Disability pension. Epidemiological and financial aspects.

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

Self-rated health as a predictor of disability pension and death--a prospective study of middle-aged men

OBJECTIVE: Self-rated health (SRH) is increasingly attracting attention as a predictor of morbidity and mortality while its relation to impaired function has been given less momentum. The aim of this study was to assess the relation between SRH and the risk of being awarded a disability pension and premature death. METHODS: Five birth-year cohorts of middle-aged men were invited to a screening programme and were followed for approximately 11 years. Of the 718 (12%) men with a disability pension granted during follow-up, 46% had perceived their health as perfect on inclusion. The corresponding figure for the remaining 5,082 men was 77%. RESULTS: The crude relative risk (RR) of disability pension for men with SRH less than perfect was 3.7 (3.2-4.2). After adjustment for premorbidity/medication, the RR declined to 3.3 (2.8-3.8). The crude RR of death associated with SRH less than perfect was 1.6 (1.3-2.0), unchanged after adjustment. CONCLUSION: The results showed that SRH is a strong and independent predictor of disability and, to a lesser degree, of mortality

Rapid test, throat culture and clinical assessment in the diagnosis of tonsillitis.

Objectives. Our aim was to identify a group of patients with clinical signs of tonsillitis to whom antibiotics could be prescribed without further diagnostic actions, and to compare the outcome of clinical assessment with the result of an antigen detection test using culture as the gold standard. Methods. During two winter months, patients aged >=4 years attending for sore throat at three primary health care centres in Malmö, Sweden, were examined. Odds ratios, sensitivities, specificities and predictive values were calculated for clinical assessment and for an antigen detection test. Results. Among the 169 participating patients, growth of group A ß-haemolytic streptococci (GAS) was found in 53 cultures, and 23 patients (14%) were clinically assessed as ‘absolutely positive’, representing positive clinical assessment. Nineteen had positive cultures for GAS. The sensitivity, specificity and predictive positive and negative value for the antigen detection test were 82, 96, 90 and 93%, respectively, and for positive clinical assessment 36, 97, 83 and 77%. Conclusion. It is possible to identify a small group of patients with convincing signs of tonsillitis in which the specificity as well as the predictive positive value of the rapid test and the clinical assessment are close to equal. Antibiotics may be prescribed to these patients without further diagnostic actions. Keywords. Antigen detection test, clinical assessment, rapid t

The relation between self-rated health, socioeconomic status, body mass index and disability pension among middle-aged men

The aim of this study was to assess the relations between self-rated health (SRH), socioeconomic status (SES), body mass index (BMI) and disability pension. Five birth-year cohorts of middle-aged male residents in Malmo, Sweden, were invited and 5313 with complete data constituted the cohort in this study. Each subject was followed for approximately 11 years. Of all subjects, 73% perceived their health as perfect and among obese men and blue collar workers, the corresponding figures were 67 and 68% respectively. The adjusted odds ratios for SRH less than perfect was 1.3 (CI: 1.1-1.7) for obese subjects and 1.7 (CI: 1.5-1.9) for blue collar workers. The interaction between low SES and obesity was estimated to 11% which was not statistically significant. The adjusted relative risks (RR) of disability pension was 3.3 for subjects with SRH less than perfect, 2.2 for blue collar workers and 2.0 for obese subjects, all statistically significant and only marginally less than the crude RR. Thus, SRH among middle-aged men was associated with obesity as well as low SES, but no evidence of synergism between obesity and low SES in relation to SRH was found. Furthermore, poor SRH in particular, but also low SES and obesity, independently predicted disability pension

Disability pension in Malmohus county: aspects on long-term financial effects

The purpose of this study was to estimate the financial costs of disability pension in order to compare the financial burden and the numerical distribution of disability pension by main diagnostic groups. During three months all new disability pensions (n = 944) granted in Malmohus county were registered. During a follow-up of approximately two and a half years, 40 subjects died and 15 pensions expired. The predominating diagnoses were musculoskeletal diseases, mental disorders including alcohol dependence, cardiovascular and neurological diseases. To analyse whether these proportions changed when the extent of the pension, age at pension and the retirement allowance were considered, the present value of the total retirement allowances was calculated. The ranking of the four predominating diagnosis categories was not affected by the extent of the pension or the age at which the pension was granted. Thus, musculoskeletal diseases still predominated, although the proportion decreased. Among unemployed subjects, mental disorders made the largest contribution to the total expenditure. The results gained may be used in further research where alternatives to disability pension for different groups of patients and/or diagnoses are investigated

The use of analgesics and hypnotics in relation to self-rated health and disability pension - A prospective study of middle-aged men

Aims: This cohort study on urban middle-aged men investigates the association between the use of analgesics and hypnotics, self-rated health (SRI-I) and disability pension. Methods: Five birth-year cohorts of middle-aged, urban, Swedish men were invited to a screening programme and were followed for approximately 11 years. Results: Out of all the subjects (n = 5798), 12.4% received a disability pension during follow-up, 27.0% rated their health as less than perfect, 10.6% used analgesics and 2.9% used hypnotics. Compared with non-users of analgesics and hypnotics, the adjusted hazard ratio of disability pension for the simultaneous use of both drugs was 7.0 (95% CI: 4.3, 11.6) and the adjusted odds ratio of poor SRH was 16.5 (6.3, 43.5). Thus, the use of analgesics and hypnotics was positively related to poor SRH and predicted award of a disability pension within an Ii-year follow-up. This may reflect that the use of analgesics and hypnotics is a proxy of disease but an independent negative effect on health cannot be excluded. Conclusions: Information on the use of these drugs could be used to predict the award of a disability pension, such as in different geographical areas or population groups