Abstract
BackgroundThe incidence of disability pension (DP) is high in several European countries. However, knowledge on associations of cause-specific DP and premature death is limited. The aims were to: 1) investigate the association between cause-specific DP and all-cause and cause-specific mortality among women and men and 2) examine period effects of this association.MethodsThree prospective population-based cohort studies were conducted, the first including all individuals aged 16–64 years who lived in Sweden all of 1995 and who were not on DP before 1995 (N = 5 006 523, 48.8% women). Those granted DP in 1995 were compared to those not granted DP regarding mortality during 1996–2009. Two other cohorts were created in a similar fashion, for 2000 and 2005, respectively, and in comparisons each of the three cohorts were followed up for four years with regard to all-cause mortality as well as death due to cancer, circulatory disorders, or suicide. All analyses were stratified by sex and we controlled for a number of socio-demographic factors and inpatient care.ResultsIndividuals with granted DP had a higher mortality risk, women (HR 1.75; 95% CI 1.68-1.82) and men (HR 1.66; 95% CI 1.61-1.71) and highest for cancer. People on DP with some diagnoses had higher risk of premature death in other causes of death than their DP diagnoses. All-cause mortality risk varied with DP-diagnosis and was lowest for musculoskeletal diagnoses. The mortality HR decreased among women with DP between the cohort 1995, HR 2.07 (1.92–2.24) and the cohort 2005, 1.84 (1.71–1.99). Here, temporal decreases in mortality risk occurred particularly in DP due to mental diagnoses and cancer.ConclusionsAll DP diagnoses were associated with a higher mortality risk. Even individuals granted DP due to diagnoses with low mortality risk displayed a higher risk for premature death. This warrants close monitoring of disability pensioners and further studies on consequences of being on disability pension.
Highlights
The incidence of disability pension (DP) is high in several European countries
This seems surprising, as physicians are involved in the process of granting DP, and healthcare usually is interested in possible consequences of a measure
The main dispute on this issue has focused on whether the higher mortality is inherently related to the underlying disease, or whether it is associated with other factors, or even with the DP itself, that is, by being on DP, or its potential psycho-social consequences [7]
Summary
The incidence of disability pension (DP) is high in several European countries. knowledge on associations of cause-specific DP and premature death is limited. The incidence of disability pension (DP) continues to be high in many European countries, despite improvements in health and increases in life expectancy [1] This development exacerbates the risk of shortage of labor and strains the economy of the society; for the individual, DP may imply economic constraints, life style changes, social isolation, and development of other diseases, e.g., depression [2]. Regarding DP, there are fewer studies and most of them focus on risk factors for DP, hardly any on the situation afterwards [2,5] This seems surprising, as physicians are involved in the process of granting DP, and healthcare usually is interested in possible consequences of a measure. As it is not possible to study these associations by randomized controlled trials, other study designs are warranted, preferably large prospective cohort studies [5]
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