title: Job strain and the risk of disability pension due to musculoskeletal disorders, depression or coronary heart disease: a prospective cohort study of 69,842 employees.
abstract: OBJECTIVE
  Observational studies suggest that high job strain is a risk factor for retirement on health grounds, but few studies have analysed specific diagnoses. We examined job strain's association with all-cause and cause-specific disability pensions.
  
  
  METHODS
  Survey responses to questions about job strain from 48,598 (response rate, 68%) public sector employees in Finland from 2000 to 2002 were used to determine work unit- and occupation-based scores. These job strain scores were assigned to all the 69,842 employees in the same work units or occupations. All participants were linked to the disability pension register of the Finnish Centre of Pensions with no loss to follow-up. Cox proportional hazard models were used to calculate HRs and their 95% CIs for disability pensions adjusted by demographic, work unit characteristics and baseline health in analyses stratified by sex and socioeconomic position.
  
  
  RESULTS
  During a mean follow-up of 4.6 years, 2572 participants (4%) were granted a disability pension. A one-unit increase in job strain was associated with a 1.3- to 2.4-fold risk of requiring a disability pension due to musculoskeletal diseases in men, women and manual workers, depending on the measure of job strain (work unit or occupation based). The risk of disability pension due to cardiovascular diseases was increased in men with high job strain but not in women nor in any socioeconomic group. No consistent pattern was found for disability pension due to depression.
  
  
  CONCLUSIONS
  High job strain is a risk factor for disability pension due to musculoskeletal diseases.
authors.affiliation: Occupational Health Care Unit of Vihti, Federation of Municipalities for Social and Health Services, Ritalantie 4 E 6, 03100 Nummela, Finland. anne.mantyniemi@fimnet.fi
authors.forename: Anne
authors.initials: A
authors.lastname: Mäntyniemi
authors.forename: Tuula
authors.initials: T
authors.lastname: Oksanen
authors.forename: Paula
authors.initials: P
authors.lastname: Salo
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
authors.forename: Noora
authors.initials: N
authors.lastname: Sjösten
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
mesh_terms: D000293:Adolescent; D000328:Adult; D003327:Coronary Disease / Q000209:etiology* / Q000523:psychology; D003863:Depression / Q000209:etiology* / Q000523:psychology; D006233:Persons with Disabilities / Q000523:psychology*; D004651:Employment / Q000523:psychology; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000209:etiology* / Q000523:psychology; D009784:Occupational Diseases / Q000209:etiology / Q000523:psychology*; D016273:Occupational Exposure / Q000009:adverse effects; D010415:Pensions; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012179:Retirement; D012307:Risk Factors; D012737:Sex Factors; D013315:Stress, Psychological / Q000150:complications*; D014937:Work / Q000523:psychology*; D055815:Young Adult