The joint contribution of diabetes and work disability to premature death during working age: a population-based study in Sweden.
OBJECTIVE
We aimed to examine how newly diagnosed diabetes and work disability jointly predict death during working age.


METHODS
We used prospective population-based register data of 25-59-year-old adults who had lived in Sweden since 2002. All those with onset of diabetes recorded in 2006 were included (n=14266). A 2% random sample (n=78598) was drawn from the general population, comprising people with no indication of diabetes during 2003-2010. Net days of sickness absence and disability pension in 2005-2006 were examined; the follow-up time for mortality was 2007-2010. Cox regression models were fitted (hazard ratios, HR, 95% confidence interval, CI) adjusting for sociodemographics and time-dependent health conditions.


RESULTS
Individuals with diabetes and work disability for over 6 months were at a higher risk of premature death (HR=14.2, 95% CI 12.0-16.8) than their counterparts without diabetes and work disability. A high risk was also observed among people without diabetes but equally prolonged work disability (HR=6.4, 95% CI 5.4-7.6). Diabetes was associated with premature death even without work disability (HR=3.5, 95% CI 2.8-4.4). The associations were particularly attenuated after adjustment for health conditions assessed over the follow-up.


CONCLUSIONS
DIABETES AND WORK DISABILITY JOINTLY INCREASE THE RISK OF DEATH DURING WORKING AGE DIABETES WITH LONG-TERM WORK DISABILITY IS ASSOCIATED WITH THE HIGHEST RISK OF PREMATURE DEATH, WHICH HIGHLIGHTS THE IMPORTANCE OF THEIR PREVENTION AND EARLY DETECTION.
Finnish Institute of Occupational Health, Helsinki, Finland Department of Public Health, University of Helsinki, Finland tea.lallukka@ttl.fi.
Tea
T
Lallukka
Finnish Institute of Occupational Health, Helsinki, Finland.
Jenni
J
Ervasti
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Ellenor
E
Mittendorfer-Rutz
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden Red Cross University College, Stockholm, Sweden.
Petter
P
Tinghög
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Linnea
L
Kjeldgård
Finnish Institute of Occupational Health, Helsinki, Finland.
Jaana
J
Pentti
Finnish Institute of Occupational Health, Helsinki, Finland.
Marianna
M
Virtanen
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Kristina
K
Alexanderson
D000041:Absenteeism; D000328:Adult; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D010415:Pensions / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D018582:Sick Leave / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology
Diabetes; chronic conditions; disability pension; insurance medicine; mortality; population-based; register data; sick-leave; socioeconomic; time-dependent