Mikael Stattin

Retirement on grounds of ill health.

Today, most modern welfare states face the challenge of an aging population and decreasing rates of labour force participation among older people. Despite increased life expectancy, improved living conditions, and better health status, the average time people spend in paid work is decreasing in most European countries.1–3 This rather paradoxical development is partly due to a delay of young people entering the labour market; however, even more important is that older workers are exiting the labour market in greater numbers. In most countries, the average age of permanent departure from paid labour is well below the statutory pension age. This development, the “early exit trend”, has been called “one of the most profound structural changes in the past 25 years”,1 a trend that is hardly sustainable because of growing financial pressure on governments. This trend is incompatible with anticipated labour shortages in the near future. Consequently, researchers and policy makers all over Europe are involved in studies and debates to find ways to “shift the vicious circle of early exit to the virtuous circle of active aging”.4 Leaving the labour market before old age pension requires alternative sources of income. Across Europe, there are many ways to bridge the time between early exit and old age pension. Depending on the configuration, availability, and generosity of such pathways, countries use different strategies of externalisation and integration of older and/or disabled workers. Integration strategies support employment among these groups, whereas externalisation strategies transfer the risk of old or sick employees to the social security system. Because of generous entering conditions in different social security programmes, many countries have adopted such an externalisation strategy. As a result, the number of premature labour market withdrawals has increased dramatically. To a very high degree, this also applies to the social security …

Poor health, unhealthy behaviors, and unfavorable work characteristics influence pathways of exit from paid employment among older workers in Europe: a four year follow-up study

OBJECTIVES The aim of this study was to get insight into the role of poor health, unhealthy behaviors, and unfavorable work characteristics on exit from paid employment due to disability pension, unemployment, and early retirement among older workers. METHODS Respondents of the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE) in 11 European countries were selected when (i) aged between 50 years and the country-specific retirement age, (ii) in paid employment at baseline, and (iii) having information on employment status during the 4-year follow-up period (N=4923). Self-perceived health, health behaviors, and physical and psychosocial work characteristics were measured by interview at baseline. Employment status was derived from follow-up interviews after two and four years. Cox proportional hazards regression analyses were used to identify determinants of unemployment, disability pension, and early retirement. RESULTS Poor health was a risk factor for disability pension [hazard ratio (HR) 3.90, 95% confidence interval (95% CI) 2.51-6.05], and a lack of physical activity was a risk factor for disability pension (HR 3.05, 95% CI 1.68-5.55) and unemployment (HR 1.84, 95% CI 1.13-3.01). A lack of job control was a risk factor for disability pension, unemployment, and early retirement (HR 1.30-1.77). CONCLUSIONS Poor health, a lack of physical activity, and a lack of job control played a role in exit from paid employment, but their relative importance differed by pathway of labor force exit. Primary preventive interventions focusing on promoting physical activity as well as increasing job control may contribute to reducing premature exit from paid employment.

Occupation, work environment, and disability pension: A prospective study of construction workers

Aims: This study investigated the importance of occupation and work environment for the risk of disability pension among construction workers in Sweden. Methods: The data include around 389,000 construction workers who participated in health examinations from 1971 to 1992. During that period 68,000 participants received disability pension in some form. Between 1985 and 1992 questionnaires were used to collect data regarding hazards in the work environment. Some 87,000 participants answered that questionnaire, and almost 6,000 of these were in receipt of a disability pension. To analyse the risk of disability pension in different occupations, incidence rates (SIR) were calculated according to the person-year method. Logistic regression was used to calculate age-controlled odds ratios according to physical and psychosocial work environment factors. Results: The results show considerable variation in risk for disability pension between different occupations within the construction industry. Furthermore, analysis of work environment factors indicated associations with physical, ergonomic, and psychosocial work environment factors. Discussion: A considerable variation between occupations indicates that characteristics in the work situation are important when explaining the risk of disability pension. The results from this study indicate that improvements in working conditions are an important area of intervention in order to facilitate and prolong labour market participation among elderly people.

Psychosocial wellbeing and reasons for retirement in Sweden

ABSTRACT Given the increased heterogeneity of the transition from work to retirement, this study aimed to analyse the associations between different reasons for retirement and psychosocial wellbeing as a pensioner. The study used data from the Swedish Panel Survey of Ageing and the Elderly (PSAE), a nationally representative survey of the living conditions of older people in Sweden. The results show that almost one-half of all pensioners cited health problems as a contributory reason for ceasing work. Furthermore, those who retired for ‘push’ reasons, such as health problems or labour market factors, experienced lower psychosocial wellbeing than those who retired for other reasons. Moreover, the results show that those who were able to influence the time of their retirement enjoyed better psychosocial wellbeing than those who had little or no opportunity to do so. This was true when controlling for other factors relevant to the wellbeing of pensioners. The results lend support to the argument that, if a mans retirement is instigated because his skills are no longer required, there will be a decidedly negative effect on his wellbeing – and that this effect is stronger than the equivalent impact on a womans wellbeing. In relation to previous findings in this field, the results make it clear that retirement is far from a uniform process or state.

Timing of retirement and mortality - A cohort study of Swedish construction workers

Recent studies indicate that early retirement per se may have a negative effect on health to such an extent that it increases mortality risk. One type of early retirement often referred to in these studies is retirement with disability pension/benefit. Given the overall objective of disability benefit programmes--to help the disabled live socially and economically satisfactory lives, freed from exposure to employment health hazards and thus avoid further declines in health--the finding is challenging. This paper examined the relationship between timing of retirement and mortality using a cohort of Swedish construction workers. The mortality risk of disability pensioners--excluding those with diagnoses normally connected to increased mortality--was compared with the risk of those continuing to work. Although initial indications were in line with earlier results, it became obvious that the increased mortality risk of disability pensioners did not depend on early retirement per se but on poor health before early retirement not explicitly recognized in the diagnosis on which the disability pension rested. The results indicate that there are no general differences in mortality depending on timing of retirement. Future studies of mortality differences arising from working or not working must sufficiently control for health selection effects into the studied retirement paths.

Heavy work and disability pension - A long term follow-up of Swedish construction workers

OBJECTIVES The objective of this study was to investigate the occurrence of disability pensions over time among workers with physically demanding jobs. METHODS The occurrence of disability pension was prospectively studied between 1980-2008 among 325 549 Swedish construction workers. The risks for disability pension and years lost of working life were compared among 22 occupational groups, adjusting for age, body mass index, height, and smoking habits. RESULTS The risk varied considerably among blue-collar workers. For example, rock workers had double the risk of disability pension [relative risk (RR) 2.16, 95% confidence interval (95% CI) 1.96-2.39] compared to electricians. Most working years lost due to disability pensions (about 75%) were found among men >50 years, mainly due to musculoskeletal and cardiovascular diseases. The years of working life lost due to disability pension varied from 0.7 (salaried employees) to 3.2 years (rock workers) among occupational groups. CONCLUSION Work environment is an important predictor for disability pension among construction workers with those in physically heavy jobs having the highest burden of disability. If the purpose is to increase labor force participation for workers with heavy jobs, strategies to reduce physical demands at work among elderly workers are important.

Impact of changes in welfare legislation on the incidence of disability pension. A cohort study of construction workers.

Aims: Study objectives were to investigate how changes in social insurance legislation influenced the incidence of disability pension. Methods: The study included 295,636 male construction workers who attended health examinations between 1971 and 1993, aged 20–60 years and without previous disability pension. Via the Swedish National Insurance Agency national register we identified 66,046 subjects who were granted disability pension up until 2010. The incidence rates were calculated and stratified according to age and diagnosis. Results: The incidence rate of disability pension was fairly stable until the 1990s when large variations occurred, followed by a strong decreasing trend from the early 2000s to 2010. Trends in incidence rates, stratified by age and diagnosis, showed a consistent decrease in cardiovascular disease for all age groups. In subjects aged 30–49 years there was a high peak around 2003 for musculoskeletal diseases and psychiatric diseases. For the age group 50–59 years, musculoskeletal diagnosis, the most common cause of disability pension, had a sharp peak around 1993 and then a decreasing trend. In the 60–64 age group, the incidence rate for psychiatric diagnosis was stable, while incidence rates for musculoskeletal diagnosis varied during the 1990s. Conclusions: There are considerable variations in the incidence rate of disability pension over time, with different patterns depending on age and diagnosis. Changes in social insurance legislation, as well as in administration processes, seem to influence the variation.