title: Neighborhood social participation, use of anxiolytic-hypnotic drugs, and women's propensity for disability pension: a multilevel analysis.
abstract: OBJECTIVE
  The increasing number of people on disability pension in Sweden is of concern for Swedish policy-makers, and there is a need for a better understanding of the mechanisms behind disability pension. We investigated (i) whether women living in the same neighborhood have a similar propensity for disability pension that relates to neighborhood social participation, and (ii) whether there is an association between anxiolytic-hypnotic drug (AHD) use and disability pension in women that is modified by the neighborhood context.
  
  
  METHODS
  We used multilevel logistic regression with 12,156 women aged 45 to 64 (first level) residing in 95 neighborhoods (second level) in the city of Malmö (250,000 inhabitants), Sweden, who participated in the Malmö Diet and Cancer Study (1991-96).
  
  
  RESULTS
  Both AHD use (OR = 2.09, 95% CI 1.65, 2.65) and neighborhood rate of low social participation (OR = 11.85, 95% CI 5.09, 27.58) were associated with higher propensity for disability pension. The interval odds ratio indicated that the influence of neighborhood social participation was large compared with the unexplained variance between the neighborhoods. The association between AHD use and disability pension was not modified by the neighborhood context. The median odds ratio was 1.44 after adjusting for individual characteristics and 1.27 after the additional adjusting for neighborhood social participation.
  
  
  CONCLUSIONS
  Women living in the same neighborhood appear to have a similar propensity for disability pension, beyond individual characteristics, and this contextual effect seems largely explained by neighborhood social participation. In addition, AHD use might increase the propensity for disability pension in women.
authors.affiliation: Centre for Family Medicine, Karolinska Institutet, Huddinge, Sweden. Kristina.Johnell@klinvet.ki.se
authors.forename: Kristina
authors.initials: K
authors.lastname: Johnell
authors.forename: Nils-Ove
authors.initials: NO
authors.lastname: Månsson
authors.forename: Jan
authors.initials: J
authors.lastname: Sundquist
authors.forename: Arne
authors.initials: A
authors.lastname: Melander
authors.forename: Göran
authors.initials: G
authors.lastname: Blennow
authors.forename: Juan
authors.initials: J
authors.lastname: Merlo
mesh_terms: D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008875:Middle Aged; D010415:Pensions / Q000706:statistics & numerical data; D012934:Social Isolation; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013548:Sweden; D016387:Women's Health
chemical_list: D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives