title: Cigarette smoking and alcohol use as predictors of disability retirement: A population-based cohort study.
abstract: BACKGROUND
  This study investigated how cigarette smoking and alcohol use predict disability retirement.
  
  
  METHODS
  Data from the longitudinal nationwide Finnish Twin Cohort study were analyzed, with clustered study design applied when computing 95% confidence intervals (CI). The sample included 21,719 individuals. Smoking and alcohol use were assessed with a questionnaire in 1975. Registry data on retirement events up till end of 2004 were obtained from the Social Insurance Institution and the Finnish Centre for Pensions.
  
  
  RESULTS
  Disability pension was granted to 4251 participants. Among men, adjusted for age and alcohol use, former (HR=1.45, 95%CI 1.28, 1.65, p<.001) and daily smokers (HR=1.93, 95%CI 1.71, 2.17, p<.001) showed elevated disability pension risk compared to never smokers. Among women, daily smokers (HR=1.25, 95%CI 1.11, 1.40, <.001) had elevated risk. The age and smoking adjusted risk estimates for alcohol were elevated among abstainers (men HR=1.41, 95%CI 1.21, 1.65, p<.001; women HR=1.36, 95%CI 1.23, 1.52, p<.001) and heavy drinkers (men HR=1.30, 95%CI 1.18, 1.43, p<.001; women HR=1.34, 95%CI 1.04, 1.72, p=.026). Those being persistent smokers and binge drinkers had over three-fold disability risk compared to those who were binge drinkers but had only a few smoking years (men: HR=3.32, 95%CI 2.43, 4.54, p<.001; women: HR=4.05, 95%CI 2.05, 8.00, p<.001). Among men and women who were not binge drinkers, longer smoking duration was needed for elevated disability risk.
  
  
  CONCLUSIONS
  Both smoking and excess alcohol use significantly predict disability retirement. In order to extend working careers, more attention should be paid to health behaviors, in addition to working conditions.
authors: Department of Public Health, University of Helsinki, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; National Institute for Health and Welfare, Helsinki, Finland. Electronic address: tellervo.korhonen@helsinki.fi.
authors: Tellervo
authors: T
authors: Korhonen
authors: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors: Eero
authors: E
authors: Smeds
authors: Department of Social Research, University of Helsinki, Helsinki, Finland.
authors: Karri
authors: K
authors: Silventoinen
authors: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors: Kauko
authors: K
authors: Heikkilä
authors: Department of Public Health, University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland; Institute for Molecular Medicine Finland FIMM, Helsinki, Finland.
authors: Jaakko
authors: J
authors: Kaprio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000523:psychology / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010415:Pensions / Q000706:statistics & numerical data; D012042:Registries; D012179:Retirement / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D055815:Young Adult
keywords: Alcohol; Disability; Pension; Smoking