title: Effort-reward imbalance as a risk factor for disability pension: the Finnish Public Sector Study.
abstract: OBJECTIVE
  Job strain has previously been shown to predict disability pension, but it is unknown whether effort-reward imbalance (ERI), another major stress model, is also associated with disability pension.
  
  
  METHODS
  We examined ERI as a risk factor for diagnosis-specific disability pension in a cohort of 51 874 public-sector employees in Finland. To control for reporting bias, work unit-level scores of ERI (based on the survey responses of 35 260 employees in 2000-2002) were constructed and linked to all eligible employees. A sub-cohort of the respondents was analyzed also with individual-level ERI. Disability pension data were derived from national pension registers with no loss to follow-up. The outcomes were all-cause disability pension and disability pension due to depression, musculoskeletal diseases, and ischemic heart diseases (IHD). Multivariate Cox proportional hazard models (adjusted for sociodemographic factors, baseline health, and work-related characteristics) were used for analyses.
  
  
  RESULTS
  During a mean 8.9 years of follow-up, 4542 participants were granted disability pension. An increased risk for disability pension due to depression was detected for both high work unit- and individual-level ERI [hazard ratio (HR) 1.63, 95% confidence interval (95% CI) 1.31-2.04 and HR 1.90, 95% CI 1.51-2.40, respectively]. High individual-level ERI increased the risk of disability pension due to musculoskeletal diseases (HR 1.32, 95% CI 1.13-1.53), but no association was observed for work unit-level ERI (HR 1.02, 95% CI 0.88-1.19). ERI was not associated with disability pension due to IHD.
  
  
  CONCLUSIONS
  The present study showed a consistent association between high ERI and an increased risk of disability pension due to depression.
authors.affiliation: Federation of Municipalities for Social and Health Services, Occupational Health Care Unit of Vihti, Ritalantie 4 E 6, 03100 Nummela, Finland. anne.juvani@fimnet.fi.
authors.forename: Anne
authors.initials: A
authors.lastname: Juvani
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: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
mesh_terms: D000328:Adult; D015331:Cohort Studies; D006233:Persons with Disabilities; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D010415:Pensions; D016016:Proportional Hazards Models; D017150:Public Sector; D012201:Reward; D012307:Risk Factors