Abstract
PurposeWork disability (WD) as a medico-legal concept refers to disability benefits (DB) that are granted due to diseases that permanently reduce work ability. We studied whether an occupational healthcare instrument for the prediction of sickness absence (SA) risk—a health risk appraisal (HRA)—also predicts permanent WD.MethodsHRA results were combined with registry data on DB of 22,023 employees from different industry sectors. We analysed how the HRA risk categories predict DB and considered occupational group, gender, age, and prior SA as confounding variables. Cumulative incidence function illustrates the difference between the HRA risk categories, and the Fine–Gray model estimates the predictors of WD during 6-year follow-up.ResultsThe most common primary reasons for permanent WD were musculoskeletal (39%) and mental disorders (21%). Self-reported health problems in the HRA, labelled as “WD risk factors”, predicted DB when controlling for age and prior SA. Hazard ratios were 10.9 or over with the lower limit of the 95% confidence interval 3.3 or over among those with two simultaneous WD risk factors. 14% of the females and 17% of the males with three or more simultaneous WD risk factors had received a DB, whereas the respective figures among those without findings were 1.9% and 0.3%.ConclusionsSelf-reported health problems in the HRA, especially multiple simultaneous WD risk factors, predict permanent WD among both genders across occupational groups. Screening WD risk with a self-administered questionnaire is a potential means for identifying high-risk employees for targeting occupational healthcare actions.
Highlights
The cost of work disability benefits (DB) has become a significant burden to public finances globally (Aumayr-Pintar et al 2016)
We present descriptive statistics to describe the eligibility categories and the most common health issues that lead to DBs
We used the cumulative incidence function (CIF) to illustrate the difference between the health risk appraisal (HRA) risk categories (Kim 2007), and the Fine–Gray proportional hazards model to estimate how HRA categories, age and occupational group affected the probability of events, i.e. a granted DB, prior to a follow-up (Fine and Gray 1999)
Summary
The cost of work disability benefits (DB) has become a significant burden to public finances globally (Aumayr-Pintar et al 2016). Across the OECD countries, public spending on DB is around 2–6% of the gross domestic product (GDP) of the working-age population, depending on the country (OECD 2010). In 2014, about 7% of the Finnish workingage population was on a DB, and the average age of the onset of a permanent DB was 52 (Laaksonen et al 2016b). Permanent work disability (WD) is a medico-legal concept (De Boer et al 2008), which in Finland is defined as having been granted a DB. The benefits programme of the Social Insurance Institution of Finland (Kela) provides coverage for lost income due to medically certified sickness up to 1 year.
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