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Kristina Alexanderson - One of the best experts on this subject based on the ideXlab platform.
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sickness absence and Disability Pension after breast cancer diagnosis a 5 year nationwide cohort study
Journal of Clinical Oncology, 2017Co-Authors: Pia Kvillemo, Ellenor Mittendorferrutz, Richard Branstrom, Kerstin Nilsson, Kristina AlexandersonAbstract:PurposeTo explore future diagnosis-specific sickness absence and Disability Pension among women with breast cancer compared with women without breast cancer. Also, to examine associations with disease-related and sociodemographic factors among those with breast cancer.MethodsLongitudinal register data on 3,547 women living in Sweden (age 20 to 65 years) who were first diagnosed with breast cancer in 2005, and a matched comparison cohort (n = 14,188), were analyzed for the annual prevalence of diagnosis-specific sickness absence and Disability Pension over 5 years. Logistic regressions were used to explore associations of disease-related and sociodemographic factors with future sickness absence and Disability Pension among women with breast cancer.ResultsImmediately after being diagnosed with breast cancer, the proportion of women with sickness absence was high but decreased continuously from the 1st through 5th year after diagnosis (71%, 40%, 30%, 22%, and 19%, respectively). In comparison, the range for ...
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prescribed antidepressants before and after Disability Pension due to common mental disorders
European Journal of Public Health, 2016Co-Authors: Shaela Rahman, Kristina Alexanderson, Michael Wiberg, Jussi Jokinen, Antti Tanskanen, Ellenor MittendorferrutzAbstract:Prescribed antidepressants before and after Disability Pension due to common mental disorders
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longitudinal changes in sickness absence and Disability Pension and associations between Disability Pension and disease specific and contextual factors and functioning in people with multiple sclerosis
Journal of the Neurological Sciences, 2016Co-Authors: Kristina Alexanderson, Petter Tinghog, Jan Hillert, Charlotte Chruzander, Charlotte Ytterberg, Lotta Widen Holmqvist, S G O JohanssonAbstract:BACKGROUND: Even though it is well known that Disability due to MS is highly associated with employment status, the long-term longitudinal perspective on sickness absence and Disability Pension ove ...
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sickness absence due to back pain or depressive episode and the risk of all cause and diagnosis specific Disability Pension a swedish cohort study of 4 823 069 individuals
European Journal of Pain, 2015Co-Authors: Thomas Dorner, Kristina Alexanderson, Annina Ropponen, Pia Svedberg, Katharina Viktoria Stein, Ellenor MittendorferrutzAbstract:Background: The aim of this study was to investigate the associations between sickness absence due to back pain or depressive episode with future all-cause and diagnosis-specific Disability Pension, while adjusting for comorbidity and socio-demographics, for all and stratifying for sex. Method: In total, 4,823,069 individuals aged 16–64 years, living in Sweden at the end of 2004, not on old-age or Disability Pension in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the study population. Crude and adjusted hazard ratios (HRs) for allcause and diagnosis-specific Disability Pension (2006–2010) in relation to diagnosis-specific sickness absence with sickness benefits paid by the Social Insurance Agency were estimated using Cox regression. Results: The HR for all-cause Disability Pension was 7.52 (7.25–7.52) in individuals with an incident sick-leave spell due to back pain, compared to individuals without sickness absence in 2005 in the fully adjusted (socio-demographics and comorbidity) model. The fully adjusted (multivariate) HRs for diagnosis-specific Disability Pension were musculoskeletal diagnoses 23.87 (22.75–25.04), mental 2.49 (2.27–2.73) or all other diagnoses, 3.44 (3.17–3.75). In individuals with an incident sick-leave spell due to a depressive episode in 2005, the multivariate adjusted HR for all-cause Disability Pension was 12.87 (12.42–13.35), while the multivariate HRs for Disability Pension due to musculoskeletal diagnoses were 4.39 (3.89–4.96), for mental diagnoses 25.32 (24.29– 26.38) and for all other somatic diagnoses 3.44 (3.09–3.82). Men who were sickness absent due to a depressive episode had a higher HR for Disability Pension compared to women. Conclusion: Results indicate that sickness absence due to a depressive episode or back pain is a strong risk factor for a future Disability Pension due to mental, musculoskeletal or other somatic diagnoses.
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psychiatric diagnoses medication and risk for Disability Pension in multiple sclerosis patients a population based register study
PLOS ONE, 2014Co-Authors: Philip Brenner, Ellenor Mittendorferrutz, Kristina Alexanderson, Charlotte Bjorkenstam, Jan Hillert, Jussi Jokinen, Petter TinghogAbstract:BACKGROUND: Psychiatric comorbidity is common among multiple sclerosis (MS) patients. The majority of MS patients of working ages are on Disability Pension. The aims of this study were to chart the ...
Ellenor Mittendorferrutz - One of the best experts on this subject based on the ideXlab platform.
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sickness absence and Disability Pension after breast cancer diagnosis a 5 year nationwide cohort study
Journal of Clinical Oncology, 2017Co-Authors: Pia Kvillemo, Ellenor Mittendorferrutz, Richard Branstrom, Kerstin Nilsson, Kristina AlexandersonAbstract:PurposeTo explore future diagnosis-specific sickness absence and Disability Pension among women with breast cancer compared with women without breast cancer. Also, to examine associations with disease-related and sociodemographic factors among those with breast cancer.MethodsLongitudinal register data on 3,547 women living in Sweden (age 20 to 65 years) who were first diagnosed with breast cancer in 2005, and a matched comparison cohort (n = 14,188), were analyzed for the annual prevalence of diagnosis-specific sickness absence and Disability Pension over 5 years. Logistic regressions were used to explore associations of disease-related and sociodemographic factors with future sickness absence and Disability Pension among women with breast cancer.ResultsImmediately after being diagnosed with breast cancer, the proportion of women with sickness absence was high but decreased continuously from the 1st through 5th year after diagnosis (71%, 40%, 30%, 22%, and 19%, respectively). In comparison, the range for ...
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prescribed antidepressants before and after Disability Pension due to common mental disorders
European Journal of Public Health, 2016Co-Authors: Shaela Rahman, Kristina Alexanderson, Michael Wiberg, Jussi Jokinen, Antti Tanskanen, Ellenor MittendorferrutzAbstract:Prescribed antidepressants before and after Disability Pension due to common mental disorders
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sickness absence due to back pain or depressive episode and the risk of all cause and diagnosis specific Disability Pension a swedish cohort study of 4 823 069 individuals
European Journal of Pain, 2015Co-Authors: Thomas Dorner, Kristina Alexanderson, Annina Ropponen, Pia Svedberg, Katharina Viktoria Stein, Ellenor MittendorferrutzAbstract:Background: The aim of this study was to investigate the associations between sickness absence due to back pain or depressive episode with future all-cause and diagnosis-specific Disability Pension, while adjusting for comorbidity and socio-demographics, for all and stratifying for sex. Method: In total, 4,823,069 individuals aged 16–64 years, living in Sweden at the end of 2004, not on old-age or Disability Pension in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the study population. Crude and adjusted hazard ratios (HRs) for allcause and diagnosis-specific Disability Pension (2006–2010) in relation to diagnosis-specific sickness absence with sickness benefits paid by the Social Insurance Agency were estimated using Cox regression. Results: The HR for all-cause Disability Pension was 7.52 (7.25–7.52) in individuals with an incident sick-leave spell due to back pain, compared to individuals without sickness absence in 2005 in the fully adjusted (socio-demographics and comorbidity) model. The fully adjusted (multivariate) HRs for diagnosis-specific Disability Pension were musculoskeletal diagnoses 23.87 (22.75–25.04), mental 2.49 (2.27–2.73) or all other diagnoses, 3.44 (3.17–3.75). In individuals with an incident sick-leave spell due to a depressive episode in 2005, the multivariate adjusted HR for all-cause Disability Pension was 12.87 (12.42–13.35), while the multivariate HRs for Disability Pension due to musculoskeletal diagnoses were 4.39 (3.89–4.96), for mental diagnoses 25.32 (24.29– 26.38) and for all other somatic diagnoses 3.44 (3.09–3.82). Men who were sickness absent due to a depressive episode had a higher HR for Disability Pension compared to women. Conclusion: Results indicate that sickness absence due to a depressive episode or back pain is a strong risk factor for a future Disability Pension due to mental, musculoskeletal or other somatic diagnoses.
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psychiatric diagnoses medication and risk for Disability Pension in multiple sclerosis patients a population based register study
PLOS ONE, 2014Co-Authors: Philip Brenner, Ellenor Mittendorferrutz, Kristina Alexanderson, Charlotte Bjorkenstam, Jan Hillert, Jussi Jokinen, Petter TinghogAbstract:BACKGROUND: Psychiatric comorbidity is common among multiple sclerosis (MS) patients. The majority of MS patients of working ages are on Disability Pension. The aims of this study were to chart the ...
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association of socio demographic factors sick leave and health care patterns with the risk of being granted a Disability Pension among psychiatric outpatients with depression
PLOS ONE, 2014Co-Authors: Ellenor Mittendorferrutz, Tommi Harkanen, Jari Tiihonen, Jari HaukkaAbstract:Background Depression ranges among the leading causes of early exit from the labor market worldwide. We aimed to investigate the associations of socio-demographic factors, sickness absence, health care and prescription patterns with the risk of being granted a Disability Pension in psychiatric outpatients with depression.
Mika Kivimaki - One of the best experts on this subject based on the ideXlab platform.
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clustering of adversity in young adults on Disability Pension due to mental disorders a latent class analysis
Social Psychiatry and Psychiatric Epidemiology, 2016Co-Authors: Matti Joensuu, Mika Kivimaki, Kirsi Ahola, Jenni Ervasti, Aki Koskinen, Pauliina Mattilaholappa, Teija Kivekas, Jussi VahteraAbstract:Mental disorders are the leading cause of work Disability among young adults. This study examined whether distinct classes could be identified among young adults on the basis of medical history before receiving a Disability Pension due to a mental disorder. Medical history was obtained from Pension applications and attached medical certificates for 1163 individuals aged 18–34 years who, in 2008, received a Disability Pension due to a mental disorder. Using latent class analysis, 10 clinical and individual adversities and their associations with sex, age and diagnostic category were examined. Three classes were identified: childhood adversity (prevalence, 33 %), comorbidity (23 %), and undefined (44 %). The childhood adversity class was characterized by adverse events and symptoms reported during childhood and it associated with depressive disorders. The comorbidity class was characterized by comorbid mental disorders, suicide attempts and substance abuse and associated with younger age and bipolar disorder. The undefined class formed no distinct profile; individuals in this class had the lowest number of adversities and it associated with psychotic disorders. The identification of subgroups characterized by childhood circumstances and comorbidity may help planning of prevention and support practices for young adults with mental disorders and risk of work Disability.
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effort reward imbalance as a risk factor for Disability Pension the finnish public sector study
Scandinavian Journal of Work Environment & Health, 2014Co-Authors: Anne Juvani, Tuula Oksanen, Paula Salo, Marianna Virtanen, Mika Kivimaki, Jaana Pentti, Jussi VahteraAbstract:Objectives Job strain has previously been shown to predict Disability Pension, but it is unknown whether effort-reward imbalance (ERI), another major stress model, is also associated with Disability Pension. Methods We examined ERI as a risk factor for diagnosis-specific Disability Pension in a cohort of 51 874 public-sector employees in Finland. To control for reporting bias, work unit-level scores of ERI (based on the survey responses of 35 260 employees in 2000-2002) were constructed and linked to all eligible employees. A sub-cohort of the respondents was analyzed also with individual-level ERI. Disability Pension data were derived from national Pension registers with no loss to follow-up. The outcomes were all-cause Disability Pension and Disability Pension due to depression, musculoskeletal diseases, and ischemic heart diseases (IHD). Multivariate Cox proportional hazard models (adjusted for sociodemographic factors, baseline health, and work-related characteristics) were used for analyses. Results During a mean 8.9 years of follow-up, 4542 participants were granted Disability Pension. An increased risk for Disability Pension due to depression was detected for both high work unit- and individual-level ERI [hazard ratio (HR) 1.63, 95% confidence interval (95% CI) 1.31-2.04 and HR 1.90, 95% CI 1.51-2.40, respectively]. High individual-level ERI increased the risk of Disability Pension due to musculoskeletal diseases (HR 1.32, 95% CI 1.13-1.53), but no association was observed for work unit-level ERI (HR 1.02, 95% CI 0.88-1.19). ERI was not associated with Disability Pension due to IHD. Conclusion The present study showed a consistent association between high ERI and an increased risk of Disability Pension due to depression.
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job strain and the risk of Disability Pension due to musculoskeletal disorders depression or coronary heart disease a prospective cohort study of 69 842 employees
Occupational and Environmental Medicine, 2012Co-Authors: Anne Mantyniemi, Tuula Oksanen, Paula Salo, Marianna Virtanen, Mika Kivimaki, Jaana Pentti, Noora Sjosten, Jussi VahteraAbstract:Objectives Observational studies suggest that high job strain is a risk factor for retirement on health grounds, but few studies have analysed specific diagnoses. We examined job strain9s association with all-cause and cause-specific Disability Pensions. Methods Survey responses to questions about job strain from 48 598 (response rate, 68%) public sector employees in Finland from 2000 to 2002 were used to determine work unit- and occupation-based scores. These job strain scores were assigned to all the 69 842 employees in the same work units or occupations. All participants were linked to the Disability Pension register of the Finnish Centre of Pensions with no loss to follow-up. Cox proportional hazard models were used to calculate HRs and their 95% CIs for Disability Pensions adjusted by demographic, work unit characteristics and baseline health in analyses stratified by sex and socioeconomic position. Results During a mean follow-up of 4.6 years, 2572 participants (4%) were granted a Disability Pension. A one-unit increase in job strain was associated with a 1.3- to 2.4-fold risk of requiring a Disability Pension due to musculoskeletal diseases in men, women and manual workers, depending on the measure of job strain (work unit or occupation based). The risk of Disability Pension due to cardiovascular diseases was increased in men with high job strain but not in women nor in any socioeconomic group. No consistent pattern was found for Disability Pension due to depression. Conclusion High job strain is a risk factor for Disability Pension due to musculoskeletal diseases.
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employee control over working times and risk of cause specific Disability Pension the finnish public sector study
Occupational and Environmental Medicine, 2010Co-Authors: Jussi Vahtera, Tuula Oksanen, Marianna Virtanen, Jaana Pentti, Sari Laine, Aki Koskinen, Mika KivimakiAbstract:Objective To examine the association between worktime control and subsequent Disability Pension among employees. Methods Two scores of worktime control (self-assessed and co-worker assessed) were obtained from a survey in 2000–2001 (score range 1–5) among 30 700 public sector employees (78% women) aged 18–64 years. Information on cause-specific Disability Pension during follow-up was collected from national registers. Results During a mean follow-up of 4.4 years, 1178 employees were granted Disability Pensions (incidence per 1000 person-years: 9.2 in women and 8.7 in men). The most common causes of a Disability Pension were musculoskeletal disorders (43% of all Pensions), mental disorders (25%), tumours (8%) and diseases of the circulatory system (6%) and nervous system (6%). A one unit increase in self-assessed and co-worker assessed worktime control score was associated with a 41–48% decrease in risk of disabling musculoskeletal disorders in men and a 33–35% decrease in women. This association was robust to adjustment for 17 baseline covariates (in men and women combined, adjusted HR 0.76, 95% CI 0.67 to 0.87 and 0.64, 95% CI 0.51 to 0.79 per one unit increase in self-assessed and co-worker assessed worktime control, respectively). Self-assessed, but not co-worker assessed, worktime control was also associated with risk of Disability retirement due to mental disorders in women. Disability Pensions from other disease categories were not related to worktime control. Conclusions In these public sector employees, high worktime control was associated with reduced risk of early retirement caused by musculoskeletal disorders independent of baseline characteristics.
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job strain as a predictor of Disability Pension the finnish public sector study
Journal of Epidemiology and Community Health, 2009Co-Authors: Sari Laine, Tuula Oksanen, Marianna Virtanen, Mika Kivimaki, Jaana Pentti, Jussi Vahtera, David Gimeno, Marko Elovainio, Aki KoskinenAbstract:Objective: To examine whether high job strain (a combination of high job demands and low job control) is a risk factor for Disability Pension. Setting: Ten municipalities and 21 hospitals in Finland. Design and participants: A prospective cohort study of 20 386 female and 4 764 male Finnish public sector employees aged 19–50 using data from two surveys (baseline in 2000–2 and follow-up in 2005) and employers’ registers. In addition to self-reported job strain, we computed work unit-aggregated job strain for each participant (the average of scores of all workers of participant’s work unit except the participant him/herself). Main results: 93 employees (0.4%) retired because of Disability during the follow-up. In multilevel logistic regression analysis adjusted for demographic characteristics and health risk behaviour, odds for Disability Pension was 2.60 (95% CI 1.26 to 5.34) times higher for employees with high self-assessed job strain than for those with low self-assessed job strain at baseline. The corresponding OR for passive job versus low job strain was 2.82 (95% CI 1.34 to 5.96). Analysis of work unit-aggregated scores replicated the association for high job strain, OR 2.25 (95% CI 1.17 to 4.35), but not that for passive job. The association between work unit job strain and Disability Pension remained significant after further adjustment for prevalent diseases, psychological distress and perceived health status. Conclusions: Job strain is associated with risk of subsequent Disability Pension. If causal, this association suggests that organisational interventions to reduce job strain may also reduce early exit from work.
Tomas Hemmingsson - One of the best experts on this subject based on the ideXlab platform.
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effects of increased alcohol availability during adolescence on the risk of all cause and cause specific Disability Pension a natural experiment
Addiction, 2017Co-Authors: Emelie Thern, Tomas Hemmingsson, Finn Rasmussen, Jeroen De Munter, George Davey Smith, Mats Ramstedt, Per TyneliusAbstract:Aim To test if being exposed to increased alcohol availability during adolescence is associated with an increased risk of receiving Disability Pension due to all-cause, alcohol use disorders and mental disorders. Design Register-based population-based study using a natural experiment setting, the alcohol policy change in Sweden (1967-1968), with increased access to strong beer in a narrow time window and geographical area. The individuals exposed to the policy change were compared with non-exposed individuals living in the rest of Sweden, excluding a border area. Setting Sweden Participants A total of 518 810 individuals (70 761 in the intervention group; 448 049 in the control group) born 1948-1953, aged 14-20 years old during the policy change. Measurements Date and diagnosis of the outcome variable of Disability Pension due to all-cause, alcohol use disorders and mental disorders were obtained from the Swedish National Social Insurance Agency database from 1971 to 2013. Individual and family level sociodemographic and health related covariates, as well as a regional level covariate were included. Findings Compared with the control group, adolescents exposed to the alcohol policy change were at an increased risk of receiving Disability Pension due to all-causes (HR 1.09, 95% CI 1.07-1.11), alcohol use disorders (HR 1.17, 95% CI 1.05-1.30) and mental disorders (HR 1.19, 95% CI 1.15-1.23). Conclusion In Sweden, a natural experiment with a 43-year follow-up suggests that exposure to increased alcohol availability during adolescence is associated with an increased risk of receiving a Disability Pension due to all-cause, alcohol use disorder and mental disorder diagnoses. This article is protected by copyright. All rights reserved.
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long term physical workload in middle age and Disability Pension in men and women a follow up study of swedish cohorts
International Archives of Occupational and Environmental Health, 2016Co-Authors: Katarina Kjellberg, Daniel Falkstedt, Andreas Lundin, Peter Allebeck, Tomas HemmingssonAbstract:The study investigates the association between level of long-term physical workload in middle age and Disability Pension (DP) before 61 years of age with adjustments made for early life factors, le ...
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the association between self assessed future work ability and long term sickness absence Disability Pension and unemployment in a general working population a 7 year follow up study
Journal of Occupational Rehabilitation, 2016Co-Authors: Katarina Kjellberg, Andreas Lundin, Tomas Hemmingsson, Ola Leijon, Laura PunnettAbstract:Purpose Work ability is commonly measured with self-assessments, in the form of indices or single items. The validity of these assessments lies in their predictive ability. Prospective studies have reported associations between work ability and sickness absence and Disability Pension, but few examined why these associations exist. Several correlates of work ability have been reported, but their mechanistic role is largely unknown. This study aims to investigate to what extent individual’s own prognosis of work ability predicts labor market participation and whether this was due to individual characteristics and/or working conditions. Methods Self-assessed prognosis of work ability, 2 years from “now,” in the Stockholm Public Health Questionnaire (2002–2003) was linked to national registers on sickness absence, Disability Pension and unemployment up to year 2010. Effects were studied with Cox regression models. Results Of a total of 12,064 individuals 1466 reported poor work ability. There were 299 cases of Disability Pension, 1466 long-term sickness absence cases and 765 long-term unemployed during follow-up. Poor work ability increased the risk of long-term sickness absence (HR 2.25, CI 95 % 1.97–2.56), Disability Pension (HR 5.19, CI 95 % 4.07–6.62), and long-term unemployment (HR 2.18, CI 95 % 1.83–2.60). These associations were partially explained by baseline health conditions, physical and (less strongly) psychosocial aspects of working conditions. Conclusions Self-assessed poor ability predicted future long-term sickness absence, Disability Pension and long-term unemployment. Self-assessed poor work ability seems to be an indicator of future labor market exclusion of different kinds, and can be used in public health monitoring.
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intelligence and Disability Pension in swedish men and women followed from childhood to late middle age
PLOS ONE, 2015Co-Authors: Andreas Lundin, Daniel Falkstedt, Peter Allebeck, Alma Sorberg Wallin, Tomas HemmingssonAbstract:Objective To investigate the association between intelligence and Disability Pension due to mental, musculoskeletal, cardiovascular, and substance-use disorders among men and women, and to assess the role of childhood social factors and adulthood work characteristics. Methods Two random samples of men and women born 1948 and 1953 (n = 10 563 and 9 434), and tested for general intelligence at age 13, were followed in registers for Disability Pension until 2009. Physical and psychological strains in adulthood were assessed using job exposure matrices. Associations were examined using Cox proportional hazard regression models, with increases in rates reported as hazard ratios (HRs) with 95% confidence intervals (95%CI) per decrease in stanine intelligence. Results In both men and women increased risks were found for Disability Pension due to all causes, musculoskeletal disorder, mental disorder other than substance use, and cardiovascular disease as intelligence decreased. Increased risk was also found for substance use disorder in men. In multivariate models, HRs were attenuated after controlling for pre-school plans in adolescence, and low job control and high physical strain in adulthood. In the fully adjusted model, increased HRs remained for all causes (male HR 1.11, 95%CI 1.07–1.15, female HR 1.06, 95%CI 1.02–1.09) and musculoskeletal disorder (male HR 1.16, 95%CI 1.09–1.24, female HR 1.08, 95%CI 1.03–1.14) during 1986 to 2009. Conclusion Relatively low childhood intelligence is associated with increased risk of Disability Pension due to musculoskeletal disorder in both men and women, even after adjustment for risk factors for Disability Pension measured over the life course.
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Do working conditions explain the increased risks of Disability Pension among men and women with low education? A follow-up of Swedish cohorts.
Scandinavian journal of work environment & health, 2014Co-Authors: Daniel Falkstedt, Mona C. Backhans, Andreas Lundin, Peter Allebeck, Tomas HemmingssonAbstract:Objectives Rates of Disability Pension are greatly increased among people with low education. This study examines the extent to which associations between education and Disability Pensions might be explained by differences in working conditions. Information on individuals at age 13 years was used to assess confounding of associations. Method Two nationally representative samples of men and women born in 1948 and 1953 in Sweden (22 889 participants in total) were linked to information from social insurance records on cause (musculoskeletal, psychiatric, and other) and date (from 1986-2008) of Disability Pension. Education data were obtained from administrative records. Occupation data were used for measurement of physical strain at work and job control. Data on paternal education, ambition to study, and intellectual performance were collected in school. Results Women were found to have higher rates of Disability Pension than men, regardless of diagnosis, whereas men had a steeper increase in Disability Pension by declining educational level. Adjustment of associations for paternal education, ambition to study, and intellectual performance at age 13 had a considerable attenuating effect, also when Disability Pension with a musculoskeletal diagnosis was the outcome. Despite this, high physical strain at work and low job control both contributed to explain the associations between low education and Disability Pensions in multivariable models. Conclusion Working conditions seem to partly explain the increased rate of Disability Pension among men and women with lower education even though this association does reflect considerable selection effects based on factors already present in late childhood.
Arnstein Mykletun - One of the best experts on this subject based on the ideXlab platform.
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widespread pain and medically certified Disability Pension in the hordaland health study
European Journal of Pain, 2012Co-Authors: Simon Øverland, Arnstein Mykletun, Ann Kristin Knudsen, Samuel B Harvey, Matthew HotopfAbstract:Widespread pain (WSP) is common in the general population and is associated with poor outcomes. The aim of this study was to quantify the risk for medically certified Disability Pension from WSP. We further studied how other common physical symptoms, common mental disorders and functional limitations influenced this risk. A prospective cohort design was established by linking the large population based Hordaland Health Study (n > 18000 individuals aged 40‐46) with an administrative registry on Disability Pension awards. We modelled hazard ratios for later all-cause and diagnosis specific Disability Pensioning from WSP, adjusted for potential confounders and examined the impact of other co-occurring health problems and functional limitations. WSP was common (12.4%) and associated with a range of mental health, and non-specific and nonmusculoskeletal symptoms. As expected, WSP was a strong predictor for Disability Pension award. Hazard ratios (HR) adjusted for socio-economic status, health behaviours and comorbid medical diagnoses indicated WSP was strongest in predicting Pensioning for musculoskeletal diagnoses (HR = 5.91, 95% CI 4.64‐7.54), but also predicted Pensioning for mental disorder (HR = 3.13, 95% CI 2.20‐4.46) and other diagnoses (HR = 1.81, 95% CI 1.30‐2.51). Further adjustments for other common symptoms, including mental illness, reduced, but did not abolish these risks. WSP is a major risk factor for Disability Pensions, and not only Pensions for musculoskeletal disorders. The global impact of WSP, and its close association to other symptoms, suggests prevention of the severe occupational outcomes for this group must have a broad focus and move beyond symptom directed approaches.
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Disability Pension by occupational class - the impact of work-related factors: The Hordaland Health Study Cohort
BMC public health, 2011Co-Authors: Inger Haukenes, Arnstein Mykletun, Ann Kristin Knudsen, Hans-tore Hansen, John Gunnar MælandAbstract:Background The social gradient in Disability Pension is well recognized, however mechanisms accounting for the gradient are largely unknown. The aim of this study was to examine the association between occupational class and subsequent Disability Pension among middle-aged men and women, and to what extent work-related factors accounted for the association.
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health problems account for a small part of the association between socioeconomic status and Disability Pension award results from the hordaland health study
BMC Public Health, 2011Co-Authors: Kristian Amundsen Ostby, Ann Kristin Knudsen, Ragnhild E Orstavik, Ted Reichbornkjennerud, Arnstein MykletunAbstract:Background Low socioeconomic status is a known risk factor for Disability Pension, and is also associated with health problems. To what degree health problems can explain the increased risk of Disability Pension award associated with low socioeconomic status is not known.
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Health anxiety and Disability Pension award: The HUSK Study.
Psychosomatic Medicine, 2009Co-Authors: Arnstein Mykletun, Ove Heradstveit, Kari Eriksen, Nick Glozier, John Gunnar Mæland, Simon Øverland, Ingvard WilhelmsenAbstract:Objective: To examine the hypothesized effect of health anxiety on subsequent Disability Pension award. Mental disorders are consistently underrecognized in general health care, leading to underestimation of its effects on related social security expenditures. According to medicolegal diagnoses for Disability Pension award, there are almost no awards of Disability benefits for health anxiety or hypochondriasis. There are no empirical longitudinal population-based studies on occupational Disability in health anxiety or the extreme of hypochondriasis. Methods: Using a historical cohort design, we utilized a unique link between a large epidemiological cohort study (n = 6819) and a comprehensive national database of Disability benefits to examine the effect of health anxiety on subsequent Disability Pension award (n = 277) during 1.0 to 6.6 years of follow-up. The data sources were merged after informed consent, using the national personal identification number. Results: Health anxiety was a strong predictor of Disability Pension award, exceeding the effect of general anxiety, and comparable to the effect of depression. This effect was partly accounted for by adjustment for income and level of education, and comorbid mental, psychosomatic, or physical conditions. The effect was not limited to high symptom levels, but followed a dose-response association. Despite the robust effect in this prospective study, health anxiety or hypochondriasis was not recognized as medicolegal diagnosis for any awards of Disability Pension, and was not accounted for by other mental disorders. Conclusions: Health anxiety is a strong, independent, and yet underrecognized risk factor for Disability Pension award.
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health status before during and after Disability Pension award the hordaland health study husk
Occupational and Environmental Medicine, 2008Co-Authors: Simon Øverland, Nick Glozier, John Gunnar Mæland, Max Henderson, Matthew Hotopf, Arnstein MykletunAbstract:Objectives: Up to one in eight of the working age population receives permanent Disability benefits. As little is known about the consequences of this major event, analysis aimed to compare health status before and after Disability Pension award. Methods: Data from the population based Hordaland Health Study (HUSK) in Norway 1997–99 (n = 18 581) were linked to official Disability benefits registries. The study identified 1087 participants who were awarded a Disability Pension before, during and after the health survey. These were grouped into different strata defined by temporal proximity between Disability Pension award and health survey participation. The study then compared health status across these strata covering the 7 years before to the 7 years after the award. Results: The study found an inverse U-shaped trend with an increase in reported symptoms (anxiety, depression, pain distribution, sleep problems and somatic symptoms) approaching the award, and a reversing of this trajectory afterwards (p,0.05 for the non-linear trend for all symptoms). We found no similar trend for the more objective health measures blood pressure, physical diagnoses and prescribed medication. For most measures, similar levels of health problems were found 3–7 years before compared to 3–7 years after the award. Conclusion: When comparing the strata defined by time to the event of Disability Pension award, there was an increase in symptoms around the time of the Disability Pension award, with a subsequent return towards preaward levels. The design precludes any firm conclusions as to what causes the observed results, but possible explanations include temporary adverse health effects from the process itself, the beneficial effects of being removed from harmful work conditions, and recovery after increasing health problems leading up to Disability Pension award.