Lengths of diagnosis-specific sickness absence spells as predictors of diagnosis-specific disability

retirement in different socio-economic groups

Laura Salonen, Jenni Blomgren & Mikko Laaksonen

Tackling Inequalitiesin Time of Austerity

Content and relevance

In recent years the political aim in Finland has been to raise the rate of work participation (TEM 2012; VM 2015)

Increasing the amount of healthy, active years (prolonging working lives)

Reducing the use of early exit pathways from labour market

Another important aim is to reduce inequality in health (STM 2001)

Disability retirement is the most common early exit route from working life

Disability retirement in Finland

Total amount of disability pension recipients have decreased during the last decade less time is spent in disability retirement (Laaksonen et al. 2016)

The rate of disability pension recipients is relatively high in Finland (OECD 2010) 6.4 % of the working age Finns received a

disability pension in 2015 (ETK 2015)

Recipients of disability pension in Finland by diagnosis

16-64 years old

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150.00

50000.00

100000.00

150000.00

200000.00

250000.00

300000.00

49 %

22 %

29 %

othermusculoskeletal diseasesmental health disorders

Kelasto (2016)

Sickness absence history before disability retirement 1

As a rule most transit to disability retirement (DR) after 300 days of sickness absence (SA)

SA and long-term sickness absence (LTSA) predict transition to disability retirement (Gjesdal & Bratberg 2003; Kivimäki et al. 2004; Pasternack et al. 2015)

Share of SA receivers is higher for persons transit to DR vs. who don’t – can be seen even years before (Laaksonen et al. 2014)

Especially those retired with musculoskeletal diseases and mental health disorders (>20 % received SA 10 years before DR)

Thus relation between SA and DR is diagnosis-dependent!

Sickness absence history before disability retirement 2

Those who had DR due to mental health disorders more often had SA due to both mental health disorders and somatic conditions (Laaksonen et al. 2016b).

The risk of DR in different phases and causes of SA differs for men and women (Karlsson et al. 2008)

What about socio-economic differences?

Those who received SA due to mental health disorders had higher risk of receiving DR 13 years later (Alexanderson et al. 2012)

Socio-economic differencesin SA and DR 1

Socio-economic gap in health in general is large and growing (Palosuo et al. 2007)

In DR socio-economic differences are found between educational levels, occupational statuses and income group

Income decreased probability of DP after receiving SA 0-5 years before DR but increased after receiving it 6-10 years before DR (Karlsson et al. 2008)

high education and income level decreases the probability of receiving a disability benefit after LTSA (Gjesdal & Bratberg 2003)

Socio-economic differences vary by cause of disability

Large differences in musculoskeletal diseases, psychoactive substance use and cardiovascular diseases but small in depression (Polvinen 2016)

Socio-economic differencesin SA and DR 2

So, are there differences between socio-economic groups in probability of transiting from diagnosis-specific SA to diagnosis-specific DR? How does the probability change as the sickness absence days accumulate?

Data and methods

Multiple registers from The Social Insurance Institution of Finland, Finnish Centre for Pensions and Statistics Finland

Follow-up of at least 30 years olds for 10 years: 2006 – 2015 (baseline 2005)

Cox regression SES by occupational status SA history by 30,60,90, …, 270 days (~2 years)

70 % population sample of 16-68 years old Finns from 1999 to 2015 (n = 3 399 399)

Alexanderson, K., Kivimäki, M., Ferrie, J. E., Westerlund, H., Vahtera, J., Singh-Manoux, A., Melchior, M., Zins, M., Goldberg, M. & Head, J. 2012. Diagnosis-specific sick leave as a long-term predictor of disability pension: a 13-year follow-up of the GAZEL cohort study. Journal of Epidemiology & Community Health, 66. 155—159.

ETK (Eläketurvakeskus). 2015. The statistical database of the Finnish Centre for Pensins. www: http://tilastot.etk.fi/?lang=1.

Kivimäki, M., Forma, P., Wikström, J., Halmeenmäki, T., Pentti, J., Elovainio, M. & Vahtera, J. 2004. Sickness absence as a risk marker of future disability pension: the 10-town study. Journal of Epidemiology & Community Health, 58(8): 710—711.

Laaksonen, M., Rantala, J., Järnefelt, N. & Kannisto, J. 2016. Työkyvyttömyyden vuoksi menetetty työura. Eläketurvakeskuksen tutkimuksia, 04/2016. Eläketurvakeskus, Helsinki.

Laaksonen, M., Blomgren, J. & Gould, R. 2014. Työkyvyttömyyseläkkeelle siirtyneiden sairauspäiväraha-, kuntoutus- ja työttömyyshistoria. Rekisteripohjainen tarkastelu. Eläketurvakeskuksen raportteja 05/2014. Eläketurvakeskus, Helsinki.

Laaksonen, M., Blomgren, J. & Tuulio-Henriksson, A. 2016b. Sickness allowance histories among disability retirees due to mental disorders: A retrospective case-control study. Scandinavian Journal of Public Health, 44(3).291—299.

OECD. 2010. Sickness, Disability and Work: Breaking the Barriers. A Synthesis of Findings across OECD countries.

Palosuo, H., Koskinen, S., Lahelma, E., Prättälä, R., Martelin, T., Ostamo, A., Keskimäki, I., Sihto, M., Talala, K., Hyvönen, E. & Linnanmäki, E. 2007. Terveyden eriarvoisuus Suomessa. Sosioekonomisten terveyserojen muutokset 1980—2005. Sosiaali-ja Terveysministeriö, 23/2007. Yliopistopaino, Helsinki.

References

Pasternack, I., Autti-Rämö, I., Hinkka, K. & Pappila, J. 2015. Miten tunnistaa varhaiskuntoutuksen tarve työelämässä? Kirjallisuuskatsaus työkyvyn heikkenemisen ennusmerkeistä ja varhaisen tunnistamisen työkaluista. Sosiaali- ja terveysturvan selosteita, 91/2015. Kela, Helsinki.

Polvinen, A. 2016. Socioeconomic status and disability retirement in Finland. Causes, changes over time and mortality. Academic dissertation. Finnish Centre for Pensions, 05/2016.

Polvinen, A., Laaksonen, M., Gould, R., Lahelma, R., Leinonen, T. & Martikainen, P. 2015. Socioeconomic inequalities in cause-specific mortality after disability retirement due to different diseases. Scadinavian Jouranl of Public Health, 43. 159—168.

STM (Sosiaali- ja terveysministeriö). 2001. Terveys 2015 –kansanterveysohjelma. Sosiaali- ja terveysministeriön esitteitä, 8/2001.

TEM (Työ- ja Elinkeinoministeriö). 2012. National Working Life Development Strategy to 2020. Työ- ja Elinkeinoministeriö.

VM (Valtiovarainministeriö). 2015. Europe 2020 –Strategy. Finland’s National Programme. Ministry of Finance publications 12c. Juvener Print.

References

Thank you!lksalo (at) utu.fi

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