Abstract
Objectives: To investigate the relationship between diabetes, mortality and exit from work using various Danish Pension schemes. Methods: We linked the Danish National Diabetes register with socioeconomic and population-based registers and followed prevalent and incident cases of diabetes for ten years, adjusting for gender, age and socio-occupational group. We analysed the proportion of individuals with diagnosed diabetes before and after entering a normal retirement pen-sion, voluntary early retirement pension or disability pension. Risk ratios for entering pensions, emigration and mortali-ty were calculated using Poisson regression. Results: Among 1,628,087 adults between the ages of 30 and 59, the relative risk for mortality was increased for those with incident and prevalent diabetes by 11-145%, compared to individuals without diabetes. Voluntary early retirement pension was the most common path out of the workforce, especially for individuals with diabetes. Compared to those without diabetes, the relative risk of disability retirement for individuals with prevalent and incident diabetes was 2.98 (95% CI, 2.89 – 3.07) and 2.40 (95% CI, 2.34 – 2.45), respectively. More than one fifth of participants were diagnosed with diabetes after retirement. There was a marked negative socio-occupational gradient for mortality, voluntary early retirement and disability pension. Conclusions: Increasing the retirement age will increase the proportion of workers who develop diabetes while still in the workforce. Since the number and severity of complications are related to longer disease duration, it is likely that, under proposed retirement reforms, more employees will experience health problems managing their jobs, especially among the most vulnerable socioeconomic groups. therefore expected to become more important as the retirement age increases. However, there is only scarce knowledge of how the incidence and prevalence of diabetes are distributed among different pension schemes.
Highlights
Actual and proposed increases to the retirement age in many Western countries, combined with the ongoing diabetes epidemic [1], raise the possibility that the prevalence of diabetes among the working population will increase considerably in the coming years
Mortality was higher among workers with incident diabetes, compared to people without diabetes, but only for younger members of the study population
The normal retirement pension option was more common for males; females more often used the voluntary early retirement option, and the rate of early retirement was even higher for women with diabetes
Summary
Actual and proposed increases to the retirement age in many Western countries, combined with the ongoing diabetes epidemic [1], raise the possibility that the prevalence of diabetes among the working population will increase considerably in the coming years. In Denmark, pension benefits are obtained in three ways: normal retirement, voluntary early retirement and disability. The Danish voluntary early retirement pension was implemented in 1979 and combines individual payment to an unemployment fund with a supplemental public welfare payment, currently beginning at age 60. The original argument for voluntary early retirement was to incentivize employee attrition in crowded occupations and in general, to favour employment of younger people when jobs are scarce. To obtain this benefit, employees must be healthy and able to work full time until the first day of eligibility for a voluntary early pension. A disability pension is granted when an employee’s working capacity is permanently reduced to the extent that no work of any kind can be performed
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