title: Diagnosis-specific disability pension and risk of all-cause and cause-specific mortality--a cohort study of 4.9 million inhabitants in Sweden.
abstract: BACKGROUND
  The incidence of disability pension (DP) is high in several European countries. However, knowledge on associations of cause-specific DP and premature death is limited. The aims were to: 1) investigate the association between cause-specific DP and all-cause and cause-specific mortality among women and men and 2) examine period effects of this association.
  
  
  METHODS
  Three prospective population-based cohort studies were conducted, the first including all individuals aged 16-64 years who lived in Sweden all of 1995 and who were not on DP before 1995 (N = 5,006,523, 48.8% women). Those granted DP in 1995 were compared to those not granted DP regarding mortality during 1996-2009. Two other cohorts were created in a similar fashion, for 2000 and 2005, respectively, and in comparisons each of the three cohorts were followed up for four years with regard to all-cause mortality as well as death due to cancer, circulatory disorders, or suicide. All analyses were stratified by sex and we controlled for a number of socio-demographic factors and inpatient care.
  
  
  RESULTS
  Individuals with granted DP had a higher mortality risk, women (HR 1.75; 95% CI 1.68-1.82) and men (HR 1.66; 95% CI 1.61-1.71) and highest for cancer. People on DP with some diagnoses had higher risk of premature death in other causes of death than their DP diagnoses. All-cause mortality risk varied with DP-diagnosis and was lowest for musculoskeletal diagnoses. The mortality HR decreased among women with DP between the cohort 1995, HR 2.07 (1.92-2.24) and the cohort 2005, 1.84 (1.71-1.99). Here, temporal decreases in mortality risk occurred particularly in DP due to mental diagnoses and cancer.
  
  
  CONCLUSIONS
  All DP diagnoses were associated with a higher mortality risk. Even individuals granted DP due to diagnoses with low mortality risk displayed a higher risk for premature death. This warrants close monitoring of disability pensioners and further studies on consequences of being on disability pension.
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden. charlotte.bjorkenstam@ki.se.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Björkenstam
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
authors.forename: Emma
authors.initials: E
authors.lastname: Björkenstam
authors.forename: Christina
authors.initials: C
authors.lastname: Lindholm
authors.forename: Ellenor
authors.initials: E
authors.lastname: Mittendorfer-Rutz
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D003710:Demography; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000401:mortality; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D061213:Mortality, Premature; D009140:Musculoskeletal Diseases / Q000401:mortality; D010415:Pensions / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology