Health-selection mechanisms in the pathway towards a disability pension

Studies emphasizing the disability pension (DP) process are rare.

To identify similarities and differences in work and health between persons who, prior to DP changed jobs due to health-reasons (health-selectors) to other disability pensioners.

a retrospective cohort study was performed on a random sample of all individuals in three counties of Sweden who, in 1998, were under the age of 65 and had been granted DP.

A questionnaire was administered in 2000 (n=917, response rate 52%). The responses and register data on sickness absence in 1990-1998 and DP diagnoses were analysed.

The health-selection group had lower self-perceived health; more partial sick-leave days during the eight years preceding DP, and DP diagnoses were more often musculoskeletal and psychiatric disorders, than the other disability pensioners. The groups did not differ regarding occupational affiliation before the last job. For subjects in the health-selection group, the job change did more often not involve a change of employer, and more had switched to jobs entailing less physical strain, particularly customer service work. Work history did not differ between the groups regarding the average level of physical work demands during the work career, however, disparities were found in the distribution of demands.

The findings pinpoint the importance of studying disability pensioning as a process over time in order to identify and elucidate how exposure and selection interact and contribute to early exclusion from the labour market.