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

Prevalence and incidence of memory complaints in employed compared to non-employed aged 55-64 years and the role of employment characteristics

Objectives

To examine the association of employment status and characteristics with prevalent and incident memory complaints (MC) in 55–64-year-olds.

Methods

Subjects were participants of the Longitudinal Aging Study Amsterdam (LASA). Respondents with baseline data were selected to examine the association of employment status (n = 1525) and employment characteristics (n = 1071) with prevalent MC (i.e., MC at baseline). Respondents without MC at baseline were selected to examine the association of employment (n = 526) and employment characteristics (n = 379; working hours, job prestige, job level, psychological job demands, iso-strain) with incident MC (i.e., no MC at baseline and MC at three-year follow-up). Associations were adjusted for relevant covariates (demographics, memory performance, physical health, mental health, personality traits). Logistic regression was applied. Data were weighed according to gender and age of the Dutch population.

Results

At baseline 20.5% reported MC. At three-year follow-up, 15.4% had incident MC. No associations were found between employment status and MC. Adjusted analysis revealed that individuals with high occupational cognitive demands were more likely to have prevalent MC.

Conclusions

Middle-aged workers are equally as likely to experience MC as non-working age-peers. Among workers, those with cognitively demanding work were more likely to experience MC, independent of memory performance. Memory decline due to ageing may be noticed sooner in 55–64-year-olds performing cognitively demanding work.

A prospective cohort study of disability pension due to mental diagnoses: the importance of health factors and behaviors

BACKGROUND

Previous studies have found associations between various health factors and behaviors and mental disorders. However, knowledge of such associations with disability pension (DP) due to mental diagnoses is scarce. Moreover, the influence of familial factors (genetics and family background) on the associations are mainly unknown. The aim of the study was to investigate associations between health factors and behaviors and future DP due to mental diagnoses in a twin cohort, accounting for familial confounding.

METHODS

A prospective cohort study of Swedish twins (N=28 613), including survey data and national register data on DP and other background factors was conducted. Cox proportional hazards regression models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI) for the whole twin cohort, and for discordant twin pairs.

RESULTS

During follow-up 1998-2008 (median 10 years), 2.2% of the cohort was granted a DP with a mental diagnosis. In the fully adjusted analyses of the whole cohort, the associations of poor or moderate self-rated health (SRH), under- or overweight, former or current tobacco use, or being an abstainer from alcohol were significantly associated with risk of DP due to mental diagnoses. Analyses of discordant twin pairs confirmed all these associations, except for current tobacco use, being independent from familial confounding. Exclusion of individuals with current or previous depression or anxiety at baseline did not influence the associations found.

CONCLUSIONS

Poor or moderate SRH, under- or overweight, former tobacco use or being an abstainer from alcohol seem to be strong direct predictors of DP due to mental diagnoses, independently of several confounders of this study, including familial factors.

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.

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.

Risk factors for long-term absence due to psychiatric sickness: a register-based 5-year follow-up from the Oslo health study

OBJECTIVE

To identify individual and work-related predictors of long-term (>8 weeks) sickness absence with psychiatric diagnoses (LSP).

METHODS

Data from the Oslo Health Study (response rate 46%) were linked to public registers. A total of 8333 subjects were followed from 2001 through 2005. Cox regression was used to compute hazard ratios for LSP.

RESULTS

At least one LSP was present in 7.8% of women and 3.9% of men. Poor support from superior had an independent and moderate effect. Path and linear regression analyses indicated that the effect of support from superior was mediated through mental distress and not the other way around. Self-reported mental distress had a strong independent effect.

CONCLUSIONS

Women had a higher risk of LSP than men. Low education and poor support from superior and mental distress were found to be determinants of LSP.

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.

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.