Incidence of and reasons for disability pension in a Swedish cohort of middle-aged men

The prevalence of disability pensions was investigated among5 birthyear cohorts (1926–30) of male residents in Malmö,Sweden (N=7,697). They were invited to a screening programmein the mid-1970s. Disability pension and mortality data wereidentified from national computerized databases. At the endof follow-up (the calendar year oftheir 58th birthday), 1,391(18%) had been granted a disability pension and 655 (9%) haddied. The most frequent causes for disability pension, accountingfor 74% of the cases, were musculoskeletal diseases, mentaldisorders (including alcohol dependence) and diseases of thecirculatory system. Alcohol dependence was more common amongthose who refrained from participating in the screening programme,while musculoskeletal and neurological diseases were more commonamong those who did participate. Mental disorders (includingalcohol dependence) predominated in younger and musculoskeletaldiseases in older age groups. Both alcohol dependence and non-participationin health screening were related to the risk of a disabilitypension. To be used for identifying subjects at risk for disabilitypension, health screenings should be designed to reach as manyof the usual non-participants as possible and should be targetedat men in younger ages.     

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 Osterg?tland 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.     

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 Osterg?tland 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.     

Cerebrovascular and ischemic heart disease in young adults born preterm: a population-based Swedish cohort study

Preterm birth is associated with overall cardiovascular mortality in young adulthood, but which specific conditions that underlie this association is unknown. We studied mortality and morbidity from cerebrovascular and ischemic heart disease in individuals born preterm. In a nationwide Swedish study, we included 1,306,943 individuals without congenital malformations born between 1983 and 1995, followed from 15 years of age to December 31st, 2010. Of these, 73,489 (5.6 %) were born preterm (<37 weeks of gestation). Cox proportional hazards regression analysis was used to calculate hazard ratios (HR) with 95 % confidence intervals (CI), after adjusting for maternal characteristics and birth weight for gestational age. Of 955 incident cases of cerebrovascular disease, 58 (6.1 %) occurred in preterm born subjects. The corresponding numbers of ischemic heart disease cases were 180 and 13 (7.2 %), respectively. Birth before 32 weeks was associated with a nearly twofold increased risk of cerebrovascular disease; adjusted HR, (95 % CI) = 1.89 (1.01–3.54) compared to term born individuals, whereas individuals born at 32–36 weeks were not at increased risk. Preterm birth was not associated with later ischemic heart disease; no cases of ischemic heart disease were recorded among those born before 32 weeks and the HR (95 % CI) for those born at 32–36 weeks of gestation was 1.45 (0.81–2.57), compared to term-born individuals. Birth before 32 weeks is associated with increased risk of cerebrovascular disease in young adulthood. Our data suggest that cardiovascular health promotion in follow-up programs after very preterm birth may be beneficial.     

Heritability of body size and muscle strength in young adulthood: a study of one million Swedish men

Moderate heritability for skeletal muscle strength has been reported in twin studies, but genetic co-variation between muscle strength at different parts of body and body size is not well known. Further, representativeness of twin cohorts needs to be critically evaluated. Height, weight, elbow flexion, hand grip and knee extension strength were measured in young adulthood in 1,139,963 Swedish men born between 1951 and 1976. We identified 154,970 full-brother pairs and 1582 monozygotic (MZ) and 1864 same-sex dizygotic (DZ) complete twin pairs. The data were analyzed using quantitative genetic modeling for twin and family data. Twins compared to singletons and MZ twins compared to DZ twins were shorter, lighter and had lower muscle strength. In singletons, there was more variation in weight and the strength measures compared to twins with known zygosity but not when compared to twins with unknown zygosity. Full-sib correlations for these traits were lower than DZ correlations. Additive genetic factors explained 81% of variation in height, 59% in body mass index and 50-60% in the strength measures. Additive genetic correlations varied from 0.13 between height and elbow flexion strength to 0.78 between elbow flexion and hand grip strength. Our results suggest that extra variation may exist in general populations not found in twin samples, probably because of selection due to non-participation. This may have inflated heritability estimates in previous twin studies. Nonetheless, we showed that genetic factors affect muscle strength and part of these genes are common to different strength indicators and body size.     

Risk of being granted disability pension among incident cancer patients before and after a structural pension reform: A Danish population-based,matched cohort study

ObjectiveThis study aimed to examine the risk of being granted a disability pension (DP) among incident cancer patients up to five years after diagnosis compared to a match control group, before and after the structural reform of the Danish Disability Pension Act in 2013.MethodsAll 20–60-year-old incident cancer-diagnosed individuals from 2000 to 2015 were identified in the Danish Cancer Registry. A control group, not previously diagnosed with cancer, was identified in Statistics Denmark matched by gender, age, education, and household income. Risk differences (RD) in cumulative incidence proportions of being granted a DP between cancer patients and controls were analyzed before and after the reform.ResultsIn total, 111 773 incident cancer patients and 506 904 controls were included in the study. Before reform 10 561 cancer patients and 11 231 controls were granted DP; and 2570 cancer patients and 2646 controls were granted DP after the reform. The adjusted RD of being granted DP was significantly higher for cancer patients versus controls at all time points before the reform. The RD increased the most during the first (RD 3.6, 95% CI 3.5–3.7) and second (RD 7.2, 95% CI 7.0–7.4) follow-up year and levelled off the remaining three years. After the reform, the adjusted RD were lower for all 1–5 follow-up years compared to before the reform (RD range 2.8–7.7, 95% CI 2.6–8.1).ConclusionThe 2013 reform of the Disability Pension Act reduced the risk of cancer patients being granted DP. The impact on a personal level should be further explored.     

Temperament in young adulthood and later mortality: prospective observational study

STUDY OBJECTIVE: To determine the association between a clinician assessment of temperament in early adulthood and cause specific mortality. DESIGN: Prospective observational study. SETTING: Glasgow University. PARTICIPANTS: 9239 male former students aged 16-30 (mean 20.5) years who participated in an ongoing health survey from 1948-68. A physician recorded free text assessment of temperament, which seemed to capture aspects of personality (trait) and mental health (state), was coded into: stable, anxious, schizoid, hypomanic, odd, depressed, immature, hypochondriacal, unstable, and obsessive. Associations between temperament and mortality were investigated using Cox proportional hazards models. MAIN RESULTS: There were 878 deaths. Most students-8342 (90.3%)-were assessed as stable, the remaining 897 (9.7%) having at least one, and 103 (1.1%) having more than one, temperament type. The second most common temperament was anxiety, recorded in 520 (5.6%) students. In multivariable analyses, having at least one temperament type was associated with increased all cause and stroke mortality, hazard ratios (95% confidence intervals): 1.23 (1.01 to 1.50) and 1.95 (1.06 to 3.59) respectively, compared with stable students. Students with more than one temperament type had higher risk of death from: all causes, 2.05 (1.36 to 3.09); stroke, 3.26 (1.01 to 10.56); and cancer, 2.90 (1.62 to 5.20). Anxiety was positively associated with all cause and cancer mortality, respective hazard ratios: 1.36 (1.07 to 1.72) and 1.51 (1.04 to 2.20). Men labelled hypomanic had increased cardiovascular mortality risk, 1.90 (1.05 to 3.44). CONCLUSIONS: Markers of early adult psychological distress are associated with increased mortality. Mechanisms underlying these associations require investigation.     

Metabolic syndrome – a risk factor for all-cause disability pension: a prospective study based on the Swedish WOLF cohort

ObjectiveThe aim was to study the impact of metabolic syndrome on the risk for disability pension among Swedish employees.MethodsA working population-based prospective cohort [Work, Lipids and Fibrinogen (WOLF) cohort, N=10 803], was linked to national registry records of all-cause disability pension for the period 1992–2013. Occupational health service data included 1992–2009 anthropometric measurements, blood samples, and questionnaires. Metabolic syndrome was defined according to International Diabetes Federation criteria, and risk for any all-cause disability pension was analyzed using Cox proportional hazard regression as hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, sex and other covariates.ResultsOf the employees, 17.9% (men 21.5%, women 9.7%) met the criteria for metabolic syndrome. The prevalence of all-cause disability pension was 15.2% in men with metabolic syndrome and 7.5% in men without metabolic syndrome; for women, the corresponding results were 23.2% and 12.7%. After adjustment for socio-demographic factors, health behaviors, work-related factors, diabetes, and obesity, the risk for all-cause disability pension among subjects with metabolic syndrome displayed an HR of 1.37 (95% CI 1.18–1.60). Results were similar for men and women. In a subgroup, further adjustment for chronic diseases resulted in an HR of 1.32 (95% CI 1.04–1.68).ConclusionThis study demonstrates an increased risk for all-cause disability pension, even after adjustment for other risk factors, among Swedish employees with metabolic syndrome compared to those without at baseline.     

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.

     

Socioeconomic inequalities and disability pension in middle-aged men

BACKGROUND: The issue of inequalities in health has generated much discussion and socioeconomic status is considered an important variable in studies of health. It is frequently used in epidemiological studies, either as a possible risk factor or a confounder and the aim of this study was to analyse the relation between socioeconomic status and risk of disability pension. METHODS: Five complete birth year cohorts of middle-aged male residents in Malmo were invited to a health survey and 5782 with complete data constituted the cohort in this prospective study. Each subject was followed for approximately 11 years and nationwide Swedish data registers were used for surveillance. RESULTS: Among the 715 men (12%), granted disability pension during follow-up, three groups were distinguished. The cumulative incidence of disability pension among blue collar workers was 17% and among lower and higher level white collar workers, 11% and 6% respectively. With simultaneous adjustment for biological risk factors and job conditions, the relative risk for being granted a disability pension (using higher level white collar workers as reference) was 2.5 among blue collar workers and 1.6 among lower level white collar workers. CONCLUSIONS: Socioeconomic status, as defined by occupation, is a risk factor for being granted disability pension even after adjusting for work conditions and other risk factors for disease.     

Organisational downsizing as a predictor of disability pension: the 10-town prospective cohort study

OBJECTIVE: To examine whether downsizing, the reduction of personnel in organisations, is a predictor of increased risk of disability retirement among employees who kept their jobs. DESIGN: Prospective cohort study. Based on reductions of personnel in participants' occupation and workplace, employees were grouped into exposure categories of no downsizing (less than 8% reduction), minor downsizing (reduction between 8% and 18%), and major downsizing (more than 18% reduction). They were followed up for a five year period after downsizing. SETTING: Four towns in Finland. PARTICIPANTS: 19 273 municipal employees, aged 21-54 years. MAIN OUTCOME MEASURES: All permanent full disability pensions granted because of medical reasons below 55 years of age between 1 January 1994 and 31 December 1998 from the national registers. RESULTS: In all, 223 employees were granted a permanent disability pension. The overall rate for disability pensions per 1000 employees was 7.7 after no downsizing, 13.1 after minor downsizing, and 14.9 after major downsizing. Cox proportional hazard models adjusted for age, sex, occupational status, type of employment contract, and town showed 1.81 (95% confidence intervals 1.22 to 2.70) times higher risk of disability retirement after major downsizing than after no downsizing. CONCLUSIONS: The immediate financial advantages of downsizing need to be considered in relation to increased occupational disability and the resulting extra costs to employers and society.     

Body mass index in young adulthood and cancer mortality: a retrospective cohort study

STUDY OBJECTIVE: To examine the relation between body mass index (BMI) in young adulthood and subsequent mortality from cancer. DESIGN: Cohort study. SETTING: University of Glasgow student health service. Weight and height were measured by a physician, and used to calculate BMI. PARTICIPANTS: 8335 men and 2340 women who attended the student health service while at university between 1948 and 1968, and who were followed up with the NHS central register. MAIN RESULTS: The main outcome measure was cancer mortality. Three hundred and thirty nine men and 82 women died of cancer during the follow up (mean 41 years). BMI was associated with mortality from all cancers in men and women, although it did not reach conventional statistical significance. The adjusted hazard ratio (HR) (95% CI) per 5 kg/m(2), was 1.22 (0.97 to 1.53) in men and 1.43 (0.95 to 2.16) in women. Two hundred men and 61 women died from cancers not related to smoking. The adjusted HR for mortality from these were 1.36 (1.02 to 1.82) and 1.80 (1.13 to 2.86) respectively. These results are adjusted for height, number of siblings, pulse rate, year of birth, age, smoking, birth order, number of siblings, and age at menarche in women. Site specific analyses, comparing the highest with the lowest quartile of the BMI distribution found increased risks of prostate cancer (n=28) and breast cancer among heavier subjects. No association between BMI and colorectal cancer was found. CONCLUSIONS: BMI in adolescence has lasting implications for risk of cancer mortality in later life. Future research will include measures of BMI throughout the lifecourse, to determine the period of greatest risk of obesity, in terms of cancer mortality.     

The development of bulimic symptoms from adolescence to young adulthood in females and males: A population-based longitudinal cohort study

Objective:

To investigate age‐related trends in bulimic symptoms and associated putative risk factors among Norwegian youth.

Method:

A sample of 3,150 participants, 1,421 (45.1%) males and 1,759 (54.9%) females, was prospectively followed for 11 years at three time points from adolescence to adulthood. Linear random coefficient models were applied.

Results:

For females, bulimic symptoms increased from age 14 to 16 and declined slowly thereafter. For males, the symptoms decreased between ages 14 and 16 and returned in the early 20s. Females had higher levels of symptoms than males at every age. Age‐associated trends in body mass index, appearance satisfaction, and symptoms of anxiety and depression were associated with some of the trends for both genders. For females, changes in alcohol consumption and cohabitation status functioned as predictors as well.

Discussion:

Males and females show distinct developmental trajectories of bulimic symptoms during adolescence and in the transition to adulthood. Prevention interventions should focus on putative risk factors in mid‐adolescence for females and in the early 20s for males. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012; 45:737–745)     

Anorexia nervosa in young men: A cohort study

OBJECTIVE: The current study investigates the background and outcome of anorexia nervosa (AN) in young men. METHOD: All (N = 61) men, born in 1968-1977 with hospital care in Sweden between 1987 and 1992 due to AN, were compared with the general population. Information about socioeconomic background, health-related outcome (hospital care for AN, other psychiatric diagnoses, abuse of alcohol/drugs and/or suicide attempt), and social outcome (major income from sick leave/sick pension or > or = 6 months social welfare, living with birth parents, and living with child and partner; education level) was taken from national registers. RESULTS: On a group level, the findings suggest some differences between male patients with AN and the male population without AN concerning social background, capacity to support oneself, and living with partner and child. Mental ill-health outcome was almost the same for men with AN as for the general population. CONCLUSION: Male gender in AN--on a group level--suggests a good psychiatric prognosis.