Permanent Disability Pension Research Articles

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...

Long-term life satisfaction in ageing women with work disability due to mental and musculoskeletal disorders.

Mental disorders (MDs) and musculoskeletal disorders (MSDs) are the major causes of global disability and increase in prevalence with age. To support healthy ageing, we studied how work disability due to MDs or MSDs is related to life satisfaction (LS) cross-sectionally and in 5- and 10-year follow-ups among ageing women. In the population-based OSTPRE cohort (women aged 58-67 in 1999), data on lifetime permanent work disability pensions (DPs) due to 'MDs only' (n=337), 'MSDs only' (n=942) and 'MDs + MSDs' (n=212) and 'no DP' (n=6322) until 1999 was obtained from the Finnish national register. The OSTPRE postal enquiry included a four-item life satisfaction (LS) scale (range 4-20: satisfied 4-6, intermediate 7-11, dissatisfied 12-20) at 5-year intervals, in 1999-2004 (n=6548) and in 1999-2009 (n=5562). In 1999, the risks of belonging to the dissatisfied LS group (score 12-20) vs. the satisfied group (score 4-6) were higher in 'MDs only' (OR=4.30; 95%CI 2.95-6.28), 'MSDs only' (OR=2.69; 2.12-3.40) and 'MDs + MSDs' (OR=2.72; 1.77-4.16) groups than in the 'no DP' group. In the follow-ups, these risks were OR5yr=5.59 (3.54-8.84) and OR10yr=4.94 (2.80-8.73) for 'MDs only', OR5yr=3.36 (2.58-4.37) and OR10yr=3.18 (2.40-4.21) for 'MSDs only', and OR5yr=4.70 (2.75-8.05) and OR10yr=6.84 (3.53-13.27) for 'MDs+MSDs' (all: p≤0.001). Adjusting for baseline LS did not change the pattern (all p≤0.001). Work disability due to MDs and MSDs undermines healthy ageing among women via life dissatisfaction.

The unemployed on sickness allowance: segmenting 3-year labour market pathways with sequence analysis

Abstract Background Understanding how the combination of unemployment and work disability affects future labour market pathways is important. We followed labour market pathways among those who were unemployed at the start of a sickness allowance spell. Methods Register data covered disability pensions (DP), rehabilitation spells, sickness allowance spells, unemployment spells and employment spells, retrieved for unemployed Finnish 18-58 years old persons who had a new sickness allowance spell in 2016. Sequence analysis and clustering were used to identify latent homogenous subgroups. Using multinomial regressions, demographic, socioeconomic, and disability-related covariates were examined. Results Preliminary analyses revealed six clusters with unique pathways and identities. 1) Unemployment; 2) Employment; 3) Rehabilitation spells, recurring disability and unemployment; 4) Unknown sources of income; 5) Permanent disability pension; and 6) Temporary disability pensions. Compared to the cluster with emphasis on return-to-work, other clusters were associated with less pre-LTSA employment days, having a pre-LTSA chronic illness, and a mental disorder. Conclusions Unemployed persons starting an LTSA have very different labour market pathways. For many, there are low chances for employment or regained work ability in the following years. Persons with poor health, long history outside employment, older age, low educational level and a mental disorder could benefit from targeted support. Key messages • Despite heterogeneous pathways found, for most of the unemployed, sickness allowance spells are followed by recurring unemployment, recurring sickness allowance, or disability retirement. • Since the unemployed with work disability rarely regain work ability in the following years, supporting their work ability is crucial in preventing permanent exclusion from working life.

Identifying labour market pathways after a 30-day-long sickness absence –a three-year sequence analysis study in Finland

BackgroundReturn-to-work (RTW) process often includes many phases. Still, multi-state analyses that follow relevant labour market states after a long-term sickness absence (LTSA), and include a comprehensive set of covariates, are scarce. The goal of this study was to follow employment, unemployment, sickness absence, rehabilitation, and disability pension spells using sequence analysis among all-cause LTSA absentees.MethodsRegister data covered full-time and partial sickness allowance, rehabilitation, employment, unemployment benefits, and permanent and temporary disability pension (DP), retrieved for a 30% representative random sample of Finnish 18–59 years old persons with a LTSA in 2016 (N = 25,194). LTSA was defined as a ≥ 30-day-long full-time sickness absence spell. Eight mutually exclusive states were constructed for each person and for 36 months after the LTSA. Sequence analysis and clustering were used to identify groups with different labour market pathways. In addition, demographic, socioeconomic, and disability-related covariates of these clusters were examined using multinomial regressions.ResultsWe identified five clusters with emphases on the different states: (1) rapid RTW cluster (62% of the sample); (2) rapid unemployment cluster (9%); (3) DP after a prolonged sickness absence cluster (11%); (4) immediate or late rehabilitation cluster (6%); (5) other states cluster (6%). Persons with a rapid RTW (cluster 1) had a more advantaged background than other clusters, such as a higher frequency of employment and less chronic diseases before LTSA. Cluster 2 associated especially with pre-LTSA unemployment and lower pre-LTSA earnings. Cluster 3 was associated especially with having a chronic illness before LTSA. Those in cluster 4 were on average younger and had a higher educational level than others. Especially clusters 3 and 4 were associated with a LTSA based on mental disorders.ConclusionsAmong long-term sickness absentees, clear groups can be identified with both differing labour market pathways after LTSA and differing backgrounds. Lower socioeconomic background, pre-LTSA chronic diseases and LTSA caused by mental disorders increase the likelihood for pathways dominated by long-term unemployment, disability pensioning and rehabilitation rather than rapid RTW. LTSA based on a mental disorder can especially increase the likelihood for entering rehabilitation or disability pension.

Economic Evaluation of Inpatient Multimodal Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy for Sick-Listed Workers with Musculoskeletal- or Common Mental Disorders

Purpose: To evaluate the cost-effectiveness and cost-benefit of inpatient multimodal occupational rehabilitation (I-MORE) compared to outpatient acceptance and commitment therapy (O-ACT) for individuals sick listed due to musculoskeletal- or common mental disorders during two-years of follow-up. Methods: We conducted an economic evaluation with a societal perspective alongside a randomized controlled trial with 24 months follow-up. Individuals sick listed 2 to 12 months were randomized to I-MORE (n = 85) or O-ACT (n = 79). The outcome was number of working days. Healthcare use and sick leave data were obtained by registry data. Results: Total healthcare costs during the 24 months was 12,057 euros (95% CI 9,181 to 14,933) higher for I-MORE compared to O-ACT, while the difference in production loss was 14,725 euros (95% CI -1,925 to 31,375) in favour of I-MORE. A difference of 43 (95% CI -6 to 92) workdays, in favour of I-MORE, gave an incremental cost-effectiveness ratio of 278 euros for one workday, less than the cost of one day production (339 euros). Net societal benefit was 2,667 euros during two years of follow-up. Conclusion: Despite considerable intervention costs, the lower production loss resulted in I-MORE being cost-effective when compared to O-ACT. Based on economic arguments, I-MORE should be implemented as a treatment alternative for individuals on long-term sick leave. However, more research on subgroup effects and further follow-up of participants’ permanent disability pension awards are warranted.

Comparing self-reports to national register data in the detection of disabling mental and musculoskeletal disorders among ageing women

BackgroundSelf-reports of diseases are used in research due to time and cost efficiency. Mental disorders (MDs) and musculoskeletal disorders (MSDs) are the leading causes of global disability. AimsTo investigate how self-reports detect physician-diagnosed severe MDs and MSDs in postmenopausal women. MethodsIn the population-based OSTPRE cohort, 1466 women (aged 57–66) had received a permanent work disability pension (DP) due to ‘MDs only’ (n = 336), ‘MSDs only’ (n = 926) or ‘MDs + MSDs’ (n = 204) by the end of 1998 and responded to a postal enquiry in 1999. In 2009, 1029 women responded to a follow-up enquiry. Self-reports were cross-checked against register data on DPs. ResultsIn 1999, 47 % of the participants in the ‘MDs only’ and 21 % in the ‘MDs + MSDs’ reported DPs due to MDs, whereas 75 % in the ‘MSDs only’ and 67 % in the ‘MDs + MSDs’ reported DPs due to MSDs. By 2009, this discrepancy increased, with the respective figures being 34 % and 19 % for MDs and 75 % for both MSDs groups. In 1999, older age was related to non-reporting in the three groups (each: p ≤ 0.001). ConclusionSelf-reports grossly underestimate the prevalence of disabling MDs and considerably that of MSDs among ageing women. Thus, additional sources of information are needed.

One-year healthcare costs of patients with spontaneous intracerebral hemorrhage treated in the intensive care unit.

Background:Spontaneous intracerebral hemorrhage (ICH) entails significant mortality and morbidity. Severely ill ICH patients are treated in intensive care units (ICUs), but data on 1-year healthcare costs and patient care cost-effectiveness are lacking.Methods:Retrospective multi-center study of 959 adult patients treated for spontaneous ICH from 2003 to 2013. The primary outcomes were 12-month mortality or permanent disability, defined as being granted a permanent disability allowance or pension by the Social Insurance Institution by 2016. Total healthcare costs were hospital, rehabilitation, and social security costs within 12 months. A multivariable linear regression of log transformed cost data, adjusting for case mix, was used to assess independent factors associated with costs.Results:Twelve-month mortality was 45% and 51% of the survivors were disabled at the end of follow-up. The mean 12-month total cost was €49,754, of which rehabilitation, tertiary hospital and social security costs accounted for 45%, 39%, and 16%, respectively. The highest effective cost per independent survivor (ECPIS) was noted among patients aged >70 years with brainstem ICHs, low Glasgow Coma Scale (GCS) scores, larger hematoma volumes, intraventricular hemorrhages, and ICH scores of 3. In multivariable analysis, age, GCS score, and severity of illness were associated independently with 1-year healthcare costs.Conclusions:Costs associated with ICHs vary between patient groups, and the ECPIS appears highest among patients older than 70 years and those with brainstem ICHs and higher ICH scores. One-third of financial resources were used for patients with favorable outcomes. Further detailed cost-analysis studies for patients with an ICH are required.

Use of Health Services and Rehabilitation before and after the Beginning of Long-Term Sickness Absence-Comparing the Use by Employment and Disability Pension Transition after the Sickness Absence in Finland.

The objective of the study was to follow the health care and rehabilitation use before, during and after long-term sickness absence (LTSA), and to compare the use by post-LTSA labour market situation in terms of disability pension and employment. Individuals aged 18–58 with a ≥30-day LTSA spell in 2015 (N = 2427) were included from the total population of the city of Oulu, Finland. Register data included LTSA spells, outpatient health care visits, inpatient care spells and rehabilitation spells, disability pensions (DP), employment dates, and demographic, socioeconomic and disability-related covariates. The study population was followed for one year before, and three years after the start of LTSA. Negative binomial regression models were utilized to examine covariate-adjusted use of the three service types and group differences. The use of outpatient health care peaked at the start of the LTSA spell, and adjusted for covariates, the height of the peak was similar regardless of post-LTSA labour market situation. Adjusted for covariates, those who transferred to permanent DP after an LTSA used more outpatient (predicted mean 4.87 for attendance days quarterly, 95% CI 4.36–5.38) and inpatient (predicted mean 84 days quarterly, 95% CI 0.62–1.06) health care than others during three years after the start of LTSA. Individuals not employed after an LTSA showed the highest and increasing level of rehabilitation use. The results indicate that Individuals returning to employment after an LTSA are provided with relatively high amount of early outpatient care, possibly aiding the return. For individuals not employed after an LTSA, rehabilitation is used quite frequently but rather late in the disability process. The frequent use of health care among future disability pensioners is consistent with their increasing health problems leading to retirement.

Employment trajectories among those treated for alcohol use disorder: A register-based cohort study.

Employment during and following treatment for alcohol use disorder (AUD) is important for the individual's health and well-being and for reducing the societal costs associated with benefit payments. Nonetheless, this is an under-researched topic. This study aimed to identify trajectories of labour force participation among people enrolled in AUD treatment and describe the characteristics of those following contrasting pathways. Using trajectory analysis, we modelled employment trajectory groups among AUD patients during the year of treatment entry and the 4 subsequent years, applying Norwegian longitudinal register data. Norway. Patients who entered treatment with AUD as the primary diagnosis during 2009 and 2010 (9000 patients, age 20-61 years). The outcome variable 'labour force attachment' was measured as being in full-time employment, partly employed, on temporary welfare benefits or on permanent disability pension. Predictors were age, gender, education and comorbid mental health and drug use disorders. We distinguished six employment trajectories among AUD patients: 15.8% were on permanent disability pension throughout, 8.7% exited the labour force on permanent disability pension during the observation period, 32.1% had a medium attachment throughout follow-up, and 9.2% had a decreasing attachment; 23.3% had a high labour force attachment throughout, and 10.9% experienced increasing attachment. High attachment throughout was negatively associated with being female (P < 0.001), having lower educational attainment (P < 0.001), and having comorbid mental health (P < 0.001) and drug use disorders (P < 0.001). Norwegian patients treated for alcohol use disorder in 2009 and 2010 followed six employment trajectories during the 5 years following treatment entry and had lower labour force participation than the general population. Nearly a quarter had a high labour force attachment throughout treatment, which was positively associated with being male, having higher educational attainment and having fewer comorbid mental health and drug use disorders.

Factors associated with returning to work after long term absence due to mental disorders

If there is a chance for a person’s ability to work to be restored through treatment or rehabilitation, a temporary disability pension may be granted in Finland. We examined the personal, socio-economic and healthcare-related factors associated with return to work (RTW) after the receipt of temporary disability pension. The study material contains comprehensive register data of individuals who were granted a temporary disability pension due to a mental disorder (ICD10: F10–F69, F80–F99) for the first time between 2010 and 2012 (N = 8615). We applied clustering analysis in order to reveal different patterns of returning to work after receipt of temporary disability pension and utilized multinominal regression analysis to examine gender-specific determinants for RTW and partial RTW in a controlled setting. Being a lower-grade employee remarkably promoted RTW for women (OR 7.85 95% CI 5.35–11.51), as did being a manual worker for men (OR 5.47 95% CI 3.48–8.78). Moreover, both active male (OR 3.51 95% CI 2.19–5.61) and female manual workers (OR 2.44 95% CI 1.66–3.59) had a higher probability of partial RTW compared to people who were initially unemployed. In addition, psychotherapy and vocational rehabilitation were associated with an increased probability of RTW. After 3 years from the initial temporary pensioning, almost two-thirds of the study population (69% of men and 64% of women) still had a temporary or by then a permanent disability pension due to a mental disorder. This and further research could improve the ability to recognize those subjects more likely to return to work than others.

Risk of a permanent work-related disability pension after incident venous thromboembolism in Denmark: A population-based cohort study.

BackgroundLong-term complications of venous thromboembolism (VTE) hamper physical function and impair quality of life; still, it remains unclear whether VTE is associated with risk of permanent work-related disability. We aimed to assess the association between VTE and the risk of receiving a permanent work-related disability pension and to assess whether this association was explained by comorbidities such as cancer and arterial cardiovascular disease.Methods and findingsA Danish nationwide population-based cohort study consisting of 43,769 individuals aged 25 to 66 years with incident VTE during 1995 to 2016 and 218,845 birth year-, sex-, and calendar year-matched individuals from the general population, among whom 45.9% (N = 120,540) were women, was established using Danish national registries. The cohorts were followed throughout 2016, with permanent work-related disability pension as the outcome. Hazard ratios (HRs) with 95% confidence intervals (CIs) for disability pension were computed and stratified by sex and age groups (25 to 34, 35 to 44, 45 to 54, and 55 to 66 years of age) and adjusted for comorbidities and socioeconomic variables.Permanent work-related disability pensions were granted to 4,415 individuals with VTE and 9,237 comparison cohort members (incidence rates = 17.8 and 6.2 per 1,000 person-years, respectively). VTE was associated with a 3-fold (HR 3.0, 95% CI: 2.8 to 3.1) higher risk of receiving a disability pension. Adjustments for socioeconomic status and comorbidities such as cancer and cardiovascular diseases reduced the estimate (HR 2.3, 95% CI: 2.2 to 2.4). The risk of disability pension receipt was slightly higher in men than in women (HR 2.5, 95% CI: 2.3 to 2.6 versus HR 2.1, 95% CI: 2.0 to 2.3). As this study is based on medical and administrative registers, information on post-VTE care, individual health behavior, and workplace factors linked to disability pension in the general population are lacking. Furthermore, as disability pension schemes vary, our results might not be directly generalizable to other countries or time periods.ConclusionsIn this study, incident VTE was associated with increased risk of subsequent permanent work-related disability, and this association was still observed after accounting for comorbidities such as cancer and cardiovascular diseases. Our results emphasize the social consequences of VTE and may help occupational and healthcare professionals to identify vulnerable individuals at risk of permanent exclusion from the labor market after a VTE event.

Work Resumption after a Fixed-Term Disability Pension: Changes over Time during a Period of Decreasing Incidence of Disability Retirement.

The incidence of disability retirement in Finland has sharply decreased over the last ten years. At the same time, the share of fixed-term pensions has increased to cover more than half of all new disability pensions. This study examined the efficiency of fixed-term disability pensions under these changing circumstances with the aim of addressing the following research questions: are fixed-term disability pensions more often converted to permanent pensions, and how have the changes affected return to work? The study was based on register data of Finnish residents aged 25–62 whose fixed-term disability pension started in 2006 (n = 10,177) or 2015 (n = 7918). Of the fixed-term disability pensions starting in 2006, 58 percent were converted to a permanent disability pension within the next four years. In 2015, the corresponding figure was 41 percent. Return to work increased from 24 to 30 percent. In addition, ending up in some other state (most often unemployment) increased, and, more often, fixed-term disability pensions continued for more than four years. Transferring to a permanent disability pension decreased more among the younger, those with a lower education, and those suffering from mental disorders. The results were not notably affected by changes in the characteristics of fixed-term disability pension recipients (e.g., demographic and occupational characteristics and rehabilitation) or the selection of applicants into a fixed-term or a permanent pension. Return to work increased more among men, the older age groups, those with a fixed-term disability pension due to somatic diseases, and those who had received vocational rehabilitation. Adjusting for the composition of fixed-term disability pensioners increased the differences between the study years, and controlling for the selection into a fixed-term pension further widened the differences. In conclusion, a decreasing proportion of fixed-term disability pensions are converted to permanent pensions, but this is only partly reflected in increased return to work. Further efforts are needed to support work resumption after a fixed-term disability pension to avoid the situation where people drop out from disability pension but are resting on unemployment and other benefits.

Occupational inequality in disability pension among persons with diabetes and comorbidity

Abstract Background Persons with type 2 diabetes (DM2) have higher probability of an early exit from the labour market and to receive permanent disability pension compared with persons without DM2. Objectives To assess the association between occupational class and disability pension among persons without disease, with DM2 only and DM2 with six comorbid conditions (CVD, musculoskeletal disorders, mental disease, cancer, cerebrovascular disease and ≥2 comorbid diseases). Methods All employed persons aged 40-64 living in Denmark in the period 2011-2017(n, year 2011=1,454,649) were stratified according to DM2 and six major concomitant diseases. We estimated the relative risk of disability pension dependent on DM2 comorbidity status and occupational class by means of a log-binomial regression. Reference group was upper non manual employees with no disease. Results The highest risks of disability pension were seen for DM2 + mental disease, age 40-59 (RR = 2.45 [2.3-2.5]), DM2 + cerebrovascular disease (RR = 2.45 CI 95% [2.1-2.8]) and DM2 + ≥2 diseases (RR = 2.98 [2.9-3.1]). Unskilled and manual workers were more likely to receive disability pension. The occupational inequality was highest among younger persons and groups of persons with DM2 only and DM2 + CVD and lowest for persons with more than one concomitant disease. Conclusions The results suggest that among people with DM2, labour market exit depend on both comorbid conditions and occupational class. Overall, our results show that the relative effects of occupational class on disability pension decrease in cases with severe comorbid conditions. In younger persons the mechanisms may be more nuanced, suggesting that persons with DM2 + comorbid conditions in particular have difficulties fulfilling the working requirements of lower occupational jobs. Practitioners may use the results in targeting prevention interventions to persons in high risk of early labour market exit. Key messages Low occupational class and comorbidity increase the risks of disability pension among persons with DM2. Constrained work-flexibility of low occupational jobs may influence diabetes self-care and explain high inequality in disability pension.

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.

Acute and long-term costs of 268 peripheral nerve injuries in the upper extremity.

BackgroundPeripheral nerve injury in the upper extremity is linked to high socioeconomic burden, yet cost-analyses are rare and from small cohorts. The objective of this study was to determine the costs and long-term socioeconomic effects of peripheral nerve injuries in the upper extremity in Germany.MethodsWe analyzed data of 250 patients with 268 work-related upper extremity nerve injuries from acute treatment to long-term follow-up on rehabilitation, sick-leave and disability-pension.ResultsPatients were on average 39.9±14.2 years old, male (85%) and mean inpatient treatment was 7±6 days. Location of nerve was 8% (N = 19) proximal to the wrist, 26% (N = 65) at the wrist and metacarpus, and 66% (N = 166) at phalangeal level. Acute in-patient treatment for (single) median nerve injury accounted for 66% with hospital reimbursement of 3.570€, ulnar nerve injury for 24% and 2.650€ and radial nerve injury for 10% and 3.166€, all including finger nerve injuries. The remaining were combined nerve injuries, with significantly higher costs, especially if combined with tendon 5.086€ or vascular injury 4.886€. Based on location, nerve injuries proximal to the wrist averaged 5.360±6.429€, at the wrist and metacarpus 3.534±2.710€ and at the phalangeal level 3.418±3.330€. 16% required rehabilitation with average costs of 5.842€ and stay of 41±21 days. Sick leave was between 11–1109 days with an average of 147 days with socioeconomic costs of 197€/day, equaling on average 17.640€. 30% received a mean yearly disability pension of 3.187€, that would account to 102.167€ per lifetime.ConclusionThis large German patient sample indicates that nerve injury has a major impact on function and employment, resulting in significant health care costs. Both proximal and distal nerve injuries led to long-term disability, subsequent sick-leave and in 30% to permanent disability pension. These data are determined to support future studies and health economical work on prevention, treatment and rehabilitation of these often small injuries with great consequences.

Temporary Disability Pension, RTW-Intentions, and RTW-Behavior: Expectations and Experiences of Disability Pensioners over 17 Months.

Purpose: Individuals receiving a temporary disability pension (TDP) should get the opportunity to return to work (RTW). The current study aims to determine the factors contributing to RTW. Methods: 453 individuals on TDP were interviewed at three measurement points (T1, T2 = T1 + approximately 7 months, T3 = T1 + approximately 17 months). Socio-demographics, psychological predictors, and current work status (maintained TDP, permanent disability pension, old-age pension, employed, or receipt of other benefits) were assessed. Results: Throughout the duration of the study, only four of the former temporary disability pensioners returned to work, and an additional seven made themselves available to the labor market. These were individuals who were younger, in TDP for a shorter period of time, and reported a higher RTW-intention. Higher RTW-intention was cross-sectionally associated with younger age, shorter TDP duration, and more positive outcome expectancies. Additionally, study participants who expected that medical rehabilitation would help them RTW were more motivated to RTW. An increase in RTW-intention over 17 months was related to younger age and better health. Conclusion: Personal factors such as self-efficacy and job-related variables appear less important for RTW than age and subjective health status. The observed RTW rates call for early support and tailored medical rehabilitation interventions that help individuals prevent functional limitations, overcome disability, and facilitate RTW.

The importance of clinical and labour market histories in psychiatric disability retirement: analysis of the comprehensive Finnish national-level RETIRE data

ObjectivesDespite the stable incidence of mental disorders in Finland and Europe, mental health-related occupational disability has been increasing. We unveiled the paths to permanent psychiatric disability, recovery, or death, by analysing sequences of labour market participation.MethodsThe RETIRE register database includes information regarding all persons (n = 42,170) awarded an ICD-10 psychiatric disability pension between 2010 and 2015 in Finland. We identified clusters of typical paths of pre-retirement labour market history. Controlling for major mental disorders, age, and sex, we evaluated factors associated with returning to work (RTW), or death, over a 5-year follow-up period.ResultsOnly 10.5% of the disabled subjects returned to work within the follow-up. Half of them ended up with a permanent disability pension. Seven distinguishable paths to disability were identified. Subjects in the cluster characterized by steady employment were relatively often females, lost their work ability due to affective disorders, and had the highest rate of returning to work (16.3%). Mortality was highest (9%) among the cluster characterized by long-term unemployment. Distributions of major diagnostic groups, as well as age and sex, differed between clusters. After their adjustment in the analysis of RTW or death, the identified labour market history paths prior to losing work ability remained as important independent prognostic factors for both outcomes.ConclusionsThe complex retirement process involves identifiable clinical and contextual associating factors. Labour market history patterns associate with varying prognoses after psychiatric retirement. Prolonged unemployment appears as a predictor of relatively poor prognoses, whereas employment indicates the opposite.

Networking of occupational health care units promotes reduction of permanent disability pensions among workers they care: A register-based study controlled by benchmarking with a 5-year follow-up.

ObjectivesEarly retirement due to disability is a problem in Finland. That causes pension costs that are heavy for the society. This study was designed to find out whether a quality network can support the reduction in incident disability pensions and promote a shift from full to partial disability pensions.MethodsThe study population (N = 41 472 in 2016) consisted of municipal employees whose occupational health care (OHC) was provided by the members of the Finnish Occupational Health Quality Network (OQN). The comparison population consisted of all municipality employees whose OHC was provided by non‐members of the OQN (N = 340 479 in 2016). The outcomes were measured by comparing the trends in incident disability pensions of full and partial permanent pension and full and partial provisional pension, partial/full pension indexes from 2011 to 2016 according to the principles of Benchmarking Controlled Trials. Linear regression models were used to explore the dynamics of different pension forms. Regression coefficients were calculated to show the average change per year.ResultsThe incidence of permanent disability pensions decreased faster in the study population (P for trend .03) and the study group showed a stronger shift from full to partial permanent pensions (P for trend <.001).ConclusionQuality networking between OHC units including common goal setting, systematic quality improvement, and repeated quality measurements decreased new permanent disability pensions and increased partial permanent pensions. Such changes are important while thriving for increased work participation.

Frequent attenders at risk of disability pension: a longitudinal study combining routine and register data.

Aims: Frequent attendance in healthcare services is associated with ill-health and chronic illnesses. More information is needed about the phenomenon’s connection with disability pensions (DPs). Methods: The study group comprised 59,676 patients divided into occasional- (1yFAs) and persistent frequent attenders (pFAs) and non-frequent attenders (non-FAs). Odds ratios for DP were analysed for these groups taking into account preceding sickness absence days. The awarded DPs were obtained from the Finnish Centre for Pensions and data on primary care visits were obtained from Pihlajalinna, a nationwide occupational healthcare provider. Results: 1yFAs and pFAs have more DPs than non-FAs. During follow-up, 14.9% of pFAs, 9.6% of 1yFAs and 1.6% of non-FAs had a DP decision of any kind. pFAs receive more partial and fixed-term decisions than the other groups and most permanent DPs are granted to 1yFAs. Musculoskeletal disorders are the most common reason for illness-based retirement in all groups but 1yFAs and pFAs have proportionally more mental disorders leading to DP. The group of non-FAs, on the other hand, has more DPs granted based on neoplasms. Both 1yFAs and pFAs have an increased risk of DP but the effect is diluted after taking into account preceding sick-leave. Conclusions: Frequent attendance of healthcare services, both occasional and persistent, is associated with increased risk of future DP. The association is linked to increased sickness absences. Frequent attenders should be identified and their rehabilitative needs evaluated. Frequency of consultation could be used in selecting candidates for early rehabilitation before sickness absences develop.

The effect of smoking cessation on work disability risk: a longitudinal study analysing observational data as non-randomized nested pseudo-trials.

BackgroundSmoking increases disability risk, but the extent to which smoking cessation reduces the risk of work disability is unclear. We used non-randomized nested pseudo-trials to estimate the benefits of smoking cessation for preventing work disability.MethodsWe analysed longitudinal data on smoking status and work disability [long-term sickness absence (≥90 days) or disability pension] from two independent prospective cohort studies—the Finnish Public Sector study (FPS) (n = 7393) and the Health and Social Support study (HeSSup) (n = 2701)—as ‘nested pseudo-trials’. All the 10 094 participants were smokers at Time 1 and free of long-term work disability at Time 2. We compared the work disability risk after Time 2 of the participants who smoked at Time 1 and Time 2 with that of those who quit smoking between these times.ResultsOf the participants in pseudo-trials, 2964 quit smoking between Times 1 and 2. During the mean follow-up of 4.8 to 8.6 years after Time 2, there were 2197 incident cases of work disability across the trials. Quitting smoking was associated with a reduced risk of any work disability [summary hazard ratio = 0.89, 95% confidence interval (CI) 0.81–0.98]. The hazard ratio for the association between quitting smoking and permanent disability pension (928 cases) was of similar magnitude, but less precisely estimated (0.91, 95% CI 0.81–1.02). Among the participants with high scores on the work disability risk score (top third), smoking cessation reduced the risk of disability pension by three percentage points. Among those with a low risk score (bottom third), smoking cessation reduced the risk by half a percentage point.ConclusionsOur results suggest an approximately 10% hazard reduction of work disability as a result of quitting smoking.