Abstract
Disability retirement causes a significant burden on the society and affects the well-being of individuals. Early health problems as determinants of disability retirement have received little attention. The objective was to study, whether interrupting compulsory military service is an early indicator of disability retirement among Finnish men and whether seeking medical advice during military service increases the risk of all-cause disability retirement and disability retirement due to mental disorders and musculoskeletal diseases. We also looked at secular trends in these associations. We examined a nationally representative sample of 2069 men, who had entered military service during 1967–1996. We linked military service health records with cause-specific register data on disability retirement from 1968 to 2008. Secular trends were explored in three service time strata. We used the Cox regression model to estimate proportional hazard ratios and their 95% confidence intervals. During the follow-up time altogether 140 (6.8%) men retired due to disability, mental disorders being the most common cause. The men who interrupted service had a remarkably higher cumulative incidence of disability retirement (18.9%). The associations between seeking medical advice during military service and all-cause disability retirement were similar across the three service time cohorts (overall hazard ratio 1.40 per one standard deviation of the number of visits; 95% confidence interval 1.26–1.56). Visits due to mental problems predicted disability retirement due to mental disorders in the men who served between 1987 and 1996 and a tendency for a similar cause-specific association was seen for musculoskeletal diseases in the men who served in 1967–1976. In conclusion, health problems—in particular mental problems—during late adolescence are strong determinants of disability retirement. Call-up examinations and military service provide access to the entire age cohort of men, where persons at risk for work disability can be identified and early preventive measures initiated.
Highlights
Disability retirement leading to early exit from working life is a major concern for the society in most developed countries, not least due to the economic burden the absence from productive working life poses
A Swedish study reported that being sometimes absent from school at the age 16 predicted adult sickness absence only in women, not in men [13]. Both musculoskeletal and mental problems manifest already in the youth [14,15,16], little is known about care-seeking in youth and later disability. The aims of this register-linked study were to examine, whether interrupting compulsory military service is an early indicator of disability retirement among Finnish men and whether seeking medical advice during military service increases the risk of all-cause disability retirement and disability retirement due to mental disorders and musculoskeletal diseases
In our register-based study we found that seeking medical advice during compulsory military service was associated with all-cause disability retirement as well as disability retirement due to mental disorders and musculoskeletal diseases
Summary
Disability retirement leading to early exit from working life is a major concern for the society in most developed countries, not least due to the economic burden the absence from productive working life poses. In Finland, the prevalence of disability retirement among working age people is 6.8% [1] Musculoskeletal diseases and mental disorders have remained the two leading causes of disability retirement in the Western countries for decades [2]. Incidence of disability retirement due to mental disorders increased in the late 1980s in Finland, leading to receivers of these pensions being the largest group among the disability retired [1, 3]. Numerous studies have looked at the predictors of disability retirement, focusing mainly at risk factors occurring in the middle aged [6]. Mental and musculoskeletal disorders have been reported to co-occur frequently in the general population and have a synergistic effect on work disability [8, 9]
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