Risk Of Future Disability Pension Research Articles

Musculoskeletal pain intensity in different body regions and risk of disability pension among female eldercare workers: prospective cohort study with 11-year register follow-up

BackgroundMusculoskeletal pain is a risk factor for leaving the labour market temporarily and permanently. While the presence of multi-site pain increases the risk of disability pension, we lack detailed knowledge about pain intensity as a risk factor. This study investigated the association between musculoskeletal pain intensity in different body regions and risk of future disability pension among eldercare workers.MethodsEight thousand seven hundred thirty-one female eldercare workers replied to a questionnaire on work and health in 2005 and were followed for 11 years in the Danish Register for Evaluation of Marginalization. Time-to-event analyses estimated hazard ratios (HR) for disability pension from pain intensities (0–9 numeric rating scale (NRS)) in the low-back, neck/shoulders, and knees during the previous 3 months. Analyses were mutually adjusted for pain regions, age, education, lifestyle, psychosocial work factors, and physical exertion at work.ResultsDuring 11-year follow-up, 1035 (11.9%) of the eldercare workers received disability pension. For all body regions among all eldercare workers, dose-response associations were observed between higher pain intensity and risk of disability pension (p < 0.001). The risk for disability pension was increased when reporting “very high” pain levels (≥7 points on the 0–9 NRS) in the low-back (HR 2.19, 95% CI 1.70–2.82), neck/shoulders (HR 2.34, 95% CI 1.88–2.92), and knees (HR 1.89, 95% CI 1.44–2.47). Population attributable risks (PAR) were 15.5, 23.2, and 9.6% for pain > 2 on NRS in the low-back, neck/shoulders, and knees, respectively, indicating that 15.5, 23.2, and 9.6% fewer eldercare workers would likely receive disability pension if the pain intensity was reduced to 2 or less. For workers ≤45 years and > 45 years, PAR was highest for neck/shoulder pain (27.6%) and low-back pain (18.8%), respectively.ConclusionsThe present study found positive dose-response associations between pain intensity in the low-back, neck/shoulders, and knees, and risk of disability pension during 11-year follow-up. Moderate to very high levels of musculoskeletal pain in eldercare workers should, therefore, be considered an early warning sign of involuntary premature exit from the labour market. These findings underscore the importance of preventing, managing, and reducing musculoskeletal pain to ensure a long and healthy working life.

The effects of multimodal rehabilitation on pain-related sickness absence – an observational study

Purpose: The aim of the current study was to examine the effects on sickness absence of multimodal rehabilitation delivered within the framework of a national implementation of evidence based rehabilitation, the rehabilitation guarantee for nonspecific musculoskeletal pain.Method: This was an observational matched controlled study of all persons receiving multimodal rehabilitation from the last quarter of 2009 until the end of 2010. The matching was based on age, sex, sickness absence the quarter before intervention start and pain-related diagnosis. The participants were followed by register data for 6 or 12 months. The matched controls received rehabilitation in accordance with treatment-as-usual.Results: Of the participants, 54% (N = 3636) were on registered sickness absence at baseline and the quarter before rehabilitation. The average difference in number of days of sickness absence between the participants who received multimodal rehabilitation and the matched controls was to the advantage of the matched controls, 14.7 days (CI 11.7; 17.7, p ≤ 0.001) at 6-month follow-up and 9.5 days (CI 6.7; 12.3, p ≤ 0.001) at 12-month follow-up. A significant difference in newly granted disability pensions was found in favor of the intervention.Conclusions: When implemented nationwide, multimodal rehabilitation appears not to reduce sickness absence compared to treatment-as-usual.Implications for RehabilitationA nationwide implementation of multimodal rehabilitation was not effective in reducing sickness absence compared to treatment-as-usual for persons with nonspecific musculoskeletal pain.Multimodal rehabilitation was effective in reducing the risk of future disability pension for persons with nonspecific musculoskeletal pain compared to treatment-as-usual.To be effective in reducing sick leave multimodal rehabilitation must be started within 60 days of sick leave.The evidence for positive effect of multimodal rehabilitation is mainly for sick listed patients. Prevention of sick leave for persons not being on sick leave should not be extrapolated from evidence for multimodal rehabilitation.

Synergistic effect between back pain and common mental disorders and the risk of future disability pension: a nationwide study from Sweden.

The aim of this study was to analyse a possible synergistic effect between back pain and common mental disorders (CMDs) in relation to future disability pension (DP). All 4,823,069 individuals aged 16-64 years, living in Sweden in December 2004, not pensioned in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the cohort of this register-based study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for DP (2006-2010) were estimated. Exposure variables were back pain (M54) (sickness absence or inpatient or specialized outpatient care in 2005) and CMD (F40-F48) [sickness absence or inpatient or specialized outpatient care or antidepressants (N06a) in 2005]. HRs for DP were 4.03 (95% CI 3.87-4.21) and 3.86 (95% CI 3.68-4.04) in women and men with back pain. HRs for DP in women and men with CMD were 4.98 (95% CI 4.88-5.08) and 6.05 (95% CI 5.90-6.21). In women and men with both conditions, HRs for DP were 15.62 (95% CI 14.40-16.94) and 19.84 (95% CI 17.94-21.94). In women, synergy index, relative excess risk due to interaction, and attributable proportion were 1.24 (95% CI 1.13-1.36), 0.18 (95% CI 0.11-0.25), and 2.08 (95% CI 1.09-3.06). The corresponding figures for men were 1.45 (95% CI 1.29-1.62), 0.29 (95% CI 0.22-0.36), and 4.21 (95% CI 2.71-5.70). Co-morbidity of back pain and CMD is associated with a higher risk of DP than either individual condition, when added up, which has possible clinical implications to prevent further disability and exclusion from the labour market.

Cannabis use in adolescence and risk of future disability pension: A 39-year longitudinal cohort study

AimsThis study aimed at examining a possible association between cannabis use in adolescence and future disability pension (DP). DP can be granted to any person in Sweden aged 16–65 years if working capacity is judged to be permanently reduced due to long-standing illness or injury. MethodsData were obtained from a longitudinal cohort study comprising 49,321 Swedish men born in 1949–1951 who were conscripted to compulsory military service aged 18–20 years. Data on DP was collected from national registers. ResultsResults showed that individuals who used cannabis in adolescence had considerably higher rates of disability pension throughout the follow-up until 59 years of age. In Cox proportional-hazards regression analyses, adjustment for covariates (social background, mental health, physical fitness, risky alcohol use, tobacco smoking and illicit drug use) attenuated the associations. However, when all covariates where entered simultaneously, about a 30% increased hazard ratio of DP from 40 to 59 years of age still remained in the group reporting cannabis use more than 50 times. ConclusionsThis study shows that heavy cannabis use in late adolescence was associated with an increased relative risk of labor market exclusion through disability pension.

Work ability as prognostic risk marker of disability pension: single-item work ability score versus multi-item work ability index

Work ability predicts future disability pension (DP). A single-item work ability score (WAS) is emerging as a measure for work ability. This study compared single-item WAS with the multi-item work ability index (WAI) in its ability to identify workers at risk of DP. This prospective cohort study comprised 11 537 male construction workers, who completed the WAI at baseline and reported DP after a mean 2.3 years of follow-up. WAS and WAI were calibrated for DP risk predictions with the Hosmer-Lemeshow (H-L) test and their ability to discriminate between high- and low-risk construction workers was investigated with the area under the receiver operating characteristic curve (AUC). At follow-up, 336 (3%) construction workers reported DP. Both WAS [odds ratio (OR) 0.72, 95% confidence interval (95% CI) 0.66-0.78] and WAI (OR 0.57, 95% CI 0.52-0.63) scores were associated with DP at follow-up. The WAS showed miscalibration (H-L model χ (�)=10.60; df=3; P=0.01) and poorly discriminated between high- and low-risk construction workers (AUC 0.67, 95% CI 0.64-0.70). In contrast, calibration (H-L model χ �=8.20; df=8; P=0.41) and discrimination (AUC 0.78, 95% CI 0.75-0.80) were both adequate for the WAI. Although associated with the risk of future DP, the single-item WAS poorly identified male construction workers at risk of DP. We recommend using the multi-item WAI to screen for risk of DP in occupational health practice.

Single and additive effects of health behaviours on the risk for disability pensions among Swedish twins

This prospective cohort study aimed to investigate single and additive effects of health behaviours for risk of future disability pension (DP) due to musculoskeletal diagnoses, DP due to mental diagnoses, DP due to circulatory system diagnoses or DP due to other diagnoses. A secondary aim was to evaluate the role of familial confounding in these associations. A sample of 31,206 Swedish twin individuals was followed from 1998-2003 to the end of 2008 via national registries for DP supplemented with additional baseline questionnaire data. Cox proportional hazard ratios (HRs) were estimated. The single effect of moderate to heavy alcohol consumption was associated with decreased risk of DP irrespective of diagnosis group in analyses accounting for background and familial factors (HR 0.42-0.88). Low frequency of physical activity (HR 1.17-1.63) or being past or regular user of tobacco products (HR 1.38-3.49) predicted increased risk for DP in all diagnosis groups. Interactions between physical activity and alcohol or tobacco consumption were significant for DP due to musculoskeletal diagnoses and mental diagnoses. Health behaviours are important risk factors for DP irrespective of diagnosis groups. The effect of health behaviours is independent from familial effects (genetics and shared environment) pointing to a direct effect of health behaviours on DP, but education, body mass index, number and severity of diseases and marital status may confound the associations. The complex interrelationships between the health behaviours revealed by interactions suggest that prevention of future DP should attempt to influence these co-existent behaviours.

Does social isolation and low societal participation predict disability pension? A population based study.

PurposeThe aim was to examine the potential influence of social isolation and low societal participation on the future risk of receiving disability pension among individuals in Sweden. A specific aim was to describe differences depending on disability pension diagnoses, and how the results were modified by sex and age.MethodThe study comprised representative samples of Swedish women and men, who had been interviewed in any of the annual Swedish Surveys of Living Conditions between 1990 and 2007. Information on disability pension and diagnoses was added from the Swedish Social Insurance Agency’s database (1991-2011). The mean number of years of follow-up for the 53920 women and men was twelve years (SD 5.5), and the study base was restricted to the ages 20 to 64 years of age. The predictors were related to disability pension by Cox’s proportional hazards regression.ResultsSocial isolation and low societal participation were associated with future disability pension also after control for age, year of interview, socio demographic conditions and self reported longstanding illness. Lone individuals were at increased risk of disability pension, and the effect of living without children was modified by sex and age. An increase in risk was particularly noticeable among younger women who reported that they had sparse contacts with others, and no close friend. Both women and men who reported that they did not participate in political discussions and who could not appeal on a decision by a public authority were also at increased risk. The effects of social isolation were mainly attributed to disability pension with mental diagnoses, and to younger individuals.ConclusionsThe study suggests that social isolation and low societal participation are predictors of future disability pension. Social isolation and low societal participation increased particularly the risk of future disability pension in mental diagnoses among younger individuals.

Association between obesity status in young adulthood and disability pension

Obesity and underweight in young adulthood are associated with greater risk of future disability pension. Neither underlying causes of disability pension nor whether overweight confers excess risk is established in this age group. The aim of this study was to investigate risk of future disability pension according to body mass index (BMI) in young adulthood. BMI was measured at military conscription (1969-1994; n=1 191 027; mean age 18.3+/-0.5 years). Date and cause of disability pension, death and emigration dates were collected from national registers (1971-2006). Muscular strength, age, municipality, socioeconomic position, testing center and year were adjusted for in Cox regressions. During 28.4 million person-years, 60 024 subjects were granted disability pension. The hazard ratios (HRs) for underweight (1.14, CI 95% 1.11-1.17), overweight (1.36, 1.32-1.40), moderate (BMI 30-34.9; 1.87, 1.76 to 1.99) and morbid obesity (BMI>or=35; 3.04, 2.72-3.40) were elevated compared to normal weight. Not adjusting for muscular strength led to overestimation of the risk in underweight (1.27, 1.24-1.31), but underestimation in overweight (1.29, 1.25-1.33), moderately (1.72, 1.62-1.82) and morbidly obese subjects (2.77, 2.48-3.09). For circulatory and musculoskeletal causes, respectively, HRs were elevated only for overweight (2.06; 1.82-2.34; 1.47; 1.39-1.55) and obesity (3.51; 2.79-4.40; 2.15; 1.94-2.38). The same applied for tumors and nervous system, but not psychiatric causes, for which underweight (1.20; 1.16-1.24) displayed similar HR as overweight (1.21; 1.16-1.27), whereas the risk in obese subjects was higher (1.60; 1.46-1.75). The risks in overweight and obese, but not underweight, subjects were significantly elevated for each cause investigated. Although causality cannot be inferred, productivity losses associated with adverse BMI in young adulthood appear to be large.

Using administrative sickness absence data as a marker of future disability pension: the prospective DREAM study of Danish private sector employees

Objectives:The aim of this study was to examine duration of sickness absence as a risk marker for future disability pension among all private sector employees in Denmark 1998–2004.Methods:All private sector...

Self-reported sickness absence as a risk marker of future disability pension. Prospective findings from the DWECS/DREAM study 1990-2004

This prospective cohort study examines number of self-reported days of sickness absence as a risk marker for future disability pension among a representative sample of employees in Denmark 1990-2004. 4177 employees between 18 and 45 years were interviewed using a self-administered questionnaire in 1990 regarding sickness absence, age, gender, socioeconomic position, health behaviour, and physical and psychosocial work environment. They were followed for 168 months in a national disability pension register. Logistic regression analysis was performed in order to assess risk estimates for levels of absence and future disability pension. During follow-up, a total of 140 persons (3.4%) received disability pension. Of these, 82 (58.6%) were women, 58 (41.4%) were men. There was a 2.5 fold risk of future disability pension for the part of the population reporting more than 6 days of sickness absence per annum at baseline, when taking into account gender, age, socioeconomic position, health behaviour, physical and psychosocial work environment. The findings suggest that information on self-reported days of sickness absence can be used to effectively identify "at risk" groups for disability pension.

Alcohol Consumption and Disability Pension among Middle-Aged Men

PURPOSE: To analyze the relation between alcohol consumption and the risk of disability pension among middle-aged men. METHODS: In the mid-seventies, complete birth-year cohorts of middle-aged male residents in Malmö, Sweden, were invited to participate in a general health survey. The 3751 men with complete data who constituted the cohort in this study were followed for 11 years. Alcohol consumption was estimated from the scores obtained from a test designed to identify subjects with alcohol related problems. RESULTS: Of the 498 men granted disability pension during follow-up, 48 stated to be teetotalers. The cumulative incidence of disability pension among teetotalers was 19%, whereas, it was 12% and 16%, respectively, among men with low and high alcohol consumption. The adjusted relative risk (RR) for acquiring a disability pension (using the group with low alcohol consumption as reference) was 1.8 among abstainers and 1.3 among men with high alcohol consumption. CONCLUSIONS: Alcohol overconsumption, as well as teetotalism, showed a positive relation to disability pension, and a moderate alcohol intake was found to be beneficial with respect to the risk of future disability pension.