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Disability pension. Epidemiological and financial aspects.

Månsson, Nils-Ove LU (1997)
Abstract (Swedish)
Popular Abstract in Swedish

Avsikten med förtidspensionering är att ge rätt till ekonomisk trygghet om arbetsförmågan skulle reduceras i förtid. Sedan sextiotalet har både totala antalet förtidspensionärer och antalet nybeviljade förtidspensioner ökat kontinuerligt. Efter att 1993 ha kulminerat med över 62.000 nybeviljade pensioner, har antalet därefter minskat. Både för den enskilde och för samhället innebär tidig utslagning från arbetsmarknaden ofta problem. För att möjliggöra att effektiva motåtgärder ska kunna sättas in måste man försöka tolka vilka mekanismer som ligger bakom förtidspensionering så att personer som är i riskzonen i tid kan identifieras. Ett sätt att bidra till detta är att studera faktorer som kan... (More)
Popular Abstract in Swedish

Avsikten med förtidspensionering är att ge rätt till ekonomisk trygghet om arbetsförmågan skulle reduceras i förtid. Sedan sextiotalet har både totala antalet förtidspensionärer och antalet nybeviljade förtidspensioner ökat kontinuerligt. Efter att 1993 ha kulminerat med över 62.000 nybeviljade pensioner, har antalet därefter minskat. Både för den enskilde och för samhället innebär tidig utslagning från arbetsmarknaden ofta problem. För att möjliggöra att effektiva motåtgärder ska kunna sättas in måste man försöka tolka vilka mekanismer som ligger bakom förtidspensionering så att personer som är i riskzonen i tid kan identifieras. Ett sätt att bidra till detta är att studera faktorer som kan misstänkas leda till ökad risk för förtidspension. Ur samhällets synvinkel är de kostnader som förtidspensioneringen för med sig intressanta; kostnader i form av pensionsbelopp för olika diagnoser kan, tillsammans med en analys av olika alternativ till förtidspension, ge en antydan om var preventiva åtgärder och rehabiliteringsinsatser kan få effekt. Alla medelålders män i Malmö inbjöds på sjuttiotalet till en hälsoundersökning och denna grupp har sedan under 11 år följts med avseende på förtidspensionering. En betydligt större andel av de som valde att inte komma till undersökningen förtidspensionerades och dödligheten i denna grupp var också högre än bland deltagarna. De pensionsgrundande diagnoserna var desamma som för landet i övrigt, och dominerades av muskuloskelettala, psykiatriska och hjärtkärlsjukdomar. De psykiatriska diagnoserna var vanligast bland yngre medan muskuloskelettala sjukdomar i synnerhet, men även hjärtkärlsjukdomar, ökade i högre åldrar. Bland de män som inte kom till undersökningen var alkoholberoende den vanligaste diagnosen. Tre tänkbara riskfaktorer studerades: Vikt, alkoholkonsumtion och socioekonomiskt status. I analyserna togs också hänsyn till andra faktorer som kunde tänkas påverka risken, t ex rökning och högt blodtryck. Särskilt fetma, men även undervikt, innebar ökad risk för förtidspension. Måttlig övervikt tycktes emellertid inte öka risken mer än marginellt. Alkoholkonsumtion skattades utifrån svar på frågor relaterade till alkoholvanor. Jämfört med män som drack lite alkohol löpte de med hög alkoholkonsumtion klart större risk att förtidspensioneras. Även absolutister pensionerades i högre grad än de med låg alkoholkonsumtion men det är inte alldeles enkelt att dra några slutsatser av detta. Socioekonomiskt status, definierat av yrke, visade sig ha stor betydelse för risken att förtidspensioneras även sedan hänsyn tagits till påverkan av vissa arbetsrelaterade faktorer och riskfaktorer för sjukdom. Risken var ökad för arbetare i synnerhet, men även för lägre tjänstemän, jämfört med tjänstemän i högre befattningar. Under den period då förtidspensionerna beviljades noterades en ökning av hjärtkärlsjukdomarna medan förekomsten av psykiatriska besvär och användande av sömntabletter var praktiskt taget oförändrade. Andelen män med subjektiva ryggbesvär var betydligt högre efter pensioneringen. På Malmöhus läns allmänna försäkringskassa registrerades under tre månader samtliga nybeviljade förtidspensioner. Efter drygt två år hade sex procent av pensionerna upphört, de flesta på grund av dödsfall men också för att en liten del av pensionerna inte förlängts. För de återstående pensionerna beräknades nuvärdet av de totala pensionsbeloppen under åren fram till ålderspension. Den inbördes ordningen mellan de vanligaste diagnosgrupperna var densamma oavsett om man studerade kostnadsandelar eller diagnosfrekvens; skillnaderna mellan kostnadsandelarna var dock mindre. Medan de muskuloskelettala sjukdomarna dominerade totalt sett, svarade emellertid de psykiatriska sjukdomarna för en större andel av kostnaderna bland arbetslösa förtidspensionärer. Ytterligare forskning behövs för att undersöka vad som ligger bakom den ökade risken för arbetare att bli förtidspensionerade. Fördjupade kunskaper är också önskvärda när det gäller förhållandet mellan absolutism, alkoholkonsumtion och förtidspension. (Less)
Abstract
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... (More)
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. (Less)
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author
opponent
  • Professor Bjurulf, Per, Department of Social Medicine, University of Linköping, University Hospital, S-581 85 Linköping, Sweden
organization
publishing date
type
Thesis
publication status
published
subject
keywords
socioeconomic status, screening, risk factor, participation, occupation, obesity, health screening, financial costs, early retirement, disability pension, diagnoses, Alcohol, body mass index, teetotalism, underweight, Social medicine, Socialmedicin, samhällsmedicin
pages
129 pages
publisher
Department of Community Medicine, Malmö University Hospital
defense location
Location: Aulan, Medicinskt Forskningscentrum, Malmö University Hospital, Malmö
defense date
1997-05-21 13:15
external identifiers
  • Other:ISRN: LUMEDW/MESO--1016--SE
ISBN
91-628-2441-4
language
English
LU publication?
yes
id
b70dd098-ed87-4b46-a3b6-fb85d515a42c (old id 29298)
date added to LUP
2007-06-14 09:47:37
date last changed
2016-09-19 08:45:14
@misc{b70dd098-ed87-4b46-a3b6-fb85d515a42c,
  abstract     = {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.},
  author       = {Månsson, Nils-Ove},
  isbn         = {91-628-2441-4},
  keyword      = {socioeconomic status,screening,risk factor,participation,occupation,obesity,health screening,financial costs,early retirement,disability pension,diagnoses,Alcohol,body mass index,teetotalism,underweight,Social medicine,Socialmedicin,samhällsmedicin},
  language     = {eng},
  pages        = {129},
  publisher    = {ARRAY(0x8446bd0)},
  title        = {Disability pension. Epidemiological and financial aspects.},
  year         = {1997},
}