Construction work and risk of occupational disability: a ten year follow up of 14,474 male workers

Aims: Most industrialised countries have public income maintenance programmes to protect workers in case of disability but studies addressing disability risk of specific professional groups are rare. The objective of this study was to establish a detailed pattern of the nature and extent of occupational disability among construction workers. Methods: A cohort study was set up including 14 474 male workers from the construction industry in Württemberg (Germany) aged 25–64 years who underwent occupational health exams between 1986 and 1992. The cohort was linked to the regional pension register of the manual workers'' pension insurance institution to identify workers who were granted a disability pension during the 10 year follow up. All-cause and cause specific standardised incidence ratios (SIR) and 95% confidence intervals (CI) were calculated using disability rates from the general workforce and from all blue collar workers in Germany as references. Results: In total, 2247 (16%) members of the cohort were granted a disability pension. Major causes of disability were musculoskeletal (45%) and cardiovascular diseases (19%). In comparison with the general workforce, construction workers experienced a higher risk of disability from cancer (SIR = 1.26; 95% CI 1.08 to 1.47), respiratory diseases (SIR = 1.27; 95% CI 1.03 to 1.55), musculoskeletal diseases (SIR = 2.16; 95% CI 2.03 to 2.30), injuries/poisoning (SIR = 2.52; 95% CI 2.06 to 3.05), and all causes combined (SIR = 1.47; 95% CI 1.41 to 1.53). When compared with the blue collar reference group, increased risks of disability among construction workers were found for musculoskeletal diseases (SIR = 1.53; 95% CI 1.44 to 1.63), injury/poisoning (SIR = 1.83; 95% CI 1.50 to 2.21), and all causes combined (SIR = 1.11; 95% CI 1.07 to 1.16). Conclusions: Musculoskeletal diseases and external causes are major factors limiting the work capability of construction workers and lead to an increased proportion of occupational disability.     

Perceived health as a predictor of early retirement

OBJECTIVES: This study examined the association between perceived health and early retirement. METHODS: A cohort of 1748 men aged 42 to 60 years from eastern Finland was followed from 1984 to 2000. At baseline, the participants had answered a questionnaire regarding their general (as measured by physician diagnoses) and perceived health status. Comprehensive pension records were obtained from the Social Insurance Institution of Finland and the Central Pension Security Institute. The risk of disability pensioning in various disease categories and nonillness-based early pensioning was analyzed using Cox regression modeling. RESULTS: Over 11 years, 855 (48.9%) men received a disability pension, and 331 (18.9%) received a nonillness-based early pension. Only 273 (15.6%) received an old age pension, without previous early pensioning. At the end of the follow-up, 289 (16.5%) were still working. After adjustment for potential confounders, men with poor perceived health at baseline had a relative risk of 2.37 [95% confidence interval (95% CI) 1.79-3.13] for disability pensioning and the highest risk of disability was due to mental illness (RR 3.84, 95% CI 1.86-7.92), followed by musculoskeletal disorders and cardiovascular diseases. The relative risk of receiving a nonillness-based pension was 2.94 (95% CI 1.92-4.50) for this group. CONCLUSIONS: Self-assessed poor health is a strong predictor of early retirement due to mental disorders, musculoskeletal disorders, and cardiovascular diseases. Moreover, the risk of retirement on a nonillness-based pension is increased among those with poor perceived health.     

Physical workload and risk of early retirement: prospective population-based study among middle-aged men

Early retirement produces a heavy economic burden in many western societies. There is a need to identify single risk factors for early retirement and to find methods for preventing it. To estimate the effect of heavy physical work on early retiring, a cohort of 1755 men aged 42 to 65 years from eastern Finland was followed up from 1984 to 2000. Self-estimated physical workload was assessed at baseline. The inclusive pension records were obtained from national pension institutions. Logistic regression modeling was used to estimate the effect of physical workload and single physical risk factors on the risk of disability pension and nonillness-based pension. Risks were estimated for both disease-specific and all disability pensions. The interaction of physical fitness and physical workload and the resulting effects on risk were also estimated. During the follow-up, 861 (49.1%) men retired on a disability pension and 331 men (18.9%) retired on a nonillness-based early pension. Only 273 (15.6%) men reached the age for getting the normal old-age pension without having had any other early pension After adjustment for age, body mass index, alcohol consumption, smoking, maximal oxygen uptake, education and corresponding illness at baseline, heavy physical work was found to be associated with an increased risk of being retired on a disability pension due to musculoskeletal disorders (odds ratio (OR) 2.21, 95% confidence interval 1.36 to 3.61) but not due to cardiovascular or mental diseases. The association was stronger if cardiorespiratory fitness was poor. Lifting, static muscular loading and uncomfortable work positions increased the risk of early retirement especially due to musculoskeletal disorders. Loading of the upper extremity alone or with the neck and shoulder region seems to be an independent risk factor for early retirement. We concluded that physical workload increases the risk of retirement on a disability pension especially due to musculoskeletal disorders. In heavy physical work, the risk is increased especially among men with musculoskeletal or cardiovascular disease and poor cardiorespiratory fitness.     

Cardiorespiratory fitness and risk of disability pension: a prospective population based study in Finnish men

Background: Early retiring is a major social problem in many western countries.

Aim: To investigate whether good cardiorespiratory fitness prevents disability pensioning in Finnish middle-aged men.

Methods: Subjects were a random population based sample of 1307 men who were 42-60 years old at baseline, had not retired before baseline or died during follow up, and had undergone a cycle ergometer test at baseline. Cardiorespiratory fitness was assessed at baseline with a maximal but symptom limited exercise test on an electrically braked cycle ergometer.

Results: During a follow up of 11 years on average, 790 (60.4%) men were awarded a disability pension, only 254 (19.4%) men reached the old-age pension without previous early pension, and 263 (20.1%) men were still working at the end of follow up. After adjustment for age, body mass index, alcohol consumption, smoking, education, occupation, and baseline chronic diseases, an inverse association was observed between cardiorespiratory fitness and the risk of disability pension. Men with VO_2max <25.98 ml/kg/min (lowest fifth) had a 3.28-fold (95% CI 1.70 to 6.32) and men with the duration of exercise test <9.54 minutes (lowest fifth) had a 4.66-fold (95% CI 2.43 to 8.92) risk of disability pension due to cardiovascular diseases compared with men in the highest fifths. Men with lowest fitness level also had an increased risk of disability pension due to musculoskeletal disorders, or all reasons combined.

Conclusions: Physical fitness is inversely associated with the risk of disability pension and especially with the risk of disability due to cardiovascular diseases.

     

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 Malm?, 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.     

Return to Work After Temporary Disability Pension in Finland

Purpose When it is possible that the employee’s work ability can be restored through treatment or rehabilitation, disability pension in Finland is granted for a fixed period. We examined which factors are associated with return to work (RTW) after such temporary disability pension. Methods The study included all Finnish residents whose temporary disability pension from the earnings-related pension system started in 2008 (N = 10,269). Competing risks regression analysis was applied to examine register-based determinants for RTW after temporary disability pension due to mental disorders, musculoskeletal diseases, other diseases, and injury over a 4-year follow-up period. Results The overall cumulative incidence of RTW was 25 %. RTW was more probable after temporary disability pension due to injury and musculoskeletal diseases and less probable after temporary disability pension due to mental disorders. Younger age and higher education increased RTW but differences between genders, private and public sector employees, and occupational classes were relatively small. The probability of RTW was higher among those who were employed before their temporary disability pension (subhazard ratio in multivariate analysis 2.41 (95 % CI 2.13–2.72) and among the 9 % who participated in vocational rehabilitation during their pension [SHR 2.10 (95 % CI 1.90–2.31)]. With some exceptions, the results were fairly similar for all diagnostic causes of temporary disability pension. Conclusion Return to work after temporary disability pension was relatively uncommon. Nevertheless, in all diagnostic groups RTW continued for the whole follow-up period. The low educated and those not employed before temporary disability pension need more support in their RTW. The strong association between vocational rehabilitation and RTW suggests that increasing rehabilitation among those with impaired work ability may promote RTW.     

Diagnosis-specific sick leave as a risk marker for disability pension in a Swedish population

OBJECTIVE: To investigate diagnosis-specific sick leave as a risk marker for subsequent disability pension. DESIGN: A prospective population based cohort study. Exposure to a new medically certified sick leave episode of more than seven days by diagnosis during 1985 was examined in relation to incident cause-specific disability pension through 1996. PARTICIPANTS: The total non-retired population of one Swedish county aged 16 to 49 years, alive and not in receipt of a disability pension at the end of 1985 (176 629 persons; 51% men). MAIN RESULTS: To eliminate confounding by sick leaves that translate into a disability pension, the follow up period for disability pension was started five years after the assessment of sick leave. After adjustment for demographic characteristics, the risk of disability pension from mental disorders was 14.1 times higher (95% confidence interval (CI), 12.1 to 16.4) for those with sick leave for mental disorders than for those with no sick leave. The corresponding hazard ratio for sick leave and disability pension within diagnostic category was 5.7 (95% CI, 5.3 to 6.2) for musculoskeletal diseases and 13.0 (7.7 to 21.8) for gastrointestinal diseases. Irrespective of diagnoses, the hazard ratio for sick leave and disability pension was 3.0 (2.9 to 3.1). CONCLUSIONS: Sick leave may provide an important risk marker for identifying groups at high risk of a disability pension, especially for psychiatric diagnoses.     

Does mastering have an effect on disability pensioning independent of health, and may it explain divides of education in the Oslo Health Survey?

AIMS: Does mastering abilities have an independent effect on disability pensioning? Are some of the large divides across education explained by mastering factors when adjusted for health? METHODS: Data from the National Insurance Administration were linked to a health survey of 10,720 Oslo inhabitants aged 40, 45, and 60 years, 46% of the total populations in these age groups who were invited to a Health Survey in 2000-01. Measures of general health, chronic somatic diseases, psychiatric symptoms, and musculoskeletal pain were self-reported. The mastering test Generalized Self Efficacy was used. RESULTS: 10.5% of our eligible sample had disability pension at the time of the survey. The risk was more than five times higher for those with primary school than for those with university education and 50% higher for women than for men. Lowest score on the Generalized Self Efficacy test (poor mastering) had an age-, gender-, and health-adjusted OR of 2.4 compared with the highest level of mastering. Adjusting for mastering lowered the educational divide but not that of gender, when health indicators were taken into consideration Those reporting poor general health had a seven times higher risk than those with good health, and those with a chronic somatic disease, musculoskeletal pain, or poor psychiatric health had a somewhat lower increase in risk of disability pension. Health measures did reduce the impact of education, but not of gender, when adjusted for mastering. CONCLUSION: Poor mastering was associated with disability pensioning, and reduced the differences across educational level and health but not across gender.     

Persistent smoking as a predictor of disability pension due to musculoskeletal diagnoses: A 23 year prospective study of Finnish twins

Objective

To investigate whether stability or changes in smoking predict disability pension (DP) due to low back diagnoses (LBD) and musculoskeletal diagnoses (MSD) after taking familial confounding into account using a co-twin design.

Method

Longitudinal smoking patterns and multiple covariates in a population-based cohort of 17,451 Finnish twins (6959 complete pairs) born before 1958 were surveyed through questionnaires in 1975 and 1981. The outcome data were collected from the national pension registers until the end of 2004. Cox proportional hazards regression models were used for statistical analyses.

Results

Disability pension due to low back diagnoses was granted to 408 individuals and disability pension due to musculoskeletal diagnoses to 1177 individuals during the follow-up of 23 years. Being a persistent smoker (current smoker both 1975 and 1981) predicted a significantly increased risk for disability pension (hazard ratio 1.69, 95% confidence interval 1.46, 1.97) compared to those individuals who had never smoked. The association remained when several confounding factors, including familial factors, were taken into account.

Conclusion

Persistent smoking predicts early disability pension due to musculoskeletal diagnoses and low back diagnoses independently from numerous confounding factors, including familial effects shared by the co-twins.     

Depression and early retirement: prospective population based study in middle aged men

BACKGROUND: Mental depression is an important health problem in many countries. It reduces productivity at work and is the fastest increasing reason for early retirement. METHODS: This study followed up a Finnish cohort of 1726 men from 1984 to 2000. Depression was assessed at baseline by HPL depression score. Pension records were obtained from the national pension registers. Cox's regression analysis was used to estimate the associations of depression with the risk of all disability pensions combined, separately for different causes of disability, and non-illness based pension. RESULTS: During the follow up, 839 men (48.6%) received a disability pension. A total of 142 men (16.9% of all disability pensions) retired because of mental disorder and of these, 75 (52.8%) because of depression. After adjustment for the potential confounders, men in the highest third of depression score had an increased risk of non-illness based pension (RR 1.86 95% CI 1.37 to 2.51) and disability pension attributable to mental disorders (RR 2.74, 95% CI 1.68 to 4.46), chronic somatic diseases (RR 1.68, 95% CI 1.05 to 2.71), cardiovascular diseases (RR 1.61, 95% CI 1.12 to 2.32). The mean age of retirement for men with a high and low depression score was 57.6 years (SD 3.87) and 59.1 years (SD 3.65) (p<0.001) respectively. CONCLUSIONS: A high depression score predicted disability attributable to any cause, especially mental disorders, and non-illness based pensions. Depressed people retired on average 1.5 years younger than those without depression. Further studies are needed to elucidate the pathways of how mental depression leads people to seek retirement pension.