Variations in the risk of disability pension in Norway 1970 - 99

Identifying labour market pathways after a 30-day-long sickness absence -a three-year sequence analysis study in Finland

BACKGROUND

Return-to-work (RTW) process often includes many phases. Still, multi-state analyses that follow relevant labour market states after a long-term sickness absence (LTSA), and include a comprehensive set of covariates, are scarce. The goal of this study was to follow employment, unemployment, sickness absence, rehabilitation, and disability pension spells using sequence analysis among all-cause LTSA absentees.

METHODS

Register data covered full-time and partial sickness allowance, rehabilitation, employment, unemployment benefits, and permanent and temporary disability pension (DP), retrieved for a 30% representative random sample of Finnish 18-59 years old persons with a LTSA in 2016 (N = 25,194). LTSA was defined as a ≥ 30-day-long full-time sickness absence spell. Eight mutually exclusive states were constructed for each person and for 36 months after the LTSA. Sequence analysis and clustering were used to identify groups with different labour market pathways. In addition, demographic, socioeconomic, and disability-related covariates of these clusters were examined using multinomial regressions.

RESULTS

We identified five clusters with emphases on the different states: (1) rapid RTW cluster (62% of the sample); (2) rapid unemployment cluster (9%); (3) DP after a prolonged sickness absence cluster (11%); (4) immediate or late rehabilitation cluster (6%); (5) other states cluster (6%). Persons with a rapid RTW (cluster 1) had a more advantaged background than other clusters, such as a higher frequency of employment and less chronic diseases before LTSA. Cluster 2 associated especially with pre-LTSA unemployment and lower pre-LTSA earnings. Cluster 3 was associated especially with having a chronic illness before LTSA. Those in cluster 4 were on average younger and had a higher educational level than others. Especially clusters 3 and 4 were associated with a LTSA based on mental disorders.

CONCLUSIONS

Among long-term sickness absentees, clear groups can be identified with both differing labour market pathways after LTSA and differing backgrounds. Lower socioeconomic background, pre-LTSA chronic diseases and LTSA caused by mental disorders increase the likelihood for pathways dominated by long-term unemployment, disability pensioning and rehabilitation rather than rapid RTW. LTSA based on a mental disorder can especially increase the likelihood for entering rehabilitation or disability pension.

Adverse perinatal conditions and receiving a disability pension early in life

OBJECTIVE

The number of young adults on disability pension (DP) is increasing in European countries, creating a need to understand the related risk factors. This study aimed to determine whether adverse perinatal conditions are associated with receiving a DP early in life.

METHODS

This longitudinal cohort study consisted of all persons (N = 453,223) born in Sweden during 1973-1977, observed from 1991 through 2010 when they were aged between 16 and 37 years. Statistics Sweden provided linked national data on the children and their parents. We used logistic regression to assess the association between perinatal health conditions (birth defect, Apgar score, and small for gestational age) and receiving a DP, adjusting for maternal education and the sex of the child.

RESULTS

New recipients of DP were significantly more likely to have had a birth defect (adjusted odds ratio [AOR] 2.74, 95% CI: 2.49-3.00), to have had low Apgar score (AOR 2.12, 95% CI: 1.77-2.52), to have been small for gestational age (AOR 1.73, 95% CI: 1.54-1.94) and to be females (AOR 1.55, 95% CI: 1.46-1.64). Higher maternal education was associated with lower odds of receiving a DP (AOR 0.74, 95% CI: 0.69-0.79) for those with high school education and (AOR 0.67, 95% CI: 0.59-0.75) for those with university education. Age-stratified analysis confirmed increased odds of receiving a DP among those with birth defects and small for gestational age, but this effect reduced with increasing age. Apgar score was significantly associated with starting to receive a DP at ages 16-18 and 19-29, but not at ages 30-33. Women had lower odds of receiving a DP at ages 16-18 (AOR 0.73, 95% CI: 0.64-0.85); however, this reversed from age 19 and upwards (AOR 1.53, 95% CI: 1.41-1.67) and (AOR 2.16, 95% CI: 1.95-2.40) for the age groups of 19-29 and 30-33, respectively. Persons with high maternal education were less likely to receive a DP regardless of age at receiving a DP.

CONCLUSION

Having a birth defect was the strongest indicator of receiving a DP during early adulthood, followed by small for gestational age and low Apgar score. Overall, the effects of the studied perinatal health conditions were pronounced in those who received a DP at 16-18 years, but this effect weakened with increasing age at receiving a DP. Our findings suggest that policies and programs geared at promoting optimal health at birth might contribute to a reduction in receiving a DP.

[Effect of age, period, and birth cohort on incapacity in community-dwelling elderly: the Bambuí Elderly Cohort (1997-2012)]

Time trends in the prevalence rates of incapacity in the elderly can occur due to the effects of age, period, or cohort. Age is related to biological factors, the period to the subject's environmental context, and the cohort to the subject's exposures from birth to the present. The study aimed to verify which time dimensions most influence the evolution in the prevalence of incapacity in the elderly over the course of 15 years. Data were used from the Bambuí Elderly Cohort, and incapacity was assessed by report of "great difficulty" or "inability" to perform at least one of the activities related to mobility and basic and instrumental activities of daily living. The analysis was done with the age-period-cohort model for aggregate data, with calculation of the effects of time dimensions by analysis of deviance. A Poisson regression model determined the associations between age, period, and cohort and prevalence of incapacity, considering the total population and stratification by sex and schooling. Period effect was the most important for the three dimensions of incapacity, with an increase in prevalence at the start of the period, followed by a reduction over time, with minor differences in relation to sex and schooling. Cohort effect was significant, although less important than period effect. The results highlight the importance of analyzing the elder's environment for reducing prevalence of incapacity, with an emphasis on policies and programs that can positively impact the time trend in this outcome, given the consistent effect of period observed in this study.

Determinants of disability pension applications and awarded disability pensions in Finland, 2009 and 2014

Aims: Examining the non-medical determinants of applying for and being awarded disability pension is important for assessing the functionality of the disability pension system. We examined how demographic and socioeconomic factors as well as factors related to the disability process associate with the probability of applying for disability pension and the probability of applicants being awarded pension in 2009 and 2014. Methods: 70% random samples of Finnish non-retired residents aged 18-64 in 2009 (n = 2,076,881) and in 2014 (n = 2,097,790) were analysed with logistic regression analysis. The application rates were 0.9% in 2009 and 0.7% in 2014, and the rates of awarded pensions were 80.6% in 2009 and 72.2% in 2014. Results: Being an upper-level non-manual employee and having more employment during the preceding four calendar years decreased the odds of applying for disability pension but increased the odds of being awarded one. Older age increased the odds of both applying for and being awarded pension. Compared to applications based on mental disorders, those applying due to neoplasms and diseases of the circulatory system had increased odds of being awarded pension whereas those applying due to musculoskeletal diseases or injuries had decreased odds. Only minor temporal changes were found in the determinants of applying for or being awarded disability pension. Conclusions: With a greater probability of disability pension applications but also a lower probability of being awarded pension, the occupational disability process involves a comprehensive disadvantage for lower socioeconomic status groups.

Adverse childhood experiences and disability pension in early midlife: results from a Swedish National Cohort Study

Background

Few studies have examined the association between adverse childhood experiences (ACEs) and disability pension (DP). The current study aimed to investigate the relationship between different ACEs, cumulative ACEs, and DP, and the mediating role of school performance. We used a Swedish cohort of 522 880 individuals born between 1973 and 1978. ACEs included parental death, parental substance abuse and psychiatric disorder, substantial parental criminality, household public assistance, parental DP and child welfare intervention. Estimates of risk of DP in 2008 were calculated as odds ratios (OR) with 95% confidence intervals (CIs). A total of 2.3% (3.0% females, 1.7% males) received DP in 2008. All studied ACEs increased the odds for DP, particularly child welfare intervention and household public assistance. Cumulative ACEs increased the odds of DP in a graded manner. Females exposed to 4+ ACEs had a 4-fold odds (OR: 4.0, 95% CI 3.5-4.5) and males a 7-fold odds (OR: 7.1, 95% CI: 6.2-8.1). School performance mediated the ACEs-DP association. This study provides evidence that ACEs is associated with increased odds of DP, particularly when accumulated. The effects of ACEs should be taken into account when considering the determinants of DP, and when identifying high-risk populations.

Prevalence of all-cause and diagnosis-specific disability pension at the time of first coronary revascularisation: a population-based Swedish cross-sectional study

BACKGROUND

Although coronary revascularisation by coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) is well documented, scientific knowledge on disability pension (DP) at the time of revascularisation is lacking. The aim was to investigate the prevalence of all-cause and diagnosis-specific DP at the time of a first coronary revascularisation, accounting for socio-demographic and medical factors.

MATERIALS AND METHODS

A population-based cross-sectional study using Swedish registers was conducted including all 65,676 patients (80% men) who when aged 30-63 years, within 1994-2006, had a first CABG (n = 22,959) or PCI (n = 42,717) and did not have old-age pension. Associations between socio-demographic and medical factors and the probability of DP were estimated by odds ratios (OR) with 95% confidence intervals (CI) using logistic regression analyses.

FINDINGS

The prevalence of DP at time of revascularisation was 24%, mainly due to musculoskeletal diagnoses. Sixty-two percent had had DP for at least four years before the revascularisation. In the multivariable analyses, DP was more common in women (OR: 2.40; 95% CI: 2.29-2.50), older patients (50-63 years); especially men aged 60-63 years with CABG (OR: 4.91; 95% CI: 4.27-5.66), lower educational level; especially men with PCI (OR: 2.96; 95% CI: 2.69-3.26), patients born outside Sweden; especially men with PCI (OR: 2.11; 95% CI: 1.96-2.27), and in women with an indication of other diagnoses than acute coronary syndrome (ACS) or stable angina pectoris for PCI (OR: 1.72; 95% CI: 1.31-2.24).

CONCLUSION

About a quarter had DP at the time of revascularisation, often due to musculoskeletal diagnoses. More than half had had DP for at least four years before the intervention. DP was associated with female gender, older age, lower educational level, and being born outside Sweden.

Early retirement in cancer patients with or without comorbid mental health conditions: a prospective cohort study

BACKGROUND

The authors investigated whether cancer patients who have comorbid mental health disorders (MD) are at greater risk of early retirement compared with those who do not have MD.

METHODS

Individuals ages 18 to 55 years from a consecutive sample of patients who were admitted for inpatient oncologic treatment were interviewed using structured clinical interviews to ascertain MD. The patients were followed for 15 months, and the date of early retirement was documented. Rates of early retirement per 100 person-years (py) in patients with and without MD were compared using multivariate Poisson regression models.

RESULTS

At baseline, 491 patients were interviewed, and 150 of those patients (30.6%) were diagnosed with MD. Forty-one patients began full early retirement during follow-up. In patients with MD, the incidence of early retirement was 9.3 per 100 py compared with 6.1 per 100 py in mentally healthy patients. The crude rate ratio (RR) was 1.5 (95% confidence interval [CI], 0.8-2.8). The effect of MD on early retirement was modified in part by income: in patients with low income, the adjusted RR was 11.7, whereas no effect was observed in higher income groups. Patients with depression were at greater risk of retirement when they had higher income (RR, 3.4; P = .05). The effects of anxiety (RR, 2.4; P = .05), adjustment disorders (RR, 1.7; P = .21), and alcohol dependence (RR, 1.8; P = .40) on early retirement were equal across income groups.

CONCLUSIONS

Mental health conditions are risk factors for early retirement in cancer patients, although this effect differs according to the type of disorder and the patient's income level.

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.

Disability pension among young women in Sweden, with special emphasis on family structure: a dynamic cohort study

OBJECTIVES

The influence of family structure on the risk of going on disability pension (DP) was investigated among young women by analysing a short-term and long-term effect, controlling for potential confounding and the 'healthy mother effect'.

DESIGN AND PARTICIPANTS

This dynamic cohort study comprised all women born in Sweden between 1960 and 1979 (1.2 million), who were 20-43 years of age during follow-up. Their annual data were retrieved from national registers for the years 1993-2003. For this period, data on family structure and potential confounders were related to the incidence of DP the year after the exposure assessment. Using a modified version of the COX proportional hazard regression, we took into account changes in the study variables of individuals over the years. In addition, a 5-year follow-up was used.

RESULTS

Cohabiting working women with children showed a decreased risk of DP in a 1-year perspective compared with cohabiting working women with no children, while the opposite was indicated in the 5-year follow-up. Lone working women with children had an increased risk of DP in both the short-term and long-term perspective. The risk of DP tended to increase with the number of children for both cohabiting and lone working women in the 5-year follow-up.

CONCLUSIONS

The study suggests that parenthood contributes to increasing the risk of going on DP among young women, which should be valuable knowledge to employers and other policy makers. It remains to be analysed to what extent the high numbers of young women exiting from working life may be counteracted by (1) extended gender equality, (2) fewer work hours among fathers and mothers of young children and (3) by financial support to lone women with children.

Mortality among the working age population receiving incapacity benefits in New Zealand, 1981-2004

Like many OECD countries New Zealand has experienced a large increase in the number of working-age people receiving incapacity benefits in the last 3 decades, despite apparent improvements in population health. This paper examines trends in mortality rates of people receiving sickness benefit or invalid's benefit (SBIB) between 1981 and 2004 using repeated cohort studies (linking the 1981, 1986, 1991, 1996, and 2001 censuses to mortality data). Mortality rates, standardised for age and ethnicity, were calculated for each census cohort for 25-64 year olds by benefit receipt status. Standardised rate differences and rate ratios and 95% confidence intervals were calculated to measure disparities on both absolute and relative scales. Between 1981 and 2004 overall SBIB receipt increased from 2% to 5% of the working age population. Mortality rates were at least three times higher in the SBIB than the non-SBIB group at all points in time for men and women. Mortality rates declined in all groups, for example in men receiving SBIB, mortality decreased from 2354/100,000 in the 1981-84 cohort to 1371/100,000 in the 2001-04 cohort. Absolute inequalities between SBIB and non-SBIB declined in both men and women (for example in women standardised rate differences decreased from 954/100,000 to 688/100,000) but relative inequalities remained largely stable (for example in men the risk ratio increased from 4.27 to 4.54). Mortality rates declined more in sickness benefit than invalid's benefit recipients. The substantial expansion of SBIB receipt in New Zealand has not been accompanied by any reduction in the excess mortality risk experienced by SBIB recipients. These findings are likely to reflect the changing nature of the economy, labour force and disability experience in New Zealand.

Understanding the role of sex differences in work injuries: Implications for primary care practice

PURPOSE

Primary care physicians care for work-injured women and men, yet there is little information on sex differences in outcomes and factors contributing to post-injury outcomes to guide their evaluation and recommendations.

METHODS

Two self-administered questionnaires were sent to a large sample of women and men with work injuries reported to the New Hampshire (USA) Department of Labour between November 2000 and March 2002. Factors associated with the work injury and outcomes were assessed.

RESULTS

A total of 3001 persons (1448 women and 1553 men) completed the first questionnaire and 67% completed the second questionnaire. Work-injured women were significantly younger, more educated, more likely to be single, had more pre-injury comorbidities, and worked in less physically demanding occupations as compared to work-injured men. Women's injuries were more often a result of routine job tasks and of gradual onset. Women had worse long-term outcomes including job stability and post-injury income. In multivariate analyses, being female was independently associated with a negative employer response and greater future work concerns.

CONCLUSIONS

Women and men differ in terms of work injury circumstances and factors contributing to post-injury outcomes. Primary care providers should consider sex when evaluating and treating work-injured adults.

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.

Coordinated and tailored work rehabilitation: a randomized controlled trial with economic evaluation undertaken with workers on sick leave due to musculoskeletal disorders

INTRODUCTION

In Denmark, the magnitude and impact of work disability on the individual worker and society has prompted the development of a new "coordinated and tailored work rehabilitation" (CTWR) approach. The aim of this study was to compare the effects of CTWR with conventional case management (CCM) on return-to-work of workers on sick leave due to musculoskeletal disorders (MSDs).

METHODS

The study was a randomized controlled trial with economic evaluation undertaken with workers on sick leave for 4-12 weeks due to MSDs. CTWR consists of a work disability screening by an interdisciplinary team followed by the collaborative development of a RTW plan. The primary outcome variable was registered cumulative sickness absence hours during 12 months follow-up. Secondary outcomes were work status as well as pain intensity and functional disability, measured at baseline, 3 and 12 months follow-up. The economic evaluation (intervention costs, productivity loss, and health care utilization costs) was based on administrative data derived from national registries.

RESULTS

For the time intervals 0-6 months, 6-12 months, and the entire follow-up period, the number of sickness absence hours was significantly lower in the CTWR group as compared to the control group. The total costs saved in CTWR participants compared to controls were estimated at US $ 1,366 per person at 6 months follow-up and US $ 10,666 per person at 12 months follow-up.

CONCLUSIONS

Workers on sick leave for 4-12 weeks due to MSD who underwent "CTWR" by an interdisciplinary team had fewer sickness absence hours than controls. The economic evaluation showed that-in terms of productivity loss-CTWR seems to be cost saving for the society.

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.

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.