Abstract
PurposeMusculoskeletal diagnoses (MSD) are one of the largest diagnostic groups for disability pensions (DP). This study investigated the associations between life events and DP due to MSD, considering sociodemographic, health, and familial factors.MethodsThe study sample included 18,530 Finnish twins, 24–64 years old at baseline, who responded to a questionnaire in 1981 including a 21-item life event inventory. Information on DP with diagnosis codes (ICD codes: M00–M99) were obtained from the official national pension registers. Life events were divided into family- and work-related events. “Positive change in life” was analyzed separately. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI).ResultsDuring the follow-up of 23 years, 1273 (7%) individuals were granted DP due to MSD. In discordant pair analysis, family-related events (≥ 4 events) increased (HR 1.63, 95% CI 1.31, 2.03) and the absence of such events decreased (HR 0.68, 95% CI 0.48, 0.95) the risk of DP due to MSD. For work-related events (≥ 3 events), the risk estimates were non-significant when controlling for familial factors. Having had a positive change in life decreased the risk of DP due to MSD (HR 0.79, 95% CI 0.65, 0.96) while controlling for familial confounding, but were non-significant in the full model controlling for various covariates (HR 0.91, 95% CI 0.75, 1.12).ConclusionsThe associations between life events and the risk of DP due to MSD are complex and potentially affected by familial and other confounding factors including sociodemographics and health.
Highlights
In Finland, as in the OECD countries in general, musculoskeletal diagnoses (MSD) are the second largest diagnosis group after mental health diagnoses for disability pensions (DP) causing early exit from the labor market with negative economic consequences for both the individual and the society as a whole (OECD 2010). Life events include both neutral and major stressful events, such as changing residence, interpersonal conflicts at work, or the death of a close one (Holmes and Rahe 1967). Both positive and negative life events may be considered as additional stressors beyond normal everyday life that may lead to increased vulnerability to illness (Lazarus 1984), being linked with suboptimal health, but subsequently with consequences of chronic illnesses such as DP (Appelberg et al 1996; Cleland et al 2016; Zhang et al 2017)
Regarding family- and work-related life events, the number of individuals having many events was lower among those with DP due to MSD compared to DP due to MSD (n = 1273)
For the life event “illness or injury causing over 3 weeks of work disability”, an increased risk of DP due to MSD was seen in the model adjusting for covariates (HR 1.73, 95% confidence intervals (CI) 1.44, 2.08) and for familial confounding (HR 1.96, 95% CI 1.60, 2.40)
Summary
In Finland, as in the OECD countries in general, musculoskeletal diagnoses (MSD) are the second largest diagnosis group after mental health diagnoses for disability pensions (DP) causing early exit from the labor market with negative economic consequences for both the individual and the society as a whole (OECD 2010). Life events include both neutral and major stressful events, such as changing residence, interpersonal conflicts at work, or the death of a close one (Holmes and Rahe 1967). The pathway from the life events to DP due to MSD might be linked with the underlying disease for DP grant or with various other factors including sociodemographic or health-related factors
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