Full Disability Pension Research Articles

Level of and Changes in Perceived Work Ability Among Partial Disability Pensioners and the Risk of Full Disability Pension—A Register-Linked Cohort Study

PurposeTo examine how the level of perceived work ability and its changes over time are associated with the risk of full disability pension (DP) among those receiving partial DP.MethodsWe retrieved survey data on perceived work ability and covariates (sociodemographic factors and health behaviors) from a cohort study of Finnish public sector employees at two time points: 2008 and 2012 and linked them with register data on DP obtained from the Finnish Centre for Pensions up to the end of 2018. Participants had begun receiving partial DP in 2008 and responded to either the 2008 survey (n = 159) or both surveys (n = 80). We used Cox regression for the analyses.ResultsDuring the follow-up, 61 (38%) of those receiving partial DP transitioned to full DP. Those with perceived poor work ability were at a higher risk of full DP (HR 1.93; 95% CI 1.11–3.38) than those with at least moderate work ability, after adjustment for covariates. During four years of receiving partial DP, perceived work ability decreased among 36% of the participants, and remained unchanged or improved among 64%. Change in work ability was not associated with a risk of full DP.ConclusionAmong those receiving partial DP, perceived poor work ability was a risk factor for full DP. Our findings highlight the importance of monitoring the level of perceived work ability of those receiving partial DP to enable identifying individuals at an increased risk of full DP.

Unemployed and disabled for work: identifying 3-year labour market pathways from the beginning of a sickness absence using sequence and cluster analyses in a register-based longitudinal study in Finland

ObjectivesThis study followed the labour market pathways of unemployed persons who started a sickness absence (SA) spell. We aimed to unravel subgroups based on altering labour market states and to...

Functional neurological symptoms are a frequent and relevant comorbidity in patients with multiple sclerosis.

Functional neurological symptoms (FNS) in multiple sclerosis (MS) have shown to be underinvestigated even though neurological diseases such as MS represent a risk factor for developing FNS. Comorbidity of FNS and MS can produce high personal and social costs since FNS patients have high healthcare utilization costs and a quality of life at least as impaired as in patients with disorders with underlying structural pathology. This study aims to assess comorbid FNS in patients with MS (pwMS) and investigate whether FNS in pwMS are associated with poorer health-related quality of life and work ability. Newly admitted patients (234) with MS were studied during their stay at Kliniken Schmieder, a neurological rehabilitation clinic in Konstanz, Germany. The degree to which the overall clinical picture was explained by MS pathology was rated by neurologists and allied health practitioners on a five-point Likert scale. Additionally, neurologists rated each symptom reported by the patients. Health-related quality of life was assessed using a self-report questionnaire and work ability was assessed using the mean number of hours worked per day and information regarding disability pension as reported by patients. In 55.1% of cases, the clinical picture was completely explained by structural pathology due to MS. 17.1% of pwMS presented an overall clinical picture half or less of which could be explained by underlying structural pathology. PwMS with a higher comorbid FNS burden had a lower health-related quality of life and reported fewer working hours per day than pwMS with symptoms explained by structural pathology. Furthermore, pwMS with a full disability pension had a higher comorbid FNS burden than pwMS with no or partial disability pension. These results show that FNS should be addressed diagnostically and therapeutically since such symptoms are an important comorbidity in MS that is related to poorer health-related quality of life and lower work ability.

Has the share of the working life expectancy that is spent receiving a partial or full disability pension changed in Finland over the period 2005–2018? A longitudinal register-based study

ObjectivesThe share of the overall working careers that is spent receiving disability benefits is unclear. We examined trends in full-time equivalent working life expectancy (FTE-WLE) among those with and without...

Determinants of transition from partial to full disability pension: A register study from Finland.

Aims: This study explored the rate of transition from partial to full disability pension (DP) and aimed to determine whether age, sex, education, employment status, employment sector, pension type and medical cause of disability were associated with transition to full DP during a four-year follow-up. Methods: We used register data, including a 70% random sample of partial disability pensioners aged 20-58 at the time that their partial DP started in 2010 or 2011 (N=5277). Competing risk analysis was used to estimate sub-hazard ratios (SHR) and their 95% confidence intervals (CI) for full DP. Results: One third of partial disability pensioners transitioned to full DP during the four-year follow-up. More than half (52%) continued on partial DP, and 15% were in some other state. Men, older people, those with low education levels, those whose pension was granted until further notice and those whose pension was due to mental disorders (MD) proceeded to full DP more often than others. The SHR for full DP was 1.62 (95% CI 1.43-1.83) among partial disability pensioners with MD and 1.15 (95% CI 1.02-1.28) among partial disability pensioners with other diseases compared to those whose pension was granted due to musculoskeletal diseases. Conclusions: Partial DP is a relatively stable state, and moving to full DP is relatively rare. However, male sex, older age, low education level, a pension granted until further notice and partial DP due to MD are important risk factors for full DP. The risk factors for ending up on full DP varies by diagnosis and pension type.

Quality improvement activity in occupational healthcare associated with reduced need for disability retirement: A Bayesian mixed effects modelling study in Finland.

Objectives:There is evidence that occupational healthcare (OHC) may improve employees’ work ability. This research was designed to study whether common quality improvement (QI) activities in the OHC quality network (OQN) – a voluntary collaborative forum – can reduce the need for disability pensions.Methods:The study population comprised employees under the care of 19 OHC units in Finland affiliated with the OQN. The association of 12 QI activities with new disability pensions during the years 2011–2017 was analyzed by Bayesian mixed effects modelling.Results:Patients of OHC units affiliated with the OQN have fewer full permanent disability pensions [odds ratio (OR) 0.77, 95% credible interval (CI) 0.60–0.98] and full provisional disability pensions (OR 0.68, 95% CI 0.53–0.87) than patients of unaffiliated units. Of the studied QI activities, the measurements of intervening in excessive use of alcohol had the strongest association with the incidence of all disability pensions (OR 0.53, 95% CI 0.41–0.68). Participation in the focus of work measurements and quality facilitator training was also associated with the reduced incidence of disability pensions (OR 0.84, 95% CI 0.71–0.98, and OR 0.92, 95 CI 0.84–0.99, respectively).Conclusions:Affiliation with a quality network seemed to improve outcomes by reducing full disability pensions or replacing them by partial disability pensions. Some QI activities in the OQN were associated with a reduction of disability pensions.

How often do partial disability pensioners end up on a full disability pension?

Abstract Background Extending working lives and deferring retirement have been important topics of discussion in recent years. Full disability pensioners seldom work, but most partial disability pensioners continuing working while receiving a pension. However, very little is known about how often partial disability pensioners end up on a full disability pension. The aims of this study were to investigate to what degree partial disability pensions become full disability pensions, and how age, gender, marital status, education, unemployment or a disability diagnosis are associated with that. Methods The register data included 2,969 Finns who were aged 18-59 years and whose partial disability retirement started in 2010. The follow-up period ranged from 2010 to the end of 2015. Cox models were used to estimate hazard ratios for full disability retirement. Results Approximately 40 per cent of the partial disability pensioners ended up on a full disability pension during the follow-up period. Partial disability pensioners who were older, had a lower educational level or a history of unemployment, or who suffered from mental disorders ended up on a full disability pension more often than others. The risk of full disability retirement was 1.5-fold among those with mental disorders compared to those with musculoskeletal diseases. Conclusions Partial disability pensioners with a low education, a history of unemployment or who suffer from mental disorders experience a higher risk of ending up on a full disability pension. More focus should be paid to improving education, preventing mental health problems and unemployment in order to help the disabled work longer. Key messages Preventing partial disability pensioners from ending up on a full disability pension can extend their working lives. Partial disability pensioners with a low education, a history of unemployment or poor mental health more often stop working altogether. More focus should be paid to improving these issues.

Working while on a disability pension in Finland: Association of diagnosis and financial factors to employment.

The aim of this study was to find out whether health and financial factors are associated with engagement in paid work during a disability pension. The data included a 10 per cent sample of Finns aged 20-62 years who were drawing earnings-related full or partial disability pension in 2012 ( n = 14,418). Logistic regression analysis was used to estimate odds ratios for working while on a full or partial disability pension. Fourteen per cent of full disability pensioners and 76 per cent of partial disability pensioners were engaged in paid work. Full disability pensioners due to mental disorders were working less often than full disability pensioners due to other diseases. Partial disability pensioners due to cardiovascular diseases were working more than partial disability pensioners due to other diseases. More recent timing of disability pension was associated with working for both partial and full disability pensioners. Working while on disability pension was more common among those with higher education. Partial disability pensioners with average pension worked more often than those with high pension. By knowing the factors associated with working while on a disability pension, policies could be more efficiently allocated to encourage disability pensioners to take up work. One way would be to support disability pensioners with low education to work more. Another way to increase work among disability pensioners is to support the recently retired in working longer.

Smoking and early retirement due to chronic disability

This paper considers the long-term effects of smoking on disability retirement in Sweden. Smoking is known to have damaging effects on health, but there is limited evidence on how the effects of smoking translate into worse labour market outcomes, such as the inability to work. In contrast to the few previous studies on smoking and disability retirement, we use a large population sample with registry information on smoking, which is recorded for all women who give birth in Sweden. Thanks to these comprehensive data, we are able to account for a much broader range of potential confounders. In particular, by the use of sibling and twin fixed effects, we account for unobserved heterogeneity in childhood environment and family characteristics. Given that smoking is often initiated in adolescence, one would suspect such factors to play important roles.Among individuals aged 50–64 in 2011, a simple model suggested smokers to have a 5 percentage point higher probability of receiving (full) disability pension, making them more than twice as likely as non-smokers to receive this. However, in a model with sibling fixed effects, the size of the effect was reduced by more than a third. The results point to the importance of confounders, such as childhood circumstances or behaviours, which were not accounted for by previous studies. We also consider effects on disability due to different health conditions. In relative terms, effects are the largest for circulatory conditions and tumours. Results are largely driven by health problems severe enough to merit hospitalization, and there is no evidence of a role played by financial incentives.

Do workplace interventions reduce disability rates?

BackgroundIncreasing life expectancy and decreasing fertility have led to a shift in the workforce age structure towards older age groups. Deteriorating health and reduced work capacity are among the challenges to retaining older workers in the labour force.AimsTo examine whether workplace interventions to facilitate work among employees with health problems or reduced work capacity affect disability rates among employees aged 50 years and older.MethodsData from a survey of Norwegian companies (n = 713) were linked with registry data on their employees aged 50-61 years (n = 30771). By means of a difference-in-differences approach, we compared change in likelihood of receiving a full disability pension among employees in companies with and without workplace interventions.ResultsEmployees in companies reporting to have workplace interventions in 2005 had a higher risk of receiving full disability pension during the period 2001-03 compared with employees in companies without such interventions [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.07-1.45]. During the period 2005-07, there was an overall reduction in disability rates (OR 0.83, 95% CI 0.71-0.96) in both the intervention and control group. However, employees in companies reporting to have interventions in 2005 experienced an additional reduction in an employee’s likelihood of receiving a full disability pension (OR 0.80, 95% CI 0.64-0.99) compared with employees in companies without interventions.ConclusionsInterventions to facilitate work among employees with health problems or reduced work capacity have reduced disability rates among employees aged 50-61. This suggests that companies’ preventive interventions are an effective means to retain older workers with deteriorating health.

Sickness allowance trajectories preceding disability retirement: a register-based retrospective study.

To identify subgroups of disability retirees with different pre-retirement sickness allowance histories and to examine whether the diagnosis of disability pension and socio-demographic variables discriminate these subgroups. The data included all Finnish residents aged 30-64 years who were granted a full disability pension in 2011 (N = 17 208). Sickness allowance trajectories during the preceding 10 years were searched using latent trajectory analysis. Multinomial logistic regression analysis was used to explore determinants of the trajectories. Six distinct sickness allowance trajectories were identified. Four large subgroups with a long sickness allowance period during the final pre-retirement year were found, characterized by increasing (29% of retirees), early high (21%), stable low (24%) or stable high (16%) sickness allowance histories. In addition, two small subgroups (6 and 4%) with only a little sickness allowance during the final year were identified. The diagnosis of disability pension strongly influenced assignment to the trajectory groups. Women were more likely to have followed the stable high or the early high sickness allowance trajectory. Older age strongly increased but being a lower non-manual employee or self-employed decreased the probability of belonging to the two small trajectory groups. Long-term unemployment slightly increased belonging to the stable low trajectory and was strongly associated with the small subgroups with little or no sickness allowance during the final year preceding retirement. Different pre-retirement sickness allowance trajectories can be found. Assignment to the trajectories differed by the diagnosis of disability pension but associations with socio-demographic variables were weak.

Smoking Behaviour and Early Retirement Due to Chronic Disability

This paper considers the long-term effects of smoking on disability retirement. Exploiting population-wide registry data from Sweden, we contribute to the literature by accounting for a much broader range of potential confounders. In particular, by the use of sibling and twin fixed effects, we account for all unobserved heterogeneity in childhood environment and family characteristics. Moreover, we are able to control for detailed information on socioeconomic status, marital status and health. We also contribute by comparing effects on different diagnoses for which disability pension was granted, thus shedding some light on the biological mechanisms linking smoking to disability retirement. We demonstrate a strong association between smoking and disability retirement. Among individuals aged 50-64, smokers have a six percentage point higher probability of receiving (full) disability pension. However, while the relationship remains significant when accounting for confounders such as family environment, the size of the effect is much attenuated. Effects are concentrated to mental and musculoskeletal conditions, but effects on neoplasms, nervous system, eye and circulatory diagnoses are also found. The results are largely driven by health problems severe enough to merit hospitalization, and there is no evidence of a role played by financial incentives.

Cost Effectiveness of Aftercare in the Cardiovascular Rehabilitation: A Five Years Follow-up Analysis

In Germany, the rehabilitative approaches towards patients with coronary artery events are not adequately sustainable despite the high costs. Both sustainability and cost effectiveness are the subjects of this 5-year analysis. The study was initiated in 2004. One year recruiting phase was followed by 3 years aftercare with telephone as an intervention. This unicentric randomised controlled trial included 600 patients of rehabilitative aftercare (intervention group [IG] 271; control group [CG] 329). Data on (i) mortality, (ii) duration of retirement, (iii) type of retirement and (iv) status of retirement were obtained from the German Retirement Insurance.The analyses for cost-effectiveness are conducted for the intention-to-treat (ITT) approach. The general assessment basis of retirements (partial and full disability pensions) are average values for the year 2013 (year of the measurement). On the reporting date (31.12.2013), the values of the IG in part (early) retirement and full (early) retirement are higher than the CG (1.5 and 2.7%, n. s. and 7.4 and 13.4%, respectively n. s.). The same applies for mortality (8.1 and 9.4%, respectively n. s.).The savings through lower pension payments amount to € 1.55 million for the adjusted ITT approach. From this, € 130 080, which represents the cost of the aftercare (intervention), must be deducted. The results of the 5-year follow-up show that a part of pension payment could be reduced. The evidence of cost effectiveness, independently of the methodological approach, is strong. The saving potential is reached by half in both approaches.

Back to work? Socioeconomic status after kidney transplantation.

Employment after kidney transplantation is an important marker of health recovery. The study addresses the impact of successful kidney transplantation on socioeconomic factors and employment in a Swiss cohort. Patients who received a kidney allograft at the University Hospital of Basel between 2000 and 2011 were investigated. A standardised survey was used to obtain information on socioeconomic factors 1 year before and after successful transplantation. A total of 610 patients were contacted; 354 (58%) answered the survey. The median age of respondents was 53.5 (interquartile range 42-61) years at the time of transplantation, 31.2% were females. Overall, 201 out of 282 working-age patients (71.3%) were working 1 year after transplantation: 102 full-time, 55 part-time, 30 patients part-time with additional disability pension, and 14 housework. Seventy-two patients (25.3%) did not work 1 year after transplantation: 63 patients had a full or partial disability pension, and nine patients were unemployed. Thirty out of 282 working-age patients (10.6%) had improved working ability after transplantation. Employment after transplantation was favoured by: living donor transplantation (p <0.0001), pre-emptive transplantation (p <0.0001), dialysis duration ≤1 year (p <0.0001), preserved employment before transplantation (p <0.0001), and higher education (p = 0.003), whereas age above 50 years (p = 0.006), and dialysis duration > 1 year (p <0.0001) had a negative impact. The employment rate in this Swiss cohort before and after successful kidney transplantation is high compared with the literature. A high number of living donors, of pre-emptive transplantations, and short dialysis vintages contribute to this observation.

How can SLE Impact patient´s life

This review examines the disease impact on life of 76 SLE patients by collecting data using special questionnaire. The impact of the disease on professional activities has confirmed that up to 63% of patients are registered disabled, of which 46% are granted full disability pension. SLE negatively affects patients’ career – up to 39% of SLE patients stated that they had to change a job due to their disease. SLE has a strong impact on everyday life of patients. SLE symptoms are significant even during the period of quiescence – they predominantly fatigue, reduced physical activity, and pain. Among the all activities of daily life the most influenced are staying in the sun and more stressful activities or sport. The fact that limitations in all monitored activities are present in more than 50% of patients is a serious issue. Treatment-related adverse events have negative impact on the quality of life in almost 70% of patients. The most frequent include gastrointestinal symptoms, visual disturbance, and osteoporosis. SLE has a significant impact on the quality of life of patients and hinders them from leading everyday life at the level comparable to healthy population.

Work disability and productivity loss in patients with inflammatory bowel diseases in Hungary in the era of biologics.

To assess work disability (WD) rates in an inflammatory bowel disease (IBD) cohort involving patients with Crohn's disease (CD) or ulcerative colitis (UC) cohort and to identify possible clinical or demographic factors associated with WD. To our knowledge, this is the first study from Eastern Europe that has estimated indirect costs in IBD. Data from 443 (M/F: 202/241, CD/UC: 260/183, mean age: 35.5 (CD) and 40.5 (UC) years, biological drug exposure 31.2/11.5%) consecutive patients were included. WD data were collected by questionnaire and the work productivity and activity impairment instrument. Disability pension (DP) rates in the general population were retrieved from public databases. The overall DP rate in this IBD population was 32.3%, with partial disability in 24.2%. Of all DP events, 88.8% were directly related to IBD. Overall, full DP was more prevalent in IBD (RR: 1.51, p < 0.001) and CD (RR: 1.74, p < 0.001) but not in UC compared to the general population and also in CD compared to UC (OR 1.57, p = 0.03). RR for full DP was increased only in young CD patients (RR<35 year olds: 9.4; RR36-40 year olds: 9.4 and 5.6, p < 0.01 for both). In CD, age group, previous surgery, disease duration, frequent relapses, and the presence of arthritis/arthralgia were associated with an increased risk for DP. Among employed patients, absenteeism and presenteeism was reported in of 25.9 and 60.3% patients, respectively, leading to a 28% loss of work productivity and a 32% activity loss, and was associated with disease activity and age group. Average cost of productivity loss due to disability and sick leave with a human capital approach was 1,450 and 430 €/patient/year in IBD, respectively (total productivity loss 1,880 €/patient/year), the costs of presenteeism were 2,605 (SD = 2,770) and 2,410 (SD = 2,970) €/patient/year in CD and UC, respectively. Risk of DP was highly increased in young CD patients (sixfold to ninefold). Previous surgery and presence of arthritis/arthralgia was identified as risk factors for DP. Work productivity is significantly impaired in IBD and is associated with high productivity loss.

Systemic Lupus Erythematosus - Disease Impact on Patients

Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease that can affect almost all organs of the body. Lupus is a non-curable disease and the treatment is based on symptom control by immunosuppressive and anti-inflammatory treatment. The disease itself as well as treatment-related adverse events have a significant negative impact on life expectancy and quality of life of patients. The aim of this study was to identify the impact of the disease on life of SLE patients. Data were collected anonymously using a special questionnaire. The survey involved 76 patients with SLE, results were processed by conventional methods and descriptive statistic methods. The survey has confirmed the impact of SLE on professional activities i.e. up to 63% of patients are registered disabled, of which 46% are granted full disability pension. SLE negatively affects patients' career--up to 39% of SLE patients stated that they had to change a job due to their disease. SLE has a strong impact on everyday life of patients. SLE symptoms are significant even during the period of quiescence--predominantly fatigue, reduced physical activity, pain. The most influenced activities of daily living included sunbathing and more strenuous activities or sport. The fact that limitations in all monitored activities are present in more than 50% of patients is a serious finding. Treatment-related adverse events have negative impact on the quality of life in almost 70% of patients. The most frequent events include gastrointestinal symptoms, visual disturbance and osteoporosis. SLE has a significant impact on the quality of life of patients and hinders them from leading everyday life at the level comparable to healthy population.

Prognostic factors for return to work, sickness benefits, and transitions between these states: a 4-year follow-up after work-related rehabilitation.

Purpose The aim of this study was to examine if age, gender, medical diagnosis, occupation, and previous sick leave predicted different probabilities for being at work and for registered sickness benefits, and differences in the transitions between any of these states, for individuals that had participated in an interdisciplinary work-related rehabilitation program. Methods 584 individuals on long-term sickness benefits (mean 9.3 months, SD = 3.4) were followed with official register data over a 4-year period after a rehabilitation program. 66 % were female, and mean age was 44 years (SD = 9.3). The majority had a mental (47 %) or a musculoskeletal (46 %) diagnosis. 7 % had other diagnoses. Proportional hazards regression models were used to analyze prognostic factors for the probability of being on, and the intensity of transitions between, any of the following seven states during follow-up; working, partial sick leave, full sick leave, medical rehabilitation, vocational rehabilitation, partial disability pension (DP), and full DP. Results In a fully adjusted model; women, those with diagnoses other than mental and musculoskeletal, blue-collar workers, and those with previous long-term sick leave, had a lower probability for being at work and a higher probability for full DP during follow-up. DP was also associated with high age. Mental diagnoses gave higher probability for being on full sick leave, but not for transitions to full sick leave. Regression models based on transition intensities showed that risk factors for entering a given state (work or receiving sickness benefits) were slightly different from risk factors for leaving the same state. Conclusions The probabilities for working and for receiving sickness benefits and DP were dependent on gender, diagnoses, type of work and previous history of sick leave, as expected. The use of novel statistical methods to analyze factors predicting transition intensities have improved our understanding of how the processes to and from work, and to and from sickness benefits may differ between groups. Further research is required to understand more about differences in prognosis for return to work after intensive work-related rehabilitation efforts.

High prevalence of sickness absence and disability pension among multiple sclerosis patients: a nationwide population-based study

Introduction: Although multiple sclerosis (MS) often implies substantial disability, there is little knowledge about sick leave and disability pension among MS patients. Objectives: The purpose of this study was to estimate the prevalence rates of sick leave and disability pension among MS patients and to explore how socio-demographics are associated with such rates. Methods: The register data of all people who lived in Sweden in 2005 and were 16–64 years old was used to identify 9721 MS patients and matched controls. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and effect modifications were evaluated with Wald X2 tests. Results: In 2005, 61.7% of the MS patients were on partial or full disability pension compared to 14.2% among the controls. Of the others, 36.8% had ≥1 sick-leave spell for >14 days during that year. Socio-demographics were similarly associated with sick leave and disability pension among MS patients and controls, with the noteworthy exceptions that female gender and immigration status were less potent risk factors in the MS population (p<0.05). Conclusion: In spite of widespread access to modern health care including disease-modifying drugs, the majority of MS patients of working ages were on a disability pension. Strategies enabling MS patients to retain their footing in the labour market are needed.

Partial sick leave associated with disability pension: propensity score approach in a register-based cohort study

ObjectivesTo support sustainability of the welfare society enhanced work retention is needed among those with impaired work ability. Partial health-related benefits have been introduced for this target. The aim was...