Disability pension. Epidemiological and financial aspects

Detta är en avhandling från Department of Community Medicine, Malmö University Hospital, S-205 02 MALMÖ, Sweden

Sammanfattning: During the last decades, the incidence of disability pension in Sweden has increased continuously and it peaked in 1993 at approximately 62,000 new pensions. Early retirement due to occupational disability often constitutes a problem for the society as well as for the individual. The aim of this thesis was to analyse aspects on the risk of disability pension, to describe changes in health after the decision on disability pension and to estimate the financial expenditure. A total of 7,697 men, comprising five complete birth-year cohorts (1926-1930) of male residents in Malmö, Sweden, were invited to a screening programme in the mid-1970’s. Decisions on disability pension and mortality data were identified from national computerised data bases. At the end of follow-up (the calendar year when the men turned 58), 18% had been granted disability pension, the incidence higher (31%) among those who refrained to participate in the screening program. Frequent causes for disability pension, altogether accounting for 74% of the cases, were musculoskeletal diseases, mental disorders (including alcohol dependence) and diseases of the circulatory system. Alcohol dependence was more common among non-participants. Mental disorders predominated in younger age groups and musculoskeletal diseases in older ones. Compared with normal body mass index, obesity in particular, but also under- and overweight, were associated with higher risk of disability pension. For those who were not teetotallers, alcohol consumption was estimated from the scores obtained at an alcohol screening test. Low alcohol consumption was related to low risk of disability pension while high alcohol consumption and high risk of disability pension showed a positive relation. Teetotallers were at higher risk of disability pension than those with low alcohol consumption, although conclusions regarding this association must be drawn with great prudence. Socioeconomic status, as defined by occupation, was associated with risk of disability pension. Compared with higher level white collar workers, blue collar workers in particular but also lower level white collar workers were at higher risk. During the period when the disability pensions were granted, an increase in circulatory disease was observed while the prevalence of psychiatric disease and use of hypnotics remained practically unchanged. The proportion of men with complaints of back problems was considerably higher after pension than before. A registration of the decisions on all new disability pensions in Malmöhus county was made during a period of three months. During the first two and a half years after the decision, a small number of the pensions were terminated mainly due to deaths but also because of pensions that were discontinued. The rankings of the diagnosis categories on the one hand and their respective financial costs on the other, were equal. However, the proportions of the costs were lower for musculoskeletal diseases and higher for mental disorders compared with the respective proportions of the diagnoses. For unemployed subjects, mental disorders made the largest contribution to the financial costs.

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