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The prognosis for individuals on disability retirement: an 18-year mortality follow-up study of 6887 men and women sampled from the general population
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
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2006 (English)In: BMC Public Health, ISSN 1471-2458, Vol. 6, no 103Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Several studies have shown a markedly higher mortality rate among disability pensioners than among non-retired. Since most disability pensions are granted because of non-fatal diseases the reason for the increased mortality therefore remains largely unknown. The aim of this study was to evaluate potential explanatory factors. METHODS: Data from five longitudinal cohort studies in Sweden, including 6,887 men and women less than 65 years old at baseline were linked to disability pension data, hospital admission data, and mortality data from 1971 until 2001. Mortality odds ratios were analyzed with Poisson regression and Cox's proportional hazards regression models. RESULTS: 1,683 (24.4%) subjects had a disability pension at baseline or received one during follow up. 525 (7.6%) subjects died during follow up. The subjects on disability pension had a higher mortality rate than the non-retired, the hazards ratio (HR) being 2.78 (95%CI 2.08-3.71) among women and 3.43 (95%CI 2.61-4.51) among men. HR was highest among individuals granted a disability pension at young ages (HR >7), and declined parallel to age at which the disability pension was granted. The higher mortality rate among the retired subjects was not explained by disability pension cause or underlying disease or differences in age, marital status, educational level, smoking habits or drug abuse. There was no significant association between reason for disability pension and cause of death. CONCLUSION: Subjects with a disability pension had increased mortality rates as compared with non-retired subjects, only modestly affected by adjustments for psycho-socio-economic factors, underlying disease, etcetera. It is unlikely that these factors were the causes of the unfavorable outcome. Other factors must be at work.

Place, publisher, year, edition, pages
2006. Vol. 6, no 103
Keyword [en]
Adult, Age Distribution, Disabled Persons/*statistics & numerical data, Female, Follow-Up Studies, Hospitalization/statistics & numerical data, Humans, Insurance; Disability/*utilization, Longitudinal Studies, Male, Middle Aged, Mortality, Odds Ratio, Pensions/classification/*statistics & numerical data, Poisson Distribution, Prognosis, Proportional Hazards Models, Research Support; Non-U.S. Gov't, Retirement/*statistics & numerical data, Survival Analysis, Sweden/epidemiology
National Category
Family Medicine
URN: urn:nbn:se:uu:diva-83616DOI: 10.1186/1471-2458-6-103PubMedID: 16630360OAI: oai:DiVA.org:uu-83616DiVA: diva2:111524
Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2011-01-17Bibliographically approved
In thesis
1. Disability Pension with Special Reference to Sick Leave Track Record, Health Effects, Health Care Utilisation and Survival: A Population-based Study
Open this publication in new window or tab >>Disability Pension with Special Reference to Sick Leave Track Record, Health Effects, Health Care Utilisation and Survival: A Population-based Study
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background. In Sweden 10 percent (550,000) of the labour force, aged 18 to 65 years are disability pensioners and about four percent are on sick leave. The knowledge of the course from healthy individual to disability pensioner is not well known and was the theme of this thesis.

Objectives, Material and Methods. The aims of the thesis were to follow the study population regarding sickness absence, health care utilisation, quality of life, and survival. Population based data including 14,538 women and men from three cities in Sweden were used, of whom 1,952 were granted a disability pension at baseline or received one during follow up. Register data, including sickness spells, health care utilisation, and mortality data during 30 years of follow up, and questionnaire data including socio-economic and quality of life data were used.

Results. The most powerful determinant for being granted a disability pension was cumulative annual sick leave days, more powerful than all other tested determinants together. The degree of explanation for all determinants combined was 96%. Health care utilisation among disability pensioners continued to be high also after disability pension, 2.3 times higher for hospital admissions and 8 times higher for primary health case appointments than among referents. Disability pensioners had lower quality of life than non-pensioners and old age pensioners. For those who became disability pensioners after the baseline measurements quality of life measures decreased progressively until disability pension was granted and were then stabilised on a low level. During follow up 525 (7.6%) subjects died. Compared with subjects who did not become disability pensioners the hazards ratio was 2.78 among women and 3.43 among men, even when the effect of a number of other outcome affecting variables were taken into account. The mortality differences were not explained by underlying disease.

Conclusions. The risk of disability pension may be predicted but only late in the course of events. Disability pensioners continue to have a high level of health care utilisation, and have a worse quality of life development and a higher mortality rate than non-pensioners. Given the unfavourable outcome of disability pension, other means of managing the reduced work capacity might be considered.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 63 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 383
Sickness absence, sick leave, disability pension, activity compensation, sickness compensation, early retirement, track record, health care utilisation, complaint score, quality of life, wellbeing, mortality
National Category
Family Medicine
urn:nbn:se:uu:diva-9308 (URN)978-91-554-7300-6 (ISBN)
Public defence
2008-11-06, Enghoffsalen, Ingång 50, Akademiska sjukhuset, Uppsala, 13:15 (English)
Available from: 2008-10-16 Created: 2008-10-16 Last updated: 2011-05-13Bibliographically approved

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Wallman, ThorneSvärdsudd, Kurt
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Family Medicine and Clinical EpidemiologyCentrum för klinisk forskning i D län (CKFD)
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