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Lengths of diagnosis-specific sickness absence spells as predictors of diagnosis-specific disability retirement in different socio-economic groups

Salonen, Blomgren & Laaksonen: Lengths of diagnosis-specific sickness absence spells as predictors of diagnosis-specific disability retirement in different socio-economic groups. Presentation at TITA Annual Research Meeting, Turku 15.-16.9.2016.

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Lengths of diagnosis-specific sickness absence spells as predictors of diagnosis-specific disability retirement in different socio-economic groups

  1. 1. 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 Inequalities in Time of Austerity
  2. 2. 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
  3. 3. 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)
  4. 4. Recipients of disability pension in Finland by diagnosis 16-64 years old 49 % 22 % 29 % 0.00 50000.00 100000.00 150000.00 200000.00 250000.00 300000.00 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 other musculoskeletal diseases mental health disorders Kelasto (2016)
  5. 5. 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!
  6. 6. 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)
  7. 7. Socio-economic differences in 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)
  8. 8.  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 differences in 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?
  9. 9. 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)
  10. 10.  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
  11. 11.  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
  12. 12. Thank you! lksalo (at) utu.fi
  13. 13. Consortium partners of TITA project

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