Abstract
ObjectiveThe 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.MethodsThis 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.ResultsNew 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.ConclusionHaving 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.
Highlights
Having a birth defect was the strongest indicator of receiving a disability pension (DP) during early adulthood, followed by small for gestational age and low Apgar score
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
Summary
Over the past few decades, Europe has witnessed an increase in the number of people receiving a disability pension (DP), [1, 2] with several countries reporting a high proportion of young adults as new recipients. [2,3,4] This trend of early exit from the labor force and reliance on DP increases financial pressures on governments and aggravates the anticipated future labor force shortage due to the aging population. [2] DP is a social security scheme that provides income support to people of working age with long-term limitations in their working capacity due to ill health, and it is an important part of the public support programs for people with disabilities in Sweden. [3, 4]Several studies have identified numerous socio-economic and health-related factors associated with the utilization of DP. [2, 5] Some of the identified adulthood socio-demographic risk factors include education, occupation, marital status, family structure, and place of residence. [6,7,8,9,10,11,12] Individuals receiving DP tend to report more adverse health outcomes, poorer self-rated health, increased alcohol use, and more frequent use of primary health care. [7, 10, 13,14,15]A few studies using the life course critical model have examined the link between childhood conditions and the risk of receiving a DP later in life [16]. We identified no single study that has investigated the association between having a birth defect or a low Apgar score and receiving a DP during early adulthood. Some evidence does suggest that persons with birth defects are more likely to report a developmental disability later in life [21,22,23], and another study reported a link between low Apgar score at five minutes and minor disabilities at school age. The aims of this study were (a) to investigate the association between perinatal health factors as measured by birth defects, Apgar score, and being small for gestational age and the receipt of a DP during early adulthood, and (b) to assess whether the effect of these perinatal outcomes differ according to the age at which one starts to receive a DP
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