Ill-health retirement: national rates and updated guidance for occupational physicians

Diagnosis-specific sick leave as a risk marker for disability pension in a Swedish population

OBJECTIVE

To investigate diagnosis-specific sick leave as a risk marker for subsequent disability pension.

DESIGN

A prospective population based cohort study. Exposure to a new medically certified sick leave episode of more than seven days by diagnosis during 1985 was examined in relation to incident cause-specific disability pension through 1996.

PARTICIPANTS

The total non-retired population of one Swedish county aged 16 to 49 years, alive and not in receipt of a disability pension at the end of 1985 (176 629 persons; 51% men).

MAIN RESULTS

To eliminate confounding by sick leaves that translate into a disability pension, the follow up period for disability pension was started five years after the assessment of sick leave. After adjustment for demographic characteristics, the risk of disability pension from mental disorders was 14.1 times higher (95% confidence interval (CI), 12.1 to 16.4) for those with sick leave for mental disorders than for those with no sick leave. The corresponding hazard ratio for sick leave and disability pension within diagnostic category was 5.7 (95% CI, 5.3 to 6.2) for musculoskeletal diseases and 13.0 (7.7 to 21.8) for gastrointestinal diseases. Irrespective of diagnoses, the hazard ratio for sick leave and disability pension was 3.0 (2.9 to 3.1).

CONCLUSIONS

Sick leave may provide an important risk marker for identifying groups at high risk of a disability pension, especially for psychiatric diagnoses.

The effect of individual counselling and education on work ability and disability pension: a prospective intervention study in the construction industry

OBJECTIVES

To investigate the effectiveness of a counselling and education programme on work ability and work disability pension for employees in the construction industry.

METHODS

Employees with a high disability risk of 38% or more in the following four years were included. Employees in the intervention group were either selected by an occupational physician or enrolled themselves. They received an assessment and individual programme focused on optimising work functioning, while the control group received care-as-usual. Data on work ability measured with the Work Ability Index (WAI) and work disability pensions were collected at baseline during a periodic occupational health examination and at 9, 18 and 26 months after the start of the intervention using a questionnaire.

RESULTS

Most employees in both the intervention (n = 83) and control group (n = 209) were carpenters (43% and 37%) and bricklayers (7% and 15%). In the intervention group, 42% successfully completed the programme. Work ability in the intervention group was lower at baseline but showed an increase over time while work ability of the control group remained the same. The work ability in the intervention group improved slightly more (p = 0.09). No statistically significant differences in percentages of employees receiving a disability pension between the intervention and control group were found at 9 or 18 months and no differences in the age-adjusted percentages of employees receiving a disability pension were found between the groups at any measurement.

CONCLUSIONS

The programme was slightly effective in improving the work ability but not in reducing work disability pensions. A more comprehensive multidisciplinary intervention programme might be necessary.

Health-related job loss: findings from a community-based survey

AIMS

To explore the frequency, nature, determinants and outcome of health-related job loss (HRJL) in men sampled from the general population of three rural areas.

METHODS

Data on lifetime occupational history, including any HRJL, were obtained as part of a postal survey of men aged 24-70 years in three rural areas of England and Wales. Incidence rates were calculated for first health-related loss of a job that had been held for >or=1 year. Associations with risk factors were examined by Poisson regression, and by application of conditional logistic regression in a nested case-control study.

RESULTS

HRJL was reported by 1408 (13%) of the 10 559 men who had held long-term jobs. The incidence rose steeply with age for cardiorespiratory and neurological disorders, but for accidents and poisoning the trend was, if anything, in the reverse direction. An increase in incidence over time was most marked for musculoskeletal disorders and mental illness, and much less prominent for cardiorespiratory and neurological disease. In comparison with other occupations, the risk was lower in agricultural workers (odds ratio (OR) 0.6, 95% CI 0.5 to 0.8), and higher in policemen (OR 2.4, 95% CI 1.6 to 3.7) and teachers (OR 2.0, 95% CI 1.5 to 2.7), this differential being even greater for HRJL caused by mental illness. Risk was also increased in employees relative to the self-employed (OR 2.0, 95% CI 1.7 to 2.3). Shift work was associated with a higher incidence of job loss caused by mental illness (OR 1.5, 95%CI 1.1-2.2), and heavy lifting with HRJL caused by musculoskeletal disorders (OR 2.6, 95% CI 2.0 to 3.5). After HRJL, 61% of subjects had subsequently obtained further long-term employment, usually within 1 year.

CONCLUSIONS

In the population studied, HRJL has become increasingly common, especially in relation to musculoskeletal disorders and mental illness. In addition to being associated with ergonomic stresses in the workplace, it may be importantly influenced by cultural and economic factors. Future research should focus on the minority of workers who leave a job for health reasons and do not rapidly return to further work.

Return to work after ill-health retirement in Scottish NHS staff and teachers

BACKGROUND

Most major public and private sector pension schemes have provision for ill-health retirement (IHR) for those who become too ill to continue to work before their normal retirement age.

AIM

To compare the causes, process and outcomes of IHR in teachers and National Health Service (NHS) staff in Scotland.

METHODS

A total of 537 teachers and 863 NHS staff who retired due to ill-health between April 1998 and March 2000 were mailed an IHR questionnaire by the Scottish Public Pensions Agency.

RESULTS

The response rate for teachers was 53% and for NHS staff 49%. The most common cause of IHR was musculoskeletal disorders for NHS staff and mental disorders for teachers. Teachers retired at a younger average age than NHS staff. Ninety-two per cent of NHS staff but only 11% of teachers attended occupational health services (OHS) prior to IHR. Eighteen per cent of NHS staff and 9% of teachers were offered part-time work by their current employer in response to their ill-health. Fifteen per cent of NHS staff and 5% of teachers were offered alternative work prior to retirement. Seventeen per cent of NHS staff and 36% of teachers subsequently found employment. Multiple logistic regression analyses showed the following variables as independent predictors of subsequent employment: occupational group, age group, sex, managerial responsibility and cause of IHR.

CONCLUSIONS

Return to work after IHR suggests that some IHR could be avoided. Teachers had a higher rate of return to work and much less access to OHS.