title: Small for gestational age and adulthood risk of disability pension: the contribution of childhood and adulthood conditions.
abstract: Early exiting from the labor force and into disability pension (DP) represents a major social problem in Sweden and elsewhere. We examined how being asymmetric (A-SGA) or symmetric (S-SGA) small for gestational age predicts transitioning into DP. We analyzed a longitudinal sample of 8125 men and women from the Stockholm Birth Cohort (SBC), born in 1953 and not on DP in 1990. The SBC consists of data from various sources, including self-reported information and data from administrative registers. The follow-up period was from 1991 to 2009. Yearly information on the receipt of DP benefits from register data was operationalized as a dichotomous variable. 13 percent of the sample moved into DP during follow-up. Cox proportional hazards regression was used to examine whether disadvantageous fetal growth--A-SGA and S-SGA--predicted DP. Men and women born A-SGA had a substantially increased hazard of DP. The full model suggested a hazard ratio of 1.68 (CI: 1.11-2.54), only being affected slightly by adulthood conditions. Several childhood conditions were also associated with DP. Such factors, however, mainly affected DP risk through adulthood conditions. The effect of SGA on DP appeared particularly strong among individuals from socioeconomically disadvantaged backgrounds. The evidence presented suggests that being A-SGA influences the risk of DP, independent of childhood and adulthood conditions, and similarly for men and women. Due to A-SGA being rather infrequent, reducing the occurrence of A-SGA would, however, only have a marginal impact on the stock of DP pensioners. For the individual affected, the elevation in the risk of DP was nevertheless substantial. Other childhood conditions exercised a larger influence on the stock of DP recipients, but they mostly operated through adulthood attainment. The importance of socioeconomic resources in childhood for the long term health consequences of SGA is interesting from a policy perspective and warrants further research.
authors.affiliation: Centre for Economic Demography, Department of Economic History, Lund University, Box 7083, 220 07 Lund, Sweden; Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, SE-106 91 Stockholm, Sweden. Electronic address: jonas.helgertz@ekh.lu.se.
authors.forename: Jonas
authors.initials: J
authors.lastname: Helgertz
authors.affiliation: Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, SE-106 91 Stockholm, Sweden. Electronic address: denny.vagero@chess.su.se.
authors.forename: Denny
authors.initials: D
authors.lastname: Vågerö
mesh_terms: D000328:Adult; D017677:Age Distribution; D049628:Body Size; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011632:Public Assistance / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology
keywords: 1991–2009; Childhood social conditions; Cox proportional hazards; Disability pension; In-utero conditions; Sweden