title: Incidence of disability pension and associations with socio-demographic factors in a Swedish twin cohort.
abstract: OBJECTIVE
  The incidence of disability pension (DP), especially due to mental diagnoses, has increased in many countries, but knowledge of socio-demographic risk factors for DP is limited. Further, the influences of genetics and early-life factors (jointly called familial factors) on these associations remain to be studied. The aims were to study incidence of DP (due to all and mental diagnoses) and associations with socio-demographic factors, and also to establish whether associations differ with DP diagnosis and sex, and are influenced by familial factors.
  
  
  METHODS
  A prospective cohort study of all twins born in 1928-1958 (n = 52,609) in Sweden was conducted. The twins were followed from 1993 to 2008 regarding DP. Cox proportional hazard models were applied.
  
  
  RESULTS
  The cumulative incidence of DP was 17 %. Of all the DP diagnoses 20 % were mental. Higher age (≥45 years), being a woman or unmarried, and/or living in a semi-urban area were risk factors for DP. Low education, being a blue-collar worker or being self-employed predicted either higher (all diagnoses) or lower (mental diagnoses) risk of DP. Rural areas were associated with DP due to mental diagnoses. The estimates varied for men and women. After adjustment for familial factors the associations of DP with education and marital status were attenuated and no longer significant. Similar results were apparent for DP due to mental diagnoses and socioeconomic status.
  
  
  CONCLUSIONS
  Familial factors may select individuals into some of the established risk environments for DP. Studies investigating the causes of DP need to take such confounding into account.
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Berzeliusväg 3, 171 77, Stockholm, Sweden. asa.samuelsson@ki.se
authors.forename: Åsa
authors.initials: Å
authors.lastname: Samuelsson
authors.forename: K
authors.initials: K
authors.lastname: Alexanderson
authors.forename: A
authors.initials: A
authors.lastname: Ropponen
authors.forename: P
authors.initials: P
authors.lastname: Lichtenstein
authors.forename: P
authors.initials: P
authors.lastname: Svedberg
mesh_terms: D000328:Adult; D000367:Age Factors; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D008875:Middle Aged; D010415:Pensions / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D014427:Twins / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data