflux disease: a population-based study in Norway

OBJECTIVE

Adverse psychosocial factors, including work-related stress, are, like gastroesophageal reflux disease (GERD), increasing health problems in industrialized countries. The importance of clarifying the relation between psychosocial factors and GERD has been stressed, but there are few population-based studies.

MATERIAL AND METHODS

This was a population-based, cross-sectional, case-control study based on two health surveys conducted in the Norwegian county Nord-Trondelag in 1984-86 and 1995-97. GERD symptoms were assessed in the second survey, which included 65,333 participants, representing 70% of the county's adult population. The 3153 persons reporting severe GERD symptoms were defined as cases and the 40,210 persons without such symptoms were defined as controls. Data on psychosocial factors and potential confounders were collected using questionnaires. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using unconditional logistic regression.

RESULTS

In models adjusted for age, sex, smoking, obesity and socioeconomic status, positive associations were observed between high job demands (OR 1.9, 95% CI 1.6-2.2), low job control (OR 1.1, 95% CI 1.0-1.2) and job strain (OR 1.9, 95% CI 1.6-2.4) and risk of GERD symptoms. Persons reporting low job satisfaction had a twofold (95% CI 1.6-2.5) increased risk of GERD compared to persons reporting high job satisfaction. Self pressure (OR 1.8, 95% CI 1.6-2.1) and time pressure (OR 2.0, 95% CI 1.7-2.4) were positively associated with GERD symptoms. These associations were attenuated after further adjustment for anxiety, depression, myocardial infarction, angina pectoris, stroke and insomnia, but remained statistically significant.

CONCLUSIONS

This population-based study reveals a link between stressful psychosocial factors, including job strain, and GERD symptoms.

Employment of persons with spinal cord lesions injured more than 20 years ago

PURPOSE

The primary objective was to study factors influencing post-injury employment and withdrawal from work in persons who sustained traumatic spinal cord injury (SCI) more than 20 years ago. A secondary objective was to study life satisfaction in the same patients.

METHOD

A cross-sectional study with retrospective data of 165 SCI-patients admitted to Sunnaas Rehabilitation Hospital 1961-1982. Multiple logistic regression was used to identify predictors for obtaining work post-injury. A Cox proportional hazards regression model was used to study factors influencing early withdrawal from work, i.e. time from injury until discontinuing employment.

RESULTS

Sixty-five percent of the participants were employed at some point after the injury. Thirty-five percent still had work at the time of the survey. The odds of obtaining work after injury were higher in persons of younger age at injury, higher in males versus females, higher for persons with paraplegia versus tetraplegia, and for persons classified as Frankel D-E compared to a more severe SCI. Factors associated with shorter time from injury until discontinuing employment were higher age at injury, incidence of injury after 1975 versus before, and a history of pre-injury medical condition(s). Life satisfaction was better for currently employed participants.

CONCLUSION

The study indicates a low employment-rate in persons with SCI, even several years after injury. From the results, we suggest more support, especially to persons of older age at injury and/or with a history of pre-injury medical condition(s), to help them to obtain work and sustain employed for more years after injury.

Employee control over working times and risk of cause-specific disability pension: the Finnish Public Sector Study

OBJECTIVE

To examine the association between worktime control and subsequent disability pension among employees.

METHODS

Two scores of worktime control (self-assessed and co-worker assessed) were obtained from a survey in 2000-2001 (score range 1-5) among 30 700 public sector employees (78% women) aged 18-64 years. Information on cause-specific disability pension during follow-up was collected from national registers.

RESULTS

During a mean follow-up of 4.4 years, 1178 employees were granted disability pensions (incidence per 1000 person-years: 9.2 in women and 8.7 in men). The most common causes of a disability pension were musculoskeletal disorders (43% of all pensions), mental disorders (25%), tumours (8%) and diseases of the circulatory system (6%) and nervous system (6%). A one unit increase in self-assessed and co-worker assessed worktime control score was associated with a 41-48% decrease in risk of disabling musculoskeletal disorders in men and a 33-35% decrease in women. This association was robust to adjustment for 17 baseline covariates (in men and women combined, adjusted HR 0.76, 95% CI 0.67 to 0.87 and 0.64, 95% CI 0.51 to 0.79 per one unit increase in self-assessed and co-worker assessed worktime control, respectively). Self-assessed, but not co-worker assessed, worktime control was also associated with risk of disability retirement due to mental disorders in women. Disability pensions from other disease categories were not related to worktime control.

CONCLUSIONS

In these public sector employees, high worktime control was associated with reduced risk of early retirement caused by musculoskeletal disorders independent of baseline characteristics.

The impact of ergonomic work environment exposures on the risk of disability pension: Prospective results from DWECS/DREAM

The objectives were to identify the impact of ergonomic work environment exposures on the risk of disability pension. A representative sample of 8475 employees of the total working population in Denmark were interviewed regarding work environment exposures and followed in a national register with data on granted disability pension. For women, approximately 34% of the disability pension cases were attributable to ergonomic work environment exposures. For men, 21% of the disability pension cases were attributable to ergonomic work environment. Ergonomic work environment, especially physically demanding work, working with hands lifted and repetitive work, are areas of intervention at the workplace that can facilitate and prolong labour market participation. The study provides estimates for the association between ergonomic exposures at work and administrative, cost-related measures of work disability in a large population-based longitudinal cohort study over 14 years. Approximately 21% for men and 34% for women of the disability pension cases were attributable to ergonomic work environment exposures.

Disability pensioning: the gender divide can be explained by occupation, income, mental distress and health

BACKGROUND

We aimed to test the hypothesis that gender divide in disability pensioning is attributable to differences in health, mental distress, occupation, and income.

METHODS

In a health survey between 2000 and 2001, a total of 11,072 (48.7%) of all Oslo inhabitants aged 40, 45, 59, and 60 years participated. Survey data were linked to data from the National Insurance Administration and Statistics Norway for 10,421 of the participants, and 9,195 of those were eligible to receive disability pension at the end of 2000. Occupation, general health, and mental distress were self-reported, while income was obtained from official statistics.

RESULTS

Approximately 5% of the eligible sample received a disability pension during the four years following the health survey. The age-adjusted odds of receiving disability pension for women was greater (odds ratio = 1.41) than for men. Self-reported health significantly contributed to the risk of receiving a pension, and seemed to reduce the imbalance in disability rates between the genders, as did adjusting for level of mental distress. Further adjustment for occupation and working conditions reduced the gender divide to an insignificant level, and the inclusion of income level (income three years prior to pensioning) completely eliminated any gender difference in risk of receiving a pension.

CONCLUSIONS

Gender differences in disability pensioning in Oslo are attributable to women's poorer self-reported health, greater levels of mental distress, lower wages, and more unfavourable working conditions such as job strain and less control over work.

Disability pensioning: can ethnic divides be explained by occupation, income, mental distress, or health?

BACKGROUND

We aimed to test the hypothesis that differences in disability pensioning among different ethnic groups were attributable to differences in occupation, income, health, and mental distress.

METHODS

In a health survey conducted between 2000 and 2001 in Oslo, nearly half (48.7%; 11,072) of all inhabitants aged 40, 45 and 59-60 years participated. Survey data related to work, general health and mental distress were linked to disability pension data from the National Insurance Administration, and to income and country of origin data from Statistics Norway. A total of 9195 persons were eligible for disability pension at the end of 2000.

RESULTS

Approximately 5% received a disability pension in the 4 years following the health survey. An age- and gender-adjusted odds ratio of 2.27 (95% confidence interval (CI) 1.55-3.23) among immigrants from developing countries and Eastern Europe as compared to ethnic Norwegians was reduced to 0.88 (95% CI 0.46-1.67) after adjusting for occupation, working conditions, and income. The odds ratio was further reduced to 0.63 (95% CI 0.32-1.25) when self-reported health and mental distress were added to the model.

CONCLUSIONS

The higher risk of receiving a disability pension among immigrants from developing countries and Eastern Europe than among ethnic Norwegians was largely explained by work factors and level of income. The addition of mental distress and self-reported health to the multivariate model further reduced the risk, although not significantly different from ethnic Norwegians.

Mortality among disability pensioners in Norway and Sweden 1990--96: comparative prospective cohort study

AIM

The aim of the study was to assess excess mortality related to disability pension (DP) status and DP diagnoses in Norway and Sweden during 1990-96.

METHODS

Representative samples of the population aged 30-59 years, without DP at baseline 1 January 1990, 71,293 women and 76,928 men from Norway, and 68,181 women and 71,950 men from Sweden, were followed up during 1990-96. Granting of DP, DP diagnosis, age and gender were explanatory variables in Cox proportional hazards analysis with death from all causes as the outcome variable.

RESULTS

Among women, 10.4% in Sweden and 7.1% in Norway obtained DP, as compared to 7.5% and 5.6% of the men. In Sweden, 66% of female and 49% of male DP recipients had musculoskeletal diagnoses, as compared to 40% and 27% in Norway. In Sweden, 3.0% of the women and 6.1% of the men with DP died, as compared to 4.6% and 8.5% in Norway. Hazard ratios (HRs) for women with DP vs. the non-DP group were 3.2 (95% confidence interval (CI)=2.7-3.8) in Sweden, and 4.9 (95% CI=4.1-5.7) in Norway. Among men with DP, there was no difference in mortality rate between the countries. HRs for men with musculoskeletal diagnoses vs. the non-DP group were 1.5 (95% CI= 1.1-2.0) in Norway and 1.4 (95% CI= 1.1-1.8) in Sweden. In both countries, the mortality rate among female disability pensioners with musculoskeletal diagnoses was not increased.

CONCLUSIONS

The study confirmed an increased mortality rate among disability pensioners, except for women with musculoskeletal diagnoses. The mortality pattern related to DP diagnoses was similar in the two countries. A high frequency of musculoskeletal DP diagnoses among women with DP in Sweden explained a lower mortality rate as compared to Norway.

Determinants of sick-leave duration: A tool for managers?

Aims: To provide managers with tools to manage episodes of sick-leave of their employees, the influence of factors such as age, gender, duration of tenure, working full-time or part-time, cause and history of sick-leave, salary and education on sick-leave duration was studied. Method: In a cross-sectional study, data derived from the 2005 sick-leave files of a Dutch university were examined. Odds ratios of the single risk factors were calculated for short spells (≤7 days), medium spells (8— 42 days), long spells (43—91 days) or extended spells (≥91 days) of sick-leave. Next, these factors were studied in multiple regression models. Results: Age, gender, duration of employment, cause and history of sick-leave, salary and membership of scientific staff, studied as single factors, have a significant influence on sick-leave duration. In multiple models, this influence remains for gender, salary, age, and history and cause of sick-leave. Only in medium or long spells and regarding the risk for a long or an extended spell do the predictive values of models consisting of psychological factors, work-related factors, salary and gender become reasonable. Conclusions: The predictive value of the risk factors used in this study is limited, and varies with the duration of the sick-leave spell. Only the risk for an extended spell of sick-leave as compared to a medium or long spell is reasonably predicted. Factors contributing to this risk may be used as tools in decision-making.

Does the number of musculoskeletal pain sites predict work disability? A 14-year prospective study

Various risk factors associated with disability pensioning have been reported. This study investigated the relationship between the number of pain sites and risk of receiving a disability pension. We hypothesised that risk of work disability would increase as the number of pain sites increased, even after controlling for potential confounders. In 1990 and 2004, questionnaire on musculoskeletal pain was sent via post to six age groups in Ullensaker, Norway. Data on demographic, health and work-related variables were also collected. After excluding individuals due to reach retirement age in 2004, we followed 1354 (66%) persons who were classified in 1990 as "employed", "unemployed", "homemaker", or "student". Among them, 176 persons had received long-term or permanent work disability pension in 2004. Bivariate analyses showed that the prevalence of disability pensions was strongly associated with the number of pain sites. Controlling for gender and age almost unaltered the relationship. However, a model controlling for all significant confounders showed that general health and sick leave previous year captured almost all the predictive power of the number of pain sites on work disability. Since these variables could be seen as intermediate variables and not confounders, they were excluded in a new model which gave a strong "dose-response" relationship between number of pain sites and disability with a 10-fold increase from 0 to 9-10 pain sites. The predictive validity of the number of pain sites in determining future disability renders this simple measurement useful for future research on musculoskeletal pain and functioning.

Long-term sickness absence and disability pension with psychiatric diagnoses: a population-based cohort study

Sickness absence certified with psychiatric diagnoses is increasing in many Western countries. A substantial proportion of the sickness absentees never return to work, but ends up with a permanent disability pension (DP). This study investigated the incidence of long-term sickness absence (LTSA) with different psychiatric diagnoses, and tested predictors of the transition to permanent DP. A special objective was to explore previously reported gender differences, using a population-based cohort study. The population at risk of LTSA was 106,674 occupational active men and 89,356 women in a Norwegian county in 1994; 314 women and 203 men with LTSA >8 weeks, certified with a psychiatric diagnosis, were followed to the end of 1999, with DP as the endpoint. Diagnoses on sickness certificates, age, gender and income were used as explanatory variables in Cox regression analysis. Annual incidence of LTSA with a psychiatric diagnosis was 7.0/1000/year for women and 3.8/1000 for men; 72% of the women and 50% of the men had a diagnosis indicating depression. During follow-up, 32% of the men and 25% of the women obtained DP. Increasing age, male gender, low income and a diagnosis of psychosis or "other" increased the DP risk. Separate analysis for men indicated a different effect of age and a larger role of serious mental illness. The study verified that women more often than men had LTSA with psychiatric diagnoses, especially with depression. Men were at higher risk of transition to DP, and the study suggested some possible explanations.

Social inequalities in injury occurrence and in disability retirement attributable to injuries: a 5 year follow-up study of a 2.1 million gainfully employed people

Background

Inequalities in injury related disability retirement may be due to differences in injury risk and or differences in retirement given injury. The aim of the present study was to measure social inequalities in injury occurrence and injury related disability retirement.

Methods

All people in the Danish labour force aged 20–59 years 1 January 1997 were followed for injury related hospital contacts during 1997 and all people in the Danish labour force aged 21–54 years 1 January 1998 were followed for injury related hospital contacts during 1997 and for disability retirements during 1998–2002. As inequality indices we used excess fractions (EF) i.e. the proportions of the cases that would not have occurred if the risks in each social group had been as low as they were in the occupational group with the highest skill requirements.

Results

With regard to the risk that an injury will occur, the EF was 36% among men and 10% among women. With regard to the risk that an injury will lead to disability retirement, the EF was 43% among men and 47% among women. The combined effect of the two types of inequalities rendered an EF for injury related disability retirement of 64% among men and 53% among women. The correlation between the case disability rate ratios among men and those among women was low (r = -0.110, P = 0.795).

Conclusion

The social inequality in injury related disability retirement lies only to some degree in the differences in the injury risk. More important are differences in the consequences of an injury. This was especially pronounced among the women.

Between health care and social security--psychiatric patients and the disability pension system in Norway and Russia

BACKGROUND

The official statistics of persons with mental disorders who are granted disability pension (DP) in Russia and Norway indicate large differences between the countries.

METHODS

This qualitative explorative hypothesis-generating study is based on text analysis of the laws, regulations and guidelines, and qualitative interviews of informants representing all the organisational elements of the DP systems in both countries.

RESULTS

The DP application process is initiated much later in Norway than in Russia, where a 3 year occupational rehabilitation and adequate treatment is mandatory before DP is granted. In Russia, two instances are responsible for preparing of the medical certification for DP, a patients medical doctor (PD) and a clinical expert commission (CEC) while there is one in Norway (PD). In Russia, the Bureau of Medical-Social Expertise is responsible for evaluation and granting of DP. In Norway, the local social insurance offices (SIO) are responsible for the DP application. Decisions are taken collectively in Russia, while the Norwegian PD and SIO officer often take decisions alone. In Russia, the medical criterion is the decisive one, while rehabilitation and treatment criteria are given priority in Norway. The size of the DP in Norway is enough to cover of subsistences expenditure, while the Russian DP is less than the level required for minimum subsistence.

CONCLUSION

There were noteworthy differences in the time frame, organisation model and process leading to a DP in the two countries. These differences may explain why so few patients with less severe mental disorders receive a DP in Russia. This fact, in combination with the size of the DP, may hamper reforms of the mental health care system in Russia.

Childhood adversities as a predictor of disability retirement

BACKGROUND

There is a large body of research on adulthood risk factors for retirement due to disability, but studies on the effect of adverse childhood experiences are scarce.

AIM

To examine whether adverse childhood experiences predict disability retirement.

METHODS

Data were derived from the Health and Social Support Study. The information was gathered from postal surveys in 1998 (baseline) and in 2003 (follow-up questionnaire). The analysed data consisted of 8817 non-retired respondents aged 40-54 years (5149 women, 3668 men). Negative childhood experiences, such as financial difficulties, serious conflicts and alcohol-related problems, were assessed at baseline and disability retirement at follow-up.

RESULTS

The risk of disability retirement increased in a dose-response manner with increasing number of childhood adversities. Respondents who had experienced multiple childhood adversities had a 3.46-fold increased risk (95% CI 2.09 to 5.71) of disability retirement compared with those who reported no such adversities. Low socioeconomic status, depression (Beck Depression Inventory-21), use of drugs for somatic diseases as well as health-related risk behaviour, such as smoking, heavy alcohol consumption and obesity, were also predictors of disability retirement. After simultaneous adjustments for all these risk factors, the association between childhood adversities and the risk of disability retirement attenuated, but remained significant (OR 1.90, 95% CI 1.07 to 3.37).

CONCLUSIONS

Information on childhood conditions may increase our understanding of the determinants of early retirement, especially due to mental disorders. Childhood adversities should be taken into account when considering determinants of disability retirement and identifying groups at risk.

Life course determinants for early disability pension: a follow-up of Norwegian men and women born 1967–1976

BACKGROUND

Most studies on disability pension (DP) have focused on work conditions, socio-economic status and other contemporary factors. We wanted to study possible determinants of an early DP with a life course perspective within a large register-based cohort, with a main focus on the biological and social factors from childhood.

METHODS

We established a longitudinal, population-based cohort of all persons liveborn in Norway between 1967 and 1976. Through linkage between several national registers we obtained personal data on biological/health related as well as social background factors. After excluding persons who died, emigrated or were granted a DP before age 20 years (at which age follow-up started) and persons who did not become gainfully employed during the study period, the study population consisted of 595,393 persons. They were categorized into four strata according to gender and educational attainment. Adjusted hazard ratios (HR) for granting a DP until the end of 2003 and the corresponding population attributable risks (PAR) were computed.

RESULTS

A total of 9,649 persons (1.6%) were granted a DP during follow-up. The disability risk was slightly higher among women than among men (1.7% vs. 1,5%). The following PARs were found: birth weight below the mean 5.7%, chronic childhood disease 6.8%, maternal marital status 4.4% and parental disability 8.8%. Low educational achievement was highly associated with DP, with a PAR more than twice as high as the overall PAR for the childhood factors.

CONCLUSIONS

Early DP is associated with several biological and social background factors from childhood. It also shows a strong dependency on educational achievement.

Does mastering have an effect on disability pensioning independent of health, and may it explain divides of education in the Oslo Health Survey?

AIMS

Does mastering abilities have an independent effect on disability pensioning? Are some of the large divides across education explained by mastering factors when adjusted for health?

METHODS

Data from the National Insurance Administration were linked to a health survey of 10,720 Oslo inhabitants aged 40, 45, and 60 years, 46% of the total populations in these age groups who were invited to a Health Survey in 2000-01. Measures of general health, chronic somatic diseases, psychiatric symptoms, and musculoskeletal pain were self-reported. The mastering test Generalized Self Efficacy was used.

RESULTS

10.5% of our eligible sample had disability pension at the time of the survey. The risk was more than five times higher for those with primary school than for those with university education and 50% higher for women than for men. Lowest score on the Generalized Self Efficacy test (poor mastering) had an age-, gender-, and health-adjusted OR of 2.4 compared with the highest level of mastering. Adjusting for mastering lowered the educational divide but not that of gender, when health indicators were taken into consideration Those reporting poor general health had a seven times higher risk than those with good health, and those with a chronic somatic disease, musculoskeletal pain, or poor psychiatric health had a somewhat lower increase in risk of disability pension. Health measures did reduce the impact of education, but not of gender, when adjusted for mastering.

CONCLUSION

Poor mastering was associated with disability pensioning, and reduced the differences across educational level and health but not across gender.

Prospective analysis of disability retirement as a consequence of injuries in a labour force population

The aim of the present work was to investigate the influence of different types of injury on the risk for disability retirement among economically active people in Denmark.

MATERIAL AND METHODS

In this prospective study, all people in the Danish labour force aged 21-54 years 1 January 1997 (N = 2 211 057) were followed for disability retirement during 1997-2001. Age and gender standardised incidence ratios (SIR) were calculated to compare retirement rates among those who received treatment for an injury during 1996 (N = 252 468, including both work-related and non-work related types) with the rates in the total labour force. Life-table methodology was used to calculate years of lost economically active life (YLEAL) by injury type.

RESULTS

Among the injured people we observed a total number of 5580 cases of subsequent disability retirement and 45% of these could be statistically attributed to the injury. The SIR for disability retirement by injury type ranged from 1.38 to 7.00. The least severe types, superficial injuries and dislocations, sprains, and strains, were most prevalent and generated the highest numbers of YLEALs.

CONCLUSION

The high frequency of injuries and their influence on retirement rates suggest that injury prevention is a highly relevant approach to reduce future costs from disability retirement. YLEAL calculations can be used to set priorities.

Factors predicting work ability following multidisciplinary rehabilitation for chronic musculoskeletal pain

INTRODUCTION

This study aimed to investigate the outcome and outcome predictors of multidisciplinary rehabilitation in terms of working ability.

METHODS

One hundred and forty three (n=143) patients with musculoskeletal pain (mean age=45.7, SD=8.9) were included. Work status, pain, functional health status and psychosocial factors were collected previous to treatment, after a 5 week intensive training and a 52 week follow-up period. Demographics and data on personal characteristics were also collected.

RESULTS

Workability increased from 57.4 to 80% during treatment period. Stepwise multivariate logistic regression indicated that age, sleeplessness, cognitive function, overall health, pain experience, and anxiety were the strongest predictors of work ability. Pain severity and depression were not found to be significant predictors of work ability.

CONCLUSIONS

These data suggest that emotional distress, cognitive function and overall health are important priority areas in rehabilitation programmes to improve work ability.

Gender differences in psychosocial influence and rehabilitation outcomes for work-disabled individuals with chronic musculoskeletal pain

INTRODUCTION

This study aimed to investigate gender differences in rehabilitation outcomes and how psychosocial factors may interact to influence rehabilitation outcome in work-disabled with chronic musculoskeletal pain.

METHODS

One hundred and sixty eight (n=168) persons (mean age = 45.5/SD=9.0) participating in a multidisciplinary rehabilitation program, were included. Data on pain, functional health and psychosocial factors were collected previous to treatment, after 5 week intensive training and after 52 week follow-up period. Demographics, socio-economics and data on personal characteristics were also collected.

RESULTS

Significant (p<.05) gender differences were found on sleeplessness, meaningfulness and manageability. No significant gender differences were found on pain or functional health status variables. Gender differences (p<.001) were found in how socio-demographic and psychosocial factors influence rehabilitation outcomes in terms of functional health status.

CONCLUSIONS

These data suggests that knowledge of gender differences and the way psychosocial factors influence rehabilitation outcomes must be taken into account in designing rehabilitation intervention.

A systematic review of the impact of work environment on smoking cessation, relapse and amount smoked

BACKGROUND

Smoking is an important issue for the majority of the world's working population. It is important to explore in which ways the workplace might contribute to changes in smoking status and smoking behavior. The present article provides a systematic review and quality assessment of studies that have addressed the impact of factors in the work environment on smoking behavior.

METHODS

An evaluation of the methodological quality of 22 prospective studies was based on 14 explicit criteria, which included features of study design, statistical analysis, sampling issues and measurement. The level of scientific evidence was evaluated for each study.

RESULTS

There was strong evidence for an effect of the work environment on the amount smoked, but insufficient or mixed evidence regarding cessation and relapse. Summarizing the results, high job demands were associated with higher amount smoked and with increased likelihood of cessation. Resources at work and social support were positively associated with cessation and negatively associated with relapse and the amount smoked.

CONCLUSIONS

The results supported the overall hypothesis that the work environment influences aspects of smoking behavior. Recommendations are made for more intervention studies where changes in work environment are carried out in combination with health promotion interventions.

Life satisfaction and resilience in medical school--a six-year longitudinal, nationwide and comparative study

BACKGROUND

This study examined the relationship between life satisfaction among medical students and a basic model of personality, stress and coping. Previous studies have shown relatively high levels of distress, such as symptoms of depression and suicidal thoughts in medical undergraduates. However despite the increased focus on positive psychological health and well-being during the past decades, only a few studies have focused on life satisfaction and coping in medical students. This is the first longitudinal study which has identified predictors of sustained high levels of life satisfaction among medical students.

METHODS

This longitudinal, nationwide questionnaire study examined the course of life satisfaction during medical school, compared the level of satisfaction of medical students with that of other university students, and identified resilience factors. T-tests were used to compare means of life satisfaction between and within the population groups. K-means cluster analyses were applied to identify subgroups among the medical students. Analysis of Variance (ANOVA) and logistic regression analyses were used to compare the subgroups.

RESULTS

Life satisfaction decreased during medical school. Medical students were as satisfied as other students in the first year of study, but reported less satisfaction in their graduation year. Medical students who sustained high levels of life satisfaction perceived medical school as interfering less with their social and personal life, and were less likely to use emotion focused coping, such as wishful thinking, than their peers.

CONCLUSION

Medical schools should encourage students to spend adequate time on their social and personal lives and emphasise the importance of health-promoting coping strategies.

The role country of birth plays in receiving disability pensions in relation to patterns of health care utilisation and socioeconomic differences: a multilevel analysis of Malmo, Sweden

Background

People of low socioeconomic status have worse health and a higher probability of being granted a disability pension than people of high socioeconomic status. It is also known that public and private general physicians and public and private specialists have varying practices for issuing sick leave certificates (which, if longstanding, may become the basis of disability pensions). However, few studies have investigated the influence of a patient's country of birth in this context.

Methods

We used multilevel logistic regression analysis with individuals (first level) nested within countries of birth (second level). We analysed the entire population between the ages of 40 and 64 years (n = 80 212) in the city of Malmo, Sweden, in 2003, and identified 73% of that population who had visited a physician at least once during that year. We studied the associations between individuals and country of birth socioeconomic characteristics, as well as individual utilisation of different kinds of physicians in relation to having been granted a disability pension.

Results

Living alone (OR_women = 1.72, 95% CI: 1.62–1.82; OR_men = 2.64, 95% CI: 2.46–2.83) and having limited educational achievement (OR_women = 2.14, 95% CI: 2.00–2.29; OR_men = 2.12, 95% CI: 1.98–2.28) were positively associated with having a disability pension. Utilisation of public specialists was associated with a higher probability (OR_women = 2.11, 95% CI: 1.98–2.25; OR_men = 2.16, 95% CI: 2.01–2.32) and utilisation of private GPs with a lower probability (OR_men = 0.76, 95% CI: 0.69–0.83) of having a disability pension. However, these associations differed by countries of birth. Over and above individual socioeconomic status, men from middle income countries had a higher probability of having a disability pension (OR_men = 1.61, 95% CI: 1.06–2.44).

Conclusion

The country of one's birth appears to play a significant role in understanding how individual socioeconomic differences bear on the likelihood of receiving a disability pension and on associated patterns of health care utilisation.

Disability pension for psychiatric disorders: regional differences in Norway 1988-2000

The aim of this study was to describe regional differences in the incidence of disability pensions (DPs) with psychiatric diagnoses, and to determine whether these differences were related to age and/or gender. We compared the incidence rates of new DPs including all diagnoses, with DP with psychiatric diagnoses in Norwegian regions from 1988 to 2000. The population at risk was all individuals aged 16-67 in each year. Individuals already on DP were excluded. Cases were collected from the Norwegian National Insurance Administration. The results showed that the incidence rate ratio (IRR; Norway reference) for DP with psychiatric diagnoses was most elevated for men 1.41 (95% CI 1.27-1.58) and women 1.48 (95% CI 1.34-1.64) living in the most rural region. Men in the urban area had a higher IRR, 1.33 (95% CI 1.26-1.40), than urban women, 1.02 (95% CI 0.96-1.07). The incidence more than doubled in the youngest age group (16-29 years) and decreased in the oldest age group (60-67 years) between 1988 and 2000. The findings conclude that individuals living in semi-rural regions of Norway are more likely to receive a DP with a psychiatric diagnosis than those living in urban areas. Large gender differences were found in the urban area. Further research is needed to investigate the impact of the psychiatric healthcare system and access to rehabilitation on psychiatric disability.

Factors explaining disability-free life expectancy in Japan: the proportion of older workers, self-reported health status, and the number of public health nurses

BACKGROUND

Disability-free life expectancy (DFLE) data for 47 prefectures in Japan were reported in 1999; however, few studies have identified the factors associated with the length of the DFLE. The objective of this study was to elucidate the primary factors that explain differences in DFLEs in Japan.

METHODS

In our ecological study, 47 prefectures in Japan were used as units of analysis. The DFLEs for men and women at 65 years of age (DFLE65), calculated by Hashimoto et al using Sullivan's method, were set as dependent variables. From various national surveys, 181 factors associated with demographics, socioeconomic status, health status and health behaviors, medical environment, social relationships, climate, and other areas were gathered as independent variables. Pearson's or Spearman's correlation coefficients were calculated to screen independent variables potentially associated with the DFLE65s. Then, multivariate linear regression analyses were conducted for the selected 24 independent variables after adjusting for the proportion of older people (65 years or more) and population density.

RESULTS

Multivariate linear regression analyses revealed that the large number of public health nurses per 100,000 population, a good self-reported health status, and a high proportion of older workers were significantly associated with long DFLE65s for both genders.

CONCLUSIONS

These three factors could potentially explain the differences in DFLE of the older population in Japan.

Sense of coherence and disability pensions. A nationwide, register based prospective population study of 2196 adult Finns

BACKGROUND

Strong sense of coherence (SOC) has been shown to be associated with good, perceived health both in cross sectional and longitudinal studies.

STUDY OBJECTIVE

To find out if level of SOC was associated to incidence of disability pension.

STUDY DESIGN

A prospective cohort study based on survey data on sense of coherence in 1989 or 1993 and data on disability pensions in 1990-1996 from national registers.

PARTICIPANTS

2196 identifiable subjects derived from a representative sample (n = 5000) in 1989 of male and female Finns between 15 and 64 years of age. Initial health was categorised on the basis of number of long term illnesses reported on entry into the study (no illnesses; one illness or several illnesses resulting in only mild or moderate functional limitation; one illness or several illnesses resulting in severe or very severe functional limitation).

MAIN RESULTS

In an interindividual comparison a decrease in initial SOC score by one point was significantly (hazard ratio 1.56, 95% confidence intervals 1.15 to 2.12) associated with receipt of a disability pension by subjects who had been 50 years of age or less on entry into the study. Sex was not associated with outcome once initial level of health, level of occupational training, level of engagement in physical exercise, and alcohol consumption were taken into consideration. No similar significant association was seen in relation to people who had been more than 50 years of age on entry into the study.

CONCLUSIONS

It seems probable that a weak SOC in people of 50 years or younger increases the likelihood of grant of a disability pension.

Construction work and risk of occupational disability: a ten year follow up of 14,474 male workers

AIMS

Most industrialised countries have public income maintenance programmes to protect workers in case of disability but studies addressing disability risk of specific professional groups are rare. The objective of this study was to establish a detailed pattern of the nature and extent of occupational disability among construction workers.

METHODS

A cohort study was set up including 14,474 male workers from the construction industry in Württemberg (Germany) aged 25-64 years who underwent occupational health exams between 1986 and 1992. The cohort was linked to the regional pension register of the manual workers' pension insurance institution to identify workers who were granted a disability pension during the 10 year follow up. All-cause and cause specific standardised incidence ratios (SIR) and 95% confidence intervals (CI) were calculated using disability rates from the general workforce and from all blue collar workers in Germany as references.

RESULTS

In total, 2247 (16%) members of the cohort were granted a disability pension. Major causes of disability were musculoskeletal (45%) and cardiovascular diseases (19%). In comparison with the general workforce, construction workers experienced a higher risk of disability from cancer (SIR = 1.26; 95% CI 1.08 to 1.47), respiratory diseases (SIR = 1.27; 95% CI 1.03 to 1.55), musculoskeletal diseases (SIR = 2.16; 95% CI 2.03 to 2.30), injuries/poisoning (SIR = 2.52; 95% CI 2.06 to 3.05), and all causes combined (SIR = 1.47; 95% CI 1.41 to 1.53). When compared with the blue collar reference group, increased risks of disability among construction workers were found for musculoskeletal diseases (SIR = 1.53; 95% CI 1.44 to 1.63), injury/poisoning (SIR = 1.83; 95% CI 1.50 to 2.21), and all causes combined (SIR = 1.11; 95% CI 1.07 to 1.16).

CONCLUSIONS

Musculoskeletal diseases and external causes are major factors limiting the work capability of construction workers and lead to an increased proportion of occupational disability.

Organisational downsizing as a predictor of disability pension: the 10-town prospective cohort study

OBJECTIVE

To examine whether downsizing, the reduction of personnel in organisations, is a predictor of increased risk of disability retirement among employees who kept their jobs.

DESIGN

Prospective cohort study. Based on reductions of personnel in participants' occupation and workplace, employees were grouped into exposure categories of no downsizing (less than 8% reduction), minor downsizing (reduction between 8% and 18%), and major downsizing (more than 18% reduction). They were followed up for a five year period after downsizing.

SETTING

Four towns in Finland.

PARTICIPANTS

19 273 municipal employees, aged 21-54 years.

MAIN OUTCOME MEASURES

All permanent full disability pensions granted because of medical reasons below 55 years of age between 1 January 1994 and 31 December 1998 from the national registers.

RESULTS

In all, 223 employees were granted a permanent disability pension. The overall rate for disability pensions per 1000 employees was 7.7 after no downsizing, 13.1 after minor downsizing, and 14.9 after major downsizing. Cox proportional hazard models adjusted for age, sex, occupational status, type of employment contract, and town showed 1.81 (95% confidence intervals 1.22 to 2.70) times higher risk of disability retirement after major downsizing than after no downsizing.

CONCLUSIONS

The immediate financial advantages of downsizing need to be considered in relation to increased occupational disability and the resulting extra costs to employers and society.

Disability retirement among former employees at the construction of the Great Belt Link

OBJECTIVE

To investigate incidences of disability retirement among men who had been employed at the construction of a large traffic link in Denmark, which involved long working hours and long distances between home and work place.

METHODS

Men aged 20-54 years at baseline who had been engaged in the construction of the Great Belt Link (n = 5882) were followed-up for disability retirements from 1996 to 2000. Age-standardized incidence ratios (SIR) were calculated and compared with those of other construction workers (n = 117,157). All economically active men in Denmark were used as the standard population.

RESULTS

The SIRs for the two groups were 2.29 (95% confidence intervals (CI): 1.95-2.67) and 0.98 (95% CI: 0.93-1.03), respectively.

CONCLUSIONS

The Great Belt construction workers had an elevated risk for disability retirement compared with other construction workers and with economically active men in general.