title: Health- and work-related predictors of work disability among employees with a cardiometabolic disease--A cohort study.
abstract: OBJECTIVE
  The proportion of aging employees with cardiometabolic diseases, such as heart or cerebrovascular disease, diabetes and chronic hypertension is on the rise. We explored the extent to which health- and work-related factors were associated with the risk of disability pension among individuals with such cardiometabolic disease.
  
  
  METHODS
  A cohort of 4798 employees with and 9716 employees without a cardiometabolic disease were followed up for 7years (2005-2011) for disability pension. For these participants, register and survey data (from 2004) were linked to records on disability pensions. Cox proportional hazards modeling was used for estimating the hazard ratios (HR) with 95% confidence intervals (CI).
  
  
  RESULTS
  Individuals with heart or cerebrovascular disease had 2.88-fold (95% CI=2.50-3.31) higher risk of all-cause disability pension compared to employees with no cardiometabolic disease. Diabetes was associated with a 1.84-fold (95% CI=1.52-2.23) and hypertension a 1.50-fold (95% CI=1.31-1.72) increased risk of disability pension. Obesity in cases of diabetes and hypertension (15%) and psychological distress in cases of heart or cerebrovascular disease (9%) were the strongest contributing factors. All 12 health- and work-related risk factors investigated accounted for 24% of the excess work disability in hypertension, 28% in diabetes, and 11% in heart or cerebrovascular disease. Cause-specific analyses (disability pension due to mental, musculoskeletal and circulatory system diseases) yielded similar results.
  
  
  CONCLUSIONS
  In this study, modifiable risk factors, such as obesity and mental comorbidity, predicted permanent exit from the labor market due to disability in individuals with cardiometabolic disease.
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland. Electronic address: jenni.ervasti@ttl.fi.
authors.forename: Jenni
authors.initials: J
authors.lastname: Ervasti
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, UK; Clinicum, Faculty of Medicine, University of Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland; Department of Psychology, University of Turku, Finland.
authors.forename: Paula
authors.initials: P
authors.lastname: Salo
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Tuula
authors.initials: T
authors.lastname: Oksanen
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland; Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D002908:Chronic Disease; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004651:Employment; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D016017:Odds Ratio; D010415:Pensions; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D014937:Work; D017132:Workplace / Q000523:psychology*
keywords: Cerebrovascular disease; Diabetes; Heart disease; Obesity; Psychological distress; Stage 2 hypertension