Occupational class inequalities in disability retirement after hospitalisation

This study aimed to investigate whether hospitalisation is associated with increased risk of disability retirement differently across four occupational classes.

170,510 employees of the City of Helsinki, Finland were followed from 1990 to 2013 using national registers for hospitalisations and disability retirement. Increases in the risk of disability retirement after hospitalisation for any cause, cardiovascular diseases, musculoskeletal disorders, mental disorders, malignant neoplasms, respiratory diseases and injuries were assessed across four occupational classes: professional, semi-professional, routine non-manual and manual, using competing risks models.

In general, hospitalisation showed a slightly more increased risk of disability retirement in the lower ranking occupational classes. Hospitalisation among women for mental disorders showed a more increased risk in the professional class (hazard ratio 14.73, 95% confidence interval 12.67 to 17.12) compared to the routine manual class (hazard ratio 7.27, 95% confidence interval 6.60 to 8.02). Occupational class differences were similar for men and women. The risk of disability retirement among women increased most in the routine non-manual class after hospitalisation for musculoskeletal disorders and injuries, and most in the professional class after hospitalisation for cardiovascular diseases. The corresponding risks among men increased most in the two lowest ranking classes after hospitalisation for injuries.

Ill-health as measured by hospitalisation affected disability retirement in four occupational classes differently, and the effects also varied by the diagnostic group of hospitalisation. Interventions that tackle work disability should consider the impact of ill-health on functioning while taking into account working conditions in each occupational class.