Social determinants of disability pension: a 10-year follow-up of 62 000 people in a Norwegian county population.
BACKGROUND
Non-medical factors may be important determinants for granting disability pension (DP) even though disability is medically defined, as in Norway. The aim of this analysis was to identify determinants of DP in a total county population in a 10-year follow-up study.


METHODS
Participants were people without DP, 20- to 66-years-old in 1984-1986. The baseline data were obtained in the Nord-Trøndelag Health Study (HUNT): 90 000 people were invited to answer questionnaires on health, disease, social, psychological, occupational, and lifestyle factors. Information on those who later received DP was obtained from the National Insurance Administration database in 1995. Data analyses were performed using Cox regression analyses.


RESULTS
The incidence of DP showed great variation with regards to age and gender, accounting for an overall increase in the follow-up period. Low level of education, low self-perceived health, occupation-related factors and any long-standing health problem were found to be the strongest independent determinants of DP. Low level of education and socioeconomic factors contributed more to younger people's risk compared to those over 50 years. For people under 50 years of age with a low level of education compared to those with a high level of education, the age-adjusted relative risk for DP was 6.35 for men and 6.95 for women. The multivariate-adjusted relative risk was 2.91 and 4.77, respectively.


CONCLUSIONS
Even for a medically based DP, low socioeconomic status, low level of education and occupational factors might be strong determinants when compared to medical factors alone. These non-medical determinants are usually not addressed by individual based health or rehabilitation programmes.
Krokstad
Steinar
S
Department of Community Medicine and General Practice, Norwegian University of Science and Technology, Trondheim, Norway. steinar.krokstad@medisin.ntnu.no
Johnsen
Roar
R
Westin
Steinar
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D016272:Occupational Health; D010415:Pensions / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors