Sturla Gjesdal

Risk factors for disability pension in a population-based cohort of men and women on long-term sick leave in Sweden

BACKGROUND Knowledge on predictors of disability pension is very limited. The aim was to assess the importance of sick-leave diagnosis and socio-demographic variables as risk factors for disability pension among individuals on long-term sickness absence and to compare these factors by gender and over time. METHODS A prospective population-based cohort study in Ostergötland County, Sweden, included 19,379 individuals who, in 1985-87, were aged 16-60 years and had a new spell of long-term sickness absence lasting > or =56 days. Follow-up was done in two time frames: 0-5 and 6-10 years after inclusion. The risk of disability pension in relation to sick-leave diagnosis and socio-demographic factors was assessed by Cox proportional hazard regression analysis. RESULTS In 5 years, after inclusion, 28% of the cohort had been granted disability pension. Those with higher age, low income, previous sick leave, no employment and non-Swedish origin had higher risk of disability pension, while those with young children had lower risk. Considering the inclusion diagnosis, the pattern differed between men and women (P < 0.001). Among men, those with mental disorders had the highest risk and among women those with musculoskeletal disorders. Except for income, the effect of which was reversed over time, the overall pattern of disability pension predictors remained 6-10 years after inclusion but was attenuated. CONCLUSION Besides socio-demographic risk factors, the sick-leave diagnoses constitute an important both medium and long-term predictor of disability pension among both men and women on long-term sickness absence.

Long-term sickness absence and disability pension with psychiatric diagnoses: A population-based cohort study

Sickness absence certified with psychiatric diagnoses is increasing in many Western countries. A substantial proportion of the sickness absentees never return to work, but ends up with a permanent disability pension (DP). This study investigated the incidence of long-term sickness absence (LTSA) with different psychiatric diagnoses, and tested predictors of the transition to permanent DP. A special objective was to explore previously reported gender differences, using a population-based cohort study. The population at risk of LTSA was 106,674 occupational active men and 89,356 women in a Norwegian county in 1994; 314 women and 203 men with LTSA >8weeks, certified with a psychiatric diagnosis, were followed to the end of 1999, with DP as the endpoint. Diagnoses on sickness certificates, age, gender and income were used as explanatory variables in Cox regression analysis. Annual incidence of LTSA with a psychiatric diagnosis was 7.0/1000/year for women and 3.8/1000 for men; 72% of the women and 50% of the men had a diagnosis indicating depression. During follow-up, 32% of the men and 25% of the women obtained DP. Increasing age, male gender, low income and a diagnosis of psychosis or “other” increased the DP risk. Separate analysis for men indicated a different effect of age and a larger role of serious mental illness. The study verified that women more often than men had LTSA with psychiatric diagnoses, especially with depression. Men were at higher risk of transition to DP, and the study suggested some possible explanations.

Mortality in relation to disability pension: Findings from a 12-year prospective population-based cohort study in Sweden

Aims: Knowledge is limited regarding the association between disability pension (DP) and mortality. The aim of this study was to examine the relative risk (RR) of mortality associated with DP among women and men of different ages over a 12-year period, for DP in general, and for full-time DP, part-time DP, and DP for labour-market reasons, respectively. Methods: A prospective cohort study was performed covering the total population of the Swedish county of Östergötland aged 16—64 years in December 1984 (n=245,704) followed up from 1985 to 1996. The RR of mortality was analysed in relation to DP, age, and gender using a Cox proportional hazards model. Results: The RR of mortality was higher for DP recipients than for individuals without DP, and this was true for both women (RR 2.79, 95% confidence interval (CI) 2.63 to 2.96) and men (RR 2.97, CI 2.83 to 3.11), and for all age groups. The RR of mortality was highest among the youngest DP recipients. The RR of mortality was especially high the first year of DP and remained elevated over the whole follow-up period. The RR of mortality among part-time DP recipients was lower than among full-time DP recipients and was significantly higher than seen for non-DP recipients. Individuals granted DP for labour-market reasons exhibited much lower RR of mortality than all other DP recipients. Conclusions: Further research is needed to investigate which factors explain the very high RR of mortality among disability pensioners.

Sickness absence with musculoskeletal or mental diagnoses, transition into disability pension and all-cause mortality: A 9-year prospective cohort study

Aims: Increased early mortality indicates poor health. This study assessed mortality among men and women after long-term sickness absence (LTSA) with musculoskeletal or mental diagnoses. A special focus was on possible differences in mortality among women and men who obtained disability pension (DP) as compared to those who did not. Methods: This was a 9-year prospective cohort study in Hordaland County, Norway, including 1417 women and 1075 men aged 16—62 years with a spell of LTSA 48 weeks, and with a musculoskeletal or mental diagnosis. The endpoint was death from all causes. Age-standardised mortality rates for those who obtained DP and those who did not were calculated and compared. Cox proportional hazards analysis was used to assess DP status and other possible predictors of premature death. All analyses were stratified for gender. Results: Overall, 36% obtained a DP and 3.2% died. Among the men, 7.2% with mental diagnoses and 4.4% with musculoskeletal sick-leave diagnoses died. Among the women, 1.9% died in both groups. Among the men, 5.6% of the DP recipients died, as compared to 4.6% among those without DP. The respective figures for the women were 2.9% and 1.3%. Male gender, increasing age and low income among men increased the mortality risk significantly. After adjustments for these variables, the hazard ratios associated with DP were 2.9 (95% confidence interval (CI) 1.2—7.0) for women and 2.3 (95% CI 1.2—4.5) for men. Conclusions: When monitoring those on LTSA, one should be aware of the high mortality among those who obtain DP and male workers with low income, and preventive actions should be considered.

Sickness absence with psychiatric diagnoses: individual and contextual predictors of permanent disability.

Sickness absence due to psychiatric problems is on the increase. Many sickness absentees do not recover and end up on a permanent disability pension (DP). A prospective cohort study of 12,283 women and 7099 men with a spell of sickness absence longer than 8 weeks, certified with a psychiatric diagnosis, was carried out. Diagnoses and socioeconomic data for each case were obtained from a national insurance research database. Socio-demographic data characterising each of Norways 19 counties were obtained from Statistics Norway, and a deprivation index was constructed. Cox regression models with county-level variables only and combinations of variables at individual and county level were estimated separately for each gender as predictors of DP. Men had the highest risk of disability. Several individual-level variables predicted permanent disability. Contextual factors had a marginal effect among women also, after adjustment for individual-level variables. No such effect was present among the men.

Musculoskeletal Impairments in the Norwegian Working Population: The Prognostic Role of Diagnoses and Socioeconomic Status: A Prospective Study of Sickness Absence and Transition to Disability Pension

Study Design. Population-based, 5-year prospective cohort study. Objective. To assess the incidence of musculoskeletal disorders (MSDs) in sickness absence longer than 8 weeks in Norway, and to identify diagnostic and socioeconomic predictors of the transition to disability pension (DP). Summary of Background Data. MSDs are prevalent and of major concern for sickness absence. Previous epidemiological studies are largely cross-sectional and based on self-reports, often with low response rates, selection, and reporting bias. Prospective studies with physician-verified diagnoses might be a better approach. Methods. Thirty-seven thousand nine hundred forty-two females and 26,307 males with an episode of sickness absence >8 weeks in 1997, certified with a MSD were followed up for 5 years. Diagnostic and sociodemographic data were obtained from a national database. Cases were divided into 9 diagnostic subgroups, based on the International Classification of Primary Health Care. Survival analysis was performed with granting of DP as the endpoint, in the full sample and for diagnostic subgroups. Results. Over all 20% of cases obtained DP during follow-up. Among those aged 50 to 62 and among those with only basic education 46% obtained DP. DP rates were highest for osteoarthrosis (47%), rheumatoid arthritis (46%), and myalgia/fibromyalgia (38%). Fractures/injuries had the lowest rate. Controlled for age, education and income, relative risk of DP was 1.5 (95% CI: 1.4–1.6) for upper limb problems, 2.0 (95% CI: 1.8–2.1) for back problems, 2.8 (95% CI: 2.5–3.1) for osteoarthrosis, 3.3 (95% CI: 3.0–3.6) for myalgia/fibromyalgia, and 4.2 (95% CI: 3.9–4.7) for rheumatoid arthritis, compared to “fractures and injuries.” Conclusion. Age, diagnoses, and socioeconomic variables were important predictors of an adverse outcome among workers with a sickness absence of 8 or more weeks. Further research is needed to determine whether differentiated follow-up strategies might prevent permanent disability.

Occupational disability caused by dizziness and vertigo: a register-based prospective study.

BACKGROUND Despite the magnitude of dizziness/vertigo in primary health care, prospective studies are scarce, and few studies have focused on vocational consequences. Using the International Classification of Primary Health Care (ICPC), GPs have two alternative diagnoses, H82 (vertiginous syndrome) and N17 (vertigo/dizziness), when issuing sickness certificates to these patients. AIM To assess the incidence of dizziness/vertigo in long-term sickness absence and to identify sociodemographic and diagnostic predictors for transition into disability pension. DESIGN OF STUDY Register-based prospective study, 5-year follow-up. SETTING All individuals in Norway eligible for sickness absence in 1997 (registered employed or unemployed). METHOD The risk of disability pension was assessed with Cox proportional hazards analysis, with medical and sociodemographic information as independent variables, stratified for sex. RESULTS Six-hundred and ninety-four women and 326 men were included. Dizziness/vertigo made up 0.9% of long-term sickness absence among women and 0.7% among men. Among both women and men, 41% was certified with H82 and 59% with N17: 23% of women and 24% of men obtained a disability pension. Age was the strongest predictor for obtaining a disability pension. Subjects with only basic education had an almost doubled risk of obtaining a disability pension compared to the highest educational group. Women with H82 had significantly higher risk for obtaining a disability pension than those with N17. The difference increased after adjustment for sociodemographic variables. Sex had no effect when all other variables were controlled for. CONCLUSION Dizziness/vertigo is an infrequent cause of certified sickness absence, but long-term sickness absentees with dizziness/vertigo have a considerable risk of obtaining a disability pension in the future.

Mortality among disability pensioners in Norway and Sweden 1990-96 : Comparative prospective cohort study

Aim: The aim of the study was to assess excess mortality related to disability pension (DP) status and DP diagnoses in Norway and Sweden during 1990—96. Methods: Representative samples of the population aged 30—59 years, without DP at baseline 1 January 1990, 71,293 women and 76,928 men from Norway, and 68,181 women and 71,950 men from Sweden, were followed up during 1990—96. Granting of DP, DP diagnosis, age and gender were explanatory variables in Cox proportional hazards analysis with death from all causes as the outcome variable. Results: Among women, 10.4% in Sweden and 7.1% in Norway obtained DP, as compared to 7.5% and 5.6% of the men. In Sweden, 66% of female and 49% of male DP recipients had musculoskeletal diagnoses, as compared to 40% and 27% in Norway. In Sweden, 3.0% of the women and 6.1% of the men with DP died, as compared to 4.6% and 8.5% in Norway. Hazard ratios (HRs) for women with DP vs. the non-DP group were 3.2 (95% confidence interval (CI)=2.7—3.8) in Sweden, and 4.9 (95% CI=4.1—5.7) in Norway. Among men with DP, there was no difference in mortality rate between the countries. HRs for men with musculoskeletal diagnoses vs. the non-DP group were 1.5 (95% CI= 1.1—2.0) in Norway and 1.4 (95% CI= 1.1—1.8) in Sweden. In both countries, the mortality rate among female disability pensioners with musculoskeletal diagnoses was not increased. Conclusions: The study confirmed an increased mortality rate among disability pensioners, except for women with musculoskeletal diagnoses. The mortality pattern related to DP diagnoses was similar in the two countries. A high frequency of musculoskeletal DP diagnoses among women with DP in Sweden explained a lower mortality rate as compared to Norway.

Variations in the risk of disability pension in Norway 1970-99. A gender-specific age-period-cohort analysis

Aims: A study was undertaken to investigate whether cohort or period effects could explain the varying and generally increasing incidence of disability pension in Norway between 1970 and 1999. Methods: The study used data from a complete national register of new disability cases in Norway, including all cases of disability pension in the 16 - 60 age group categorized according to age and gender for each year from 1970 to 1999. The population at risk was defined for each year from census data and number of individuals already receiving disability pension. Data were organized in five-year age groups, five-year time periods and corresponding overlapping nine-year birth cohorts. Age- and gender-specific rates were displayed graphically for periods and cohorts. Separate Poisson regression models were fitted for age periods and age cohorts. Finally a combined age, period, and cohort model was applied. Results: The overall incidence was 7.4/1,000 non-disabled persons per year for women and 6.0/1,000 for men. For women 52.1% of the cases were in the 51 - 60 age group, whereas the corresponding figure for men was 57.6%. Statistical analysis showed an increasing trend for both genders, more pronounced for women than men. All time periods deviated significantly from the trend, either upwards or downwards. Age-cohort models showed less variation, but recent cohorts had higher than expected rates, especially for men. Conclusions: Further studies should investigate why Norwegian women were more affected by the period effects than men. An increasing incidence of disability pension among recent cohorts is a major challenge for the Norwegian welfare system.

Young people and their GP: a register-based study of 1717 Norwegian GPs

BACKGROUND Internationally, there has been a call to improve the youth-friendliness of health services. In surveys, 60-90% of young people report having contact with a GP at least once a year. Regular contact with the GP can be assumed to be an indicator of a youth-friendly health service. The aim of the current study was to identify associations between a high consultation rate with young people (15-24 years) on the one hand and GP characteristics, patient list characteristics and practice profiling factors on the other. METHODS A cross-sectional national register-based study from 2002-04 in Norwegian general practice. Data on 1717 GPs, their practice populations and a sample of 316 773 consultations with young people were used to estimate differences between GPs, using one-way analysis of variance and logistic regression. RESULTS The mean annual consultation rate with young people was 1.4 (95% confidence interval 1.4-1.5) and 2.2 (2.1-2.2) for the age groups 15-19 and 20-24, respectively. List characteristics indicating free capacity-a shorter patient list, a growing patient list and a high access for persons not on the patient list-were associated with a high youth consultation rate. Young age of the GP, low educational level among the list population and a high rate of interdisciplinary activity by the GP were also associated with a high youth consultation rate. CONCLUSIONS GPs seem to assign especially low priority to young people when workload is high or free capacity low. Increased awareness of these mechanisms and greater interdisciplinary cooperation could increase the youth-friendliness of general practice.