Risk Of Disability Pension Research Articles

Predictors of disability retirement - a prediction model for disability pension application risk

Abstract Background Regarding the objective of preventing early exits from labor market, the late life-course years present an important timeframe. It is essential to identify the employees in the greatest risk of permanently losing their work ability. In practical applications, multifactorial models are needed to evaluate the combined effect of risk factors. In this study, the disability pension risk is modeled based on large unique register data, at the same time assessing the effect of sickness absences (SA) of different lengths. Methods We utilize a logistic model for the risk of filing a first-time disability pension application (DPA) based on register data on 222,321 Finnish municipal sector employees. The data include employment and sickness spells, occupations, and wages in 2016-2018 as covariates. During the 3-year follow-up, 2,969 employees filed a DPA. The data include also short SA spells, a novelty in these kinds of studies. DPA is used as a follow-up to include employees who receive a rejecting decision but still carry a physician’s evaluation of diminished work ability. Results The resulting model can accurately predict the risk of DPA in employee groups. Age, occupation, cumulative SAs preceding the application, and the number of SA spells of all lengths, also short ones, have a significant increasing effect on the DPA risk. Proximity of the retirement age and high earnings decrease the risk of DPA. Surprisingly gender had no effect on the risk. Conclusions The results indicate that register-based sociodemographic data is very useful in modeling the employee DPA risk in public sector employee groups. The resulting model provides a basis for tools for predicting the risk status of employee groups for the use of employers responsible for risk management and early intervention, also allowing for the assessment of economic effects of SAs and disability risk. The presented modeling results are already utilized among public sector employers in Finland. Key messages • Disability pension risk can accurately be predicted in public sector employee groups based on readily available sociodemographic register data. • All sickness absences have a significant increasing effect on the risk of disability pension application, but the effect varies greatly depending on age and occupation.

Does country of resettlement influence the risk of labor market marginalization among refugees? A cohort study in Sweden and Norway.

This study aimed to compare the risk of labor market marginalization among refugees across different host countries of resettlement and examine the moderating role of birth country and length of stay on these associations. Cohorts of refugees and native-born individuals aged 19-60 in Sweden (N=3 605 949, 3.5% refugees) and Norway (N=1 784 861, 1.7% refugees) were followed during 2010-2016. Rates (per 1000 person-years) of long-term unemployment, long-term sickness absence, and disability pension were estimated for refugees and the host populations. Cox regression models estimated crude and adjusted (for sex, age, educational level, and civil status) hazard ratio (HRadj) for refugees compared to their respective host population, with 95% confidence intervals (CI). Analyses were also stratified by birth country and length of stay. Refugees in Norway and Sweden had a higher incidence of labor market marginalization compared to their host population. Refugees in Sweden had a comparatively lower relative risk of long-term unemployment but higher risk of disability pension (HRadj 3.44, 95% CI, 3.38-3.50 and HRadj 2.45, 2.35-2.56, respectively) than refugees in Norway (HRadj 3.70, 3.58-3.82 and HRadj 1.57, 1.49-1.66, respectively). These relative risks varied when stratifying by birth country. A shorter length of stay was associated with a higher risk of long-term unemployment and a lower risk of disability pension, with a stronger gradient in Sweden than in Norway. The relative risk of labor market marginalization varied by the refugees' birth country but followed similar trends in Sweden and Norway. Although speculative, these findings may hint at non-structural factors related to the refugee experience playing a more important role than host country structural factors for the risk of labor market marginalization among refugees. Future research, including host countries with more variability in structural factors, is required to further investigate these associations. The higher risk of long-term unemployment among refugees with shorter length of stay indicates a need for more efficient labor market integration policies for newly-arrived refugees.

Post-injury long-term sickness absence and risk of disability pension: the role of socioeconomic status

Previous research has identified low socioeconomic status (SES) as a risk factor for long-term sickness absence (LTSA) and disability pension (DP) following trauma. However, most studies lack information on medical diagnoses, limiting our understanding of the underlying factors. To address this gap, we retrieved information about diagnostic causes for receipt of welfare benefits to explore the role of SES in the transition from post-injury LTSA to permanent DP among the working population in Norway. We conducted a population-based cohort study of all Norwegian residents aged 25-59 years registered with a spell of LTSA due to injury commencing in the period 2000-2003. This cohort was followed through 2014 by linking information on receipt of welfare benefits with sociodemographic data from administrative registers. SES was defined as a composite measure of educational attainment and income level. We used flexible parametric survival models to estimate hazard ratios (HR) with 95 % confidence intervals (CI) for all-cause and diagnosis-specific DP according to SES, adjusting for sex, age, marital status, immigrant status and healthcare region of residence. Of 53,937 adults with post-injury LTSA, 9,665 (18 %) transferred to DP during follow-up. The crude risk of DP was highest for LTSA spells due to poisoning and head injuries. Overall, individuals in the lowest SES category had twice the risk of DP compared to those in the highest SES category (HR = 2.25, 95 % CI 2.13-2.38). The difference by SES was greatest for LTSA due to poisoning and smallest for LTSA due to head injuries. A majority (75 %) of DP recipients had a non-injury diagnosis as the primary cause of DP. The socioeconomic gradient was more pronounced for non-injury causes of DP (HR = 2.47, 95 % CI 2.31-2.63) than for injury causes (HR = 1.73, 95 % CI 1.56-1.92) and was especially steep for DP due to musculoskeletal diseases and mental and behavioural disorders. The relationship between SES and DP varied by both the type of injury that caused LTSA and the diagnosis used to grant DP, highlighting the importance of taking diagnostic information into account when investigating long-term consequences of injuries.

The importance of a healthy lifestyle despite chronic pain: Prospective cohort with 11-year register follow-up

The purpose of the study was to investigate to which extent a healthy lifestyle in female healthcare workers with chronic pain contributes to reducing the risk of disability pension. We conducted a prospective cohort study with an 11-year registry follow-up.Overall, 2386 Danish female healthcare workers with chronic pain completed a questionnaire about work and lifestyle (leisure-time physical activity, smoking, and body mass index (BMI)). Data on disability benefit payments were obtained from the Danish Register for Evaluation of Marginalization. Two models (minimally and fully adjusted for different potential confounders) were tested using the Cox proportional hazards model.During the follow-up period, 17.9% of the healthcare workers obtained disability pension. Low levels of leisure time physical activity (reference: moderate level) increased the risk of disability pension in the minimally (Hazard Ratio: 1.38 (95% CI: 1.14–1.69)) and fully adjusted models (Hazard Ratio: 1.27 (95% CI: 1.04–1.56)). Being highly physically active, as opposed to being moderately active, did not confer additional protection. Additionally, a positive association was observed between smoking and disability pension in the minimally adjusted model (Hazard Ratio: 1.27 (95% CI: 1.05–1.54)). BMI was not an influential factor. In female healthcare workers with chronic pain, at least moderate levels of physical activity is a protective factor for disability pension. Effective promotion strategies should be designed for both workplace and non-workplace settings.

Long-term benzodiazepine use and risk of labor market marginalization in Finland: A cohort study with 5-year follow-up.

Benzodiazepines and related drugs (BZDRs) are widely used in the treatment of anxiety and sleep disorders, but cognitive adverse effects have been reported in long-term use, and these may increase the risk of labor market marginalization (LMM). The aim of this study was to investigate whether the risk of LMM is associated with new long-term BZDR use compared to short-term use. This register-based nationwide cohort study from Finland included 37,703 incident BZDR users aged 18-60years who initiated BZDR use in 2006. During the first year of use, BZDR users were categorized as long-term users (≥180days) versus short-term users based on PRE2DUP method. The main outcome was LMM, defined as receipt of disability pension, long-term sickness absence (>90days), or long-term unemployment (>180days). The risk of outcomes was analyzed with Cox regression models, adjusted with sociodemographic background, somatic and psychiatric morbidity, other types of medication and previous sickness absence. During 5 years of follow-up, long-term use (34.4%, N=12,962) was associated with 27% (adjusted Hazard Ratio, aHR 1.27, 95% CI 1.23-1.31) increased risk of LMM compared with short-term use. Long-term use was associated with 42% (aHR 1.42, 95% CI 1.34-1.50) increased risk of disability pension and 26% increased risk of both long-term unemployment and long-term sickness absence. These results indicate that long-term use of BZDRs is associated with increased risk of dropping out from labor market. This may be partly explained by cognitive adverse effects of prolonged BZDR use, which should be taken into account when prescribing BZDRs.

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.

Risk of unemployment and work disability among refugee and non-refugee migrants with incident psychotic disorders in Sweden and Denmark.

Unemployment and work disability are common among individuals with non-affective psychotic disorders (NAPDs) but it is unknown whether rates differ among migrants and native-born individuals. The present study aimed to compare the risk of these outcomes during the first 5 years of illness in non-refugee migrants, refugees and native-born individuals with NAPDs in Sweden and Denmark-two countries with different immigration policies and models of early psychosis care. Using national registers, we identified all individuals aged 18-35 years in Sweden and Denmark who received an incident NAPD diagnosis between 2006 and 2013 (N = 6750 and 8320, respectively). Cohorts were followed for 5 years to determine the days of unemployment and sickness absence (analyzed using zero-inflated negative binomial models) and the time to receipt of disability pension (analyzed using complementary log-log models). Relative to their native-born peers, refugees and non-refugee migrants in Sweden and non-refugee migrants in Denmark were significantly less likely to have zero unemployment days (OR range: 0.54-0.72) and all migrant groups experienced more unemployment days (IRR range: 1.26-1.37). Results were largely unchanged after adjustment for sociodemographic and clinical factors. In the adjusted model, both Swedish migrant groups and refugees in Denmark were more likely to experience zero sickness absence days than native-born individuals (OR range: 1.48-1.56). Only refugees in Denmark were at greater risk of disability pension. Non-refugee migrants and refugees with NAPDs in both Sweden and Denmark are particularly vulnerable to experiencing unemployment. Targeted interventions may help to reduce these disparities and promote long-term work ability among migrant groups.

The impact of cardiorespiratory fitness and physical workload on disability pension–a cohort study of Swedish men

ObjectiveUnderstanding the impact of physical capacity in combination with high physical workload could be beneficial for the prevention of health-related exits from work. Therefore, the aim of this study was to investigate the separate and combined effects of low cardiorespiratory fitness and high physical workload on disability pension (DP) due to any cause, musculoskeletal disorders (MSD), and cardiovascular diseases (CVD).MethodsA total of 279 353 men born between 1951 and 1961 were followed regarding DP between 2006 and 2020, ages 45–64. Cardiorespiratory fitness was assessed during military conscription, using an ergometer bicycle test. Physical workload was based on a job-exposure matrix (JEM) linked to occupational title in 2005. Cox regression models estimated separate and combined associations with DP.ResultsLow cardiorespiratory fitness and high physical workload were associated with increased risk of DP. For all cause DP, the fully adjusted hazard ratio and 95% confidence interval for those with low cardiorespiratory fitness was 1.38 (1.32–1.46) and for those with high physical workload 1.48 (1.39–1.57). For all cause and MSD DP, but not for CVD DP, the combination of low cardiorespiratory fitness and high physical workload resulted in higher risks than when adding the effect of the single exposures.ConclusionBoth low cardiorespiratory fitness in youth and later exposure to high physical workload were associated with an increased risk of DP, where workers with the combination of both low cardiorespiratory fitness and a high physical workload had the highest risks (all-cause and MSD DP).

Disability pension and sociodemographic & work-related risk factors among 2.3 million migrants and natives in Finland (2011–2019): a prospective population study

BackgroundIncreasing employment and immigration have been proposed as possible solutions to tackle the problem of the labour force shortage in aging societies. Ensuring sufficient health and work ability among migrants is a key factor in increasing and maintaining their employment. Many studies have found higher disability pension (DP) rates among migrants compared to natives but such studies lack in determining the risk of DP by occupational class and industrial sector. This study explores the risk of DP and the contribution of sociodemographic and work-related factors between migrants and natives in Finland.MethodsFull-population panel data obtained from the administrative registers of Statistics Finland were used to study 2.3 million individuals aged 25–60 years in 2010. We calculated hazard ratios (HR) and their 95% confidence intervals (CI) to estimate the risk of having a DP in 2011–2019 using Cox proportional hazard models adjusting for different sociodemographic and work-related factors.ResultsCompared to natives, migrants had a lower risk of a DP (HR 0.58, 95% CI 0.53–0.63). We found great variation between countries of origin, where compared to natives, migrants from refugee-exporting countries (HR 1.37, 95% CI 1.22–1.53) and other non-European countries (HR 1.30; CI 1.18–1.43) had a higher risk of DP, but migrants from other countries did not differ or had a slightly lower risk of DP than natives. The associations between sociodemographic factors and the risk of DP were very similar between natives and migrants.ConclusionMigrants had a lower risk of a DP than natives except for migrants from outside Europe. The associations between different sociodemographic and work-related factors and the risk of DP were similar between natives and migrants and did not completely explain the differences in the risk of DP.

Acts of offensive behaviour and risk of disability pension in Danish female eldercare workers: prospective cohort with 11-year register follow-up.

To investigate whether acts of offensive behaviour (threats, violence, workplace bullying and sexual harassment) in the workplace and type of perpetrator (internal or external to the workplace) of the offensive behaviours predicted risk of disability pension in Danish eldercare workers. We merged survey responses from 8731 female eldercare workers with a national register on social transfer payments (Danish Register for Evaluation of Marginalisation (DREAM)), including all types of disability benefits. Using Cox proportional hazards models, we investigated the prospective association between self-reported exposures at baseline and the risk of receiving disability pension (any type of disability benefit payment) during 11 years of follow-up, while adjusting for potential confounders. Self-reported exposure to threats (hazard ratio (HR) 1.14; 95% confidence interval (CI) 1.00-1.32), violence (HR 1.16; 95% CI 1.00-1.35) and bullying (HR 1.44; 95% CI 1.22-1.71) predicted increased risk of disability pension during follow-up, when adjusted for age and educational attainment. When further adjusted for psychosocial working conditions only bullying remained a statistically significant (HR 1.39; 95% CI 1.16-1.67) predictor of disability pension. The results indicated no elevated risk for participants reporting sexual harassment. Moreover, we observed stronger associations between self-reported exposure to threats, violence and workplace bullying and risk of disability pension when the perpetrator was internal to the workplace (i.e. colleagues, managers and/or subordinates), than when the perpetrator was reported to be external to the workplace (i.e. service users, and/or relatives of service users). Results indicate that prevention of work-related exposure to threats, violence and workplace bullying may contribute to reduce involuntary early retirement in female eldercare workers.

Perceived work-ability and its associated factors among nurses working in the Northwest of Amhara regional state Referral Hospitals, Northwest Ethiopia, 2022

BackgroundNurses with reduced work ability had a high risk of disability pension, sickness absences, retirement intention, and leave their job and profession early. Nurses frequently suffer from job related stress, occupational fatigue and sleep problems, which can further compromise their work ability.Aims of the studyThe aim of this study was to assess perceived work ability and its associated factors among nurses working in the Northwest of Amhara regional state Referral Hospitals, Northwest Ethiopia, 2022.MethodsA multicenter, an institutional based, cross-sectional study was conducted among 410 nurses working in five selected Referral hospitals, found in the Northwest of Amhara regional state, Northwest Ethiopia, 2022. The data were collected using a structured, self-administered questionnaire and entered using Epi info version 7.2.5 software, analyzed using SPSS version 25. Summary statistics (median or IQR for continuous data and frequency and percentage for categorical variables) were used. The ordinal logistic regression was used to assess’ the presence of association between dependent and independent variables.ResultsThe findings of this study revealed that 59.0% of nurses had poor level of work ability, whereas 34.4% and 6.6% of nurses had sub-optimal and optimal level of work ability respectively. Multivariable ordinal logistic regression revealed that being male [AOR = 2.43; 95% CI (1.52, 3.91)], being BSC nurse [AOR = 0.21; 95% CI (0.08, 0.51)], nurses who had poor sleep quality [AOR = 0.34; 95% CI (0.12, 0.98)] and nurses who had chronic disease [AOR = 0.18; 95% CI (0.08, 0.41)] were significantly associated with nurses’ level of work ability, p-value < 0.05.ConclusionsIn this study, the prevalence of poor level of work ability among nurses was high. Nurses with a female sex, nurses who had chronic disease, BSC holders and nurses who had poor sleep quality had a poor level of work ability. The federal Minister of health and the study hospitals collaborative with concerned stakeholders to design strategies to enhance work ability among nurses.

The physical and psychological aspects of quality of life mediates the effect of radiation-induced urgency syndrome on disability pension in gynecological cancer survivors.

Radiation-induced fecal urgency syndrome is highly prevalent in gynecological cancer survivors. It is associated with decreased quality of life (QoL) and with disability pension. The literature remains unclear about the mediating role of physical and psychological aspects of QoL in the association between urgency syndrome and disability pension. Identifying the pathways between urgency syndrome and disability pension may help to create effective and timely interventions for increasing QoL and reducing disability pension among gynecological cancer survivors. We used patient-reported outcome measures from working-age gynecological cancer survivors (n = 247) and data on their disability pension from the official register. The mediating role of physical and psychological aspects of QoL was studied by utilizing mediation analysis based on the counterfactual framework, appropriate for binary outcome, binary mediator with an exposure-mediator interaction. The total effect (TE) was divided into direct and indirect effects using single mediation analysis. Adjusted relative risks and percentage mediated (95% confidence intervals) were calculated. All statistical tests were two-sided. Urgency syndrome increased the risk of disability pension both directly and indirectly (via QoL). Satisfaction with sleep mediated half of the TE (RR = 2.2 (1.1-4.1)) of urgency syndrome on disability pension. Physical health also mediated a similar proportion of the TE (RR = 2.1 (1.2-3.9)). The proportions mediated were higher for physical aspects of QoL (35%-71%) than for psychological aspects (2%-47%). The investigated aspects of the self-assessed QoL of gynecological cancer survivors may play a role in these women's continuing work-life. It appears that physical health, satisfaction with sleep, psychological well-being, and other investigated aspects of QoL mediate the urgency syndrome-disability pension association.

Job demands and job control and their associations with disability pension—a register-based cohort study of middle-aged and older Swedish workers

ObjectivesJob demands and control at work and their combination, job strain, have been studied in relation to risk of disability pension (DP) previously. In the present study, based on registry data, we aimed to deepen the knowledge by analyzing major disease groups among the DPs, dose–response shape of the associations, and potential confounding effects of physical workload.MethodsApproximately 1.8 million workers aged 44 or older and living in Sweden in 2005 were followed up for 16 years, up to a maximum of 65 years of age. We linked mean values of job demands and job control, estimated in a job-exposure matrice (JEM) by gender, to individuals through their occupational titles in 2005. These values were categorized by rank order, and, for the construction of job-strain quadrants, we used a median cut-off. Associations with DP were estimated in Cox proportional-hazards models.ResultsIn models accounting for covariates including physical workload, low levels of job control were associated with higher risk of DP among both men and women. This association was most clear for DP with a psychiatric diagnosis, although a dose–response shape was found only among the men. High levels of job demands were associated with decreased risk of DP across diagnoses among men, but the same association varied from weak to non-existing among women. The high- and passive job-strain quadrants both showed increased risk of DP with a psychiatric diagnosis.ConclusionThe results suggest that, at the occupational level, low job control, but not high job demands, contributes to an increased incidence of DP, particularly regarding DP with a psychiatric diagnosis.

Analgesics and ASH medications in workers increase the risk of disability pension and mortality: prospective cohort.

Relying on medication for musculoskeletal and mental disorders are common, but may have long-term consequences. This study investigates whether use of analgesics and anxiolytic/sedative/hypnotic (ASH) medication increases the risk of disability pension and mortality. After completing a survey in 2005, 7773 female eldercare workers were followed for 11 years in a national register. We estimated hazard ratios (HRs) for disability pension and mortality from using analgesics and ASH. During follow-up, 10.3% obtained disability pension and 2.4% died. For use of analgesics, a frequency-response association for the risk of disability pension existed with HR's (95% confidence interval) of 1.30 (1.07-1.57), 2.00 (1.62-2.46) and 3.47 (2.69-4.47) for monthly, weekly and daily use, respectively. For ASH, an increased risk of disability pension also existed (HR's between 1.51 and 1.64). For mortality risk, only daily use of analgesics and ASH remained significant. Population attributable fractions of analgesics and ASH, respectively, were 30% and 3% for disability pension and 5% and 3% for mortality. Frequent use of analgesics and ASH medication in workers increase the risk of disability pension and early death. Better management of musculoskeletal and mental health conditions, without excessive medication use, is necessary.

Combined exposure to heavy physical workload and low job control and the risk of disability pension: A cohort study of employed men and women in Sweden

ObjectiveTo investigate the separate and combined effects of overall heavy physical workload (PWL) and low decision authority on all-cause disability pension (DP) or musculoskeletal DP.MethodsThis study uses a sample of 1,804,242 Swedish workers aged 44–63 at the 2009 baseline. Job Exposure Matrices (JEMs) estimated exposure to PWL and decision authority. Mean JEM values were linked to occupational codes, then split into tertiles and combined. DP cases were taken from register data from 2010 to 2019. Cox regression models estimated sex-specific Hazard Ratios (HR) with 95% confidence intervals (95% CI). The Synergy Index (SI) estimated interaction effects.ResultsHeavy physical workload and low decision authority were associated with an increased risk of DP. Workers with combined exposure to heavy PWL and low decision authority often had greater risks of all-cause DP or musculoskeletal DP than when adding the effects of the single exposures. The results for the SI were above 1 for all-cause DP (men: SI 1.35 95%CI 1.18–1.55, women: SI 1.19 95%CI 1.05–1.35) and musculoskeletal disorder DP (men: SI 1.35 95%CI 1.08–1.69, women: 1.13 95%CI 0.85–1.49). After adjustment, the estimates for SI remained above 1 but were not statistically significant.ConclusionHeavy physical workload and low decision authority were separately associated with DP. The combination of heavy PWL and low decision authority was often associated with higher risks of DP than would be expected from adding the effects of the single exposures. Increasing decision authority among workers with heavy PWL could help reduce the risk of DP.

Pain Control Beliefs Predict Premature Withdrawal From the Labor Market in Workers With Persistent Pain: Prospective Cohort Study With 11-Year Register Follow-up

While a range of work-related psychosocial factors has been associated with various pain disorders and early retirement, less is known about pain cognitions and their influence on premature exit from the labor market. Therefore, as a primary objective, this study investigates associations between pain control beliefs and risk of disability pension among Danish eldercare workers. In 2005, 2257 female eldercare workers with low-back and/or neck/shoulder pain>90 days within the previous 12 months, replied to a survey and were followed for 11 years in a national register of social transfer payments. Using Cox regression, we estimated the risk of disability pension during follow-up from experiencing different levels of “pain control” and “pain influence,” controlling for pain intensity and other relevant confounders. In the fully adjusted model for pain control with “high” as reference, hazard ratios of 1.30 (95% CI 1.03–1.64) and 2.09 (95% CI 1.45–3.01) are observed for “moderate” and “low,” respectively, while the metric of pain influence shows hazard ratios of 1.43 (95% CI 1.11–1.87) and 2.10 (1.53–2.89), respectively. Pain control beliefs are associated with disability pension among eldercare workers with persistent pain. These results highlight the importance of evaluating not only bodily manifestations of pain, but also individual pain-related cognitions that may influence the experience of pain. PerspectiveThis article addresses the complex experience of pain within an organizational context. We introduce the metrics of “pain control” and “pain influence” among workers with persistent pain, showing that the psychometric properties of these measures are prospectively associated with premature exit from the labor market.

Number of children and disability pension due to mental and musculoskeletal disorders: A longitudinal register-based study in Norway

Earlier research has documented a relationship between parity and all-cause mortality, as well as parity and cause-specific mortality (e.g. cancer and cardiovascular disease mortality). Less is known about the relationship between parity and two very common (but less deadly) types of disorder: mental and musculoskeletal. We examine the association between parity and risk of disability pensioning from all causes and due to mental or musculoskeletal disorders, using Norwegian register data. In addition to controlling for adult socio-demographic characteristics, we control for unobserved confounding from family background by estimating sibling fixed-effects models. We find a higher risk of disability pensioning among the childless and those with one child than for parents with two children, both for all causes combined and for mental disorders. Childless men and fathers with one child also experience excess risk of being pensioned due to musculoskeletal disorders. For mental disorders, we find a positive association with high parity, particularly for men.

Association of common mental disorders and related multimorbidity with subsequent labor market marginalization among refugee and Swedish-born young adults.

Common mental disorders (CMDs), multimorbidity, and refugee status are associated with poor labor market outcome. Little is known about how these factors interact in young adults. We aimed to i) investigate whether the association of CMDs and multimorbidity with labor market marginalization (LMM) differs between refugee and Swedish-born young adults and ii) identify diagnostic groups with particularly high risk for LMM. This longitudinal registry-based study included individuals aged 20-25 years followed from 2012 to 2016 in Sweden (41,516 refugees and 207,729 age and sex-matched Swedish-born individuals). LMM was defined as granted disability pension (DP) or > 180 days of unemployment (UE). A disease co-occurrence network was constructed for all diagnostic groups from 2009 to 2011 to derive a personalized multimorbidity score for LMM. Multivariate logistic regression was used to estimate odds ratios of LMM in refugee and Swedish-born youth as a function of their multimorbidity score. The relative risk (RR, 95% CI) of LMM for refugees with CMDs compared to Swedish-born with CMDs was computed in each diagnostic group. In total, 5.5% of refugees and 7.2% of Swedish-born with CMDs were granted DP; 22.2 and 9.4%, respectively received UE benefit during follow-up. While both CMDs and multimorbidity independently elevated the risk of DP considerably in Swedish-born, CMDs but not multimorbidity elevated the risk of UE. Regarding UE in refugees, multimorbidity with the presence of CMDs showed stronger estimates. Multimorbidity interacted with refugee status toward UE (p < 0.0001) and with CMDs toward DP (p = 0.0049). Two diagnostic groups that demonstrated particularly high RR of UE were schizophrenia, schizotypal and delusional disorders (RR [95% CI]: 3.46 [1.77, 6.75]), and behavioral syndromes (RR [95% CI]: 3.41 [1.90, 6.10]). To combat LMM, public health measures and intervention strategies need to be tailored to young adults based on their CMDs, multimorbidity, and refugee status.

Sexual-orientation differences in risk of health-related impaired ability to work and to remain in the paid workforce: a prospective population-based twin study

BackgroundStudies consistently show an increased risk of poor health among sexual minorities (i.e., those identifying as lesbian, gay, bisexual [LGB] or other non-heterosexuals individuals), as compared to those identifying as heterosexual. It is largely unknown whether the increased risk of mental and physical health problems among sexual minorities is also reflected in an increased risk of health-related impaired ability to work, in terms of sickness absence (SA) and disability pension (DP), or successfully remain in the paid workforce. This study made use of a large sample of Swedish twins with self-reported information about sexual behavior in young adulthood to examine sexual orientation difference in SA and DP during a 12-year follow-up period.MethodData from the Swedish Twin project of Disability pension and Sickness absence (STODS), including Swedish twins born 1959–1985 was used (N = 17,539; n = 1,238 sexual minority). Self-report survey data on sexual behavior was linked to information about SA and DP benefits from the MicroData for Analysis of the Social Insurance database (MiDAS), the National Social Insurance Agency. Sexual orientation differences in SA and DP between 2006 and 2018 was analyzed, as well as, the influence of sociodemographic, social stress exposure (i.e., victimization, discrimination), mental health treatment, and family confounding on these differences.ResultsCompared to heterosexuals, sexual minorities were more likely to having experienced SA and having been granted DP. The odds were highest for DP, where sexual minorities were 58% more likely to having been granted DP compared to heterosexuals. The higher odds for SA due to any diagnosis could largely be explained by sociodemographic factors. The higher odds of SA due to mental diagnosis could partially be explained by increased risk of being exposed to discrimination and victimization, and partially by having received treatment with antidepressant medication. The higher odds of being granted DP could also partially be explain by increased risk of being exposed to social stress and treatment with antidepressant medication.ConclusionTo our knowledge, this is the first study to report on sexual orientation differences in risk of SA and DP in a population-based sample. We found higher period prevalence of both SA and DP among sexual minorities as compared to heterosexuals. The higher odds of SA and DP could partially or fully be explained by sexual orientation differences in sociodemographic factors, exposure to social stress, and antidepressant treatment for depression. Future studies can extend these findings by continuing to investigate risk factors for SA and DP among sexual minorities and how such factors can be reduced.

Time period effects in work disability due to common mental disorders among young employees in Sweden-a register-based cohort study across occupational classes and employment sectors.

We aimed to investigate time period effects in the risk of work disability, defined as long-term sickness absence (LTSA) and disability pension (DP) due to common mental disorders (CMDs), among young employees according to employment sector (private/public) and occupational class (non-manual/manual). Three cohorts, including all employed individuals with complete information on employment sector and occupational class, aged 19-29 years and resident in Sweden on 31 December 2004, 2009 and 2014 (n = 573516, 665138 and 600889, respectively) were followed for 4 years. Multivariate-adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated to examine the risk of LTSA and DP due to CMDs using Cox regression analyses. In all cohorts, public sector employees had higher aHRs for LTSA due to CMDs than private sector employees, irrespective of occupational class, e.g. aHR, 95% CI: 1.24, 1.16-1.33 and 1.15, 1.08-1.23 among non-manual and manual workers in cohort 2004. The rates of DP due to CMDs were much lower in cohorts 2009 and 2014 than 2004 leading to uncertain risk estimates in the later cohorts. Still, public sector manual workers had a higher risk for DP due to CMDs than manual workers in the private sector in cohort 2014 than in 2004 (aHR, 95% CI: 1.54, 1.34-1.76 and 3.64, 2.14-6.18, respectively). Manual workers in the public sector seem to have a higher risk of work disability due to CMDs than their counterparts in the private sector calling for the need for early intervention strategies to prevent long-term work disability.