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PubMed1990

[Performance spectrum in occupational disability. Causes--occupational groups--age--duration of insurance].

The causes of disability were elaborated in an extensive study. Accidents, coronary heart disease, diseases of the spine, and orthopedic diseases are the four most common diagnoses and account together for 52.4% of all cases of disability. The incidence of other even rarer diagnoses was shown. The average ages differ from diagnosis to diagnosis. While the average of all cases is at age 45.5 years for the beginning of disability and 9.8 years for the duration period there are diagnoses that lead to disability at an earlier age and after a shorter duration period such as for instance schizophrenia, inflammatory bowel diseases, allergies and skin affections. Heart and circulatory diseases and depressions on the other side occur at a later age and after a longer duration period. At the evaluation of risks special attention should be paid to those causes of early disability since they can turn into a claim after a short duration period and therefore can cause great subsequent costs. Some general statements can be made about occupational groups and causes of disability. Diseases of heart and circulation are rarer in physically active occupations such as construction, agriculture, and industry than in white collar workers and liberal professions. On the other side orthopedic diseases and accidents occur more frequently in construction, industry and agriculture. White collar workers tend to have more psychiatric problems which can be explained with a higher potential of conflicts at work.

Adult↗
PubMed2005

[Medical insurance focus on sports disabilities: the knee joint].

This retrospective epidemiological study analyzes the distribution of sports invalidism in Berlin and Brandenburg in a period of four years, based on the data material of the German Lloyd sports insurance company and medical expert opinions. Over 600 cases occurred in a period of four years in more than 40 types of sports disciplines; most of them were registered in soccer (57%), followed by handball (13%), volleyball (4%) and judo (4%). Most of disablements were found during competition (63%). Most of incapacities were concerned with the knee joint (48%).

Age Distribution↗
PubMed2002

Access to community-based long-term care: Medicaid's role.

OBJECTIVE: The authors explore state variation in expenditures for Medicaid community-based care services for the period 1990 to 1997. METHOD: A random effects panel model is used to explore the relationship between state demographic, supply, economic, programmatic, and political factors and states' Medicaid community-based care expenditures. RESULTS: Although states increased provision of services over the study period, significant state-level variation was evident. Expenditures were positively associated with state per capita income, regulation of nursing home bed supply, and the number of Medicare home health users but were negatively related to nursing home bed supply. CONCLUSIONS: Recent legal rulings, combined with the demonstrated preferences of most individuals to receive care in the community, require policies to foster the expansion of Medicaid community-based care. The most consistent relationships that are amenable to policy intervention relate to state fiscal resources and long-term care supply regulation.

Aged↗
PubMed2003

Special issues for younger Medicare beneficiaries with disabilities.

While most people know that older Americans are eligible for Medicare and Social Security retirement benefits at age 65, many do not know that people with disabilities under age 65 can also be covered by Medicare. In this brief we focus on how people with disabilities qualify for Medicare and how their Medicare benefits coordinate with other types of health benefits they may have.

Adult↗
PubMed1990

Disability adjudication and the insurance medical director.

In short, medical risk management can be a key strategy for medical directors. Its effective implementation, particularly in the claims area but also at the front end in product design and at the risk selection stage, can result in a major positive financial impact for the company.

Disability Evaluation↗
PubMed2004

Risk factors for disability pension over 11 years in a cohort of young persons initially sick-listed with low back, neck, or shoulder diagnoses.

AIM: A study was undertaken to ascertain whether the differences in risk in relation to gender and citizenship observed in a previous study of the same cohort would remain if more recent data on sickness absence were used. METHODS: This was an 11-year prospective population-based cohort study. The dataset includes all individuals in a Swedish city who, in 1985, were aged 25-34 and had a sick-leave spell > or = 28 days with neck, shoulder, or back diagnoses (n=213). The data covered the following: for 1985-96, disability pension, emigration, and death; for 1982-96, sickness absence; for 1985, sex and citizenship. The data were subjected to Cox regression analyses with a time-dependent covariate. RESULTS: Disability pension was granted to 22% (n=46) of the cohort. The relative risk for disability pension increased by 9.3 with each sick-leave spell > or = 90 days during the two previous years. The risk was higher for women than men, and also higher for foreign citizens than Swedes. CONCLUSION: Many studies have revealed a gender difference in the risk of being on disability pension, and it was found that this difference was still apparent when sick leave during the follow-up period is taken into account. Thus, the reason for the gender differences ought to be found among other factors than prior levels of sickness absence.

Cohort Studies↗
PubMed2004

Predictors of disability pension in long-term sickness absence: results from a population-based and prospective study in Norway 1994-1999.

BACKGROUND: While several socio-demographic predictors of disability pension (DP) have been identified, less is known about the importance of the medical aspects. METHODS: A representative sample of Norwegian long-term sickness absentees, 2043 women and 1585 men, with detailed diagnostic information based on the International Classification of Primary Care (ICPC) was followed up for 5 years. The date of granting DP was obtained from the Norwegian DP-register and used as the dependent variable in Cox multivariate regression analysis. Medical and socio-demographic factors were entered as explanatory variables. RESULTS: Kaplan-Meier estimates of the 5 year risk of DP were 22.9% for the full sample, 22.5% for men and 23.3% for the women. Men on sick leave for mental health disorders had an increased disability risk. Except for pregnancy-related cases, which carried a very low risk for future DP, there was no significant difference between the main diagnostic groups among women. Previous sickness absence increased the disability risk but was significant only for total absence above 20 weeks in the 4 years preceding inclusion. Age was the strongest predictor of future DP. Increasing income decreased the risk, bur not linearly. Unemployment status in the year preceding inclusion increased disability risk for women, but not for men. Among cases with musculoskeletal disorders (54.5% of the sample), subgroups with different disability risks were identified in Cox' regression analysis, with a gender-specific pattern. CONCLUSION: In addition to previously known socio-demographic predictors, medical variables were important in identifying sickness absentees with an increased risk of DP.

Adolescent↗
PubMed2000

Trends in sickness benefits in Great Britain and the contribution of mental disorders.

BACKGROUND: Government benefits paid to those unfit for work or the work market as a result of ill health have been rising dramatically in Great Britain, in parallel with increases throughout Europe and North America. Psychological conditions are known to be an important cause of sickness absence. This study set out to examine trends in government sickness and invalidity benefits in Britain between April 1984 and April 1995. The importance of mental disorders as a cause of 'incapacity' (the condition for which benefits are paid) was examined. METHODS: Data from the Department of Social Security were used to chart trends in incapacity according to gender, age group, employment category and cause. An exploratory ecological analysis of associations between regional rates of incapacity and socio-economic and health indices was also undertaken using correlation analysis and multiple regression. RESULTS: Steadily increasing rates of incapacity were observed, primarily reflecting increases in the longer-term 'invalidity' benefit. The non-employed made up a rising proportion of recipients. Regional incapacity rate was most strongly associated with socio-economic factors, particularly social class. Mental disorders were the second most numerous causal category and consisted mainly of milder conditions, namely depressive and neurotic disorders. CONCLUSION: The dramatic increase in incapacity benefits is unlikely to be attributable to changes in population size or structure. It contrasts with improvements in the objective health status of the population. Mental disorders, and particularly milder conditions, account for a substantial and increasing amount of incapacity. The data are consistent with the hypothesis that sickness benefits increasingly represent disguised unemployment.

Absenteeism↗
PubMed1999

Risk factors for disability pension among unemployed women on long-term sick-leave.

BACKGROUND: In 1996 some 520,000 people (13% of Sweden's working force) were either long-term sick-listed or on disability pensions. To reintroduce sick and injured people to the workforce, vocational rehabilitation has received increasing emphasis. Unemployed women seem particularly difficult to rehabilitate. One explanation could be that unemployed women have more complex problems than others; another could concern the selection of cases for vocational rehabilitation programmes. AIM: The primary aim of this study was to test the hypothesis that unemployed women on sick-leave have more severe problems than others. A second purpose was to investigate whether the manner of selection for vocational rehabilitation programmes is different for unemployed women than for others. MATERIAL AND METHOD: The study analysed 364 registered long-term sick-leave cases (90 days or more) initiated during 1992-1994 in the city of Stockholm, Sweden. RESULT: Our hypothesis was supported by the study. Unemployed women were exposed to more risk factors than unemployed men or employed men and women. Regarding the selection of cases for rehabilitation, no difference was present between unemployed women and others. A finding, however not statistically significant, was that people in vocational rehabilitation, regardless of sex and employment status, were less exposed to risk factors than people not undergoing rehabilitation.

Persons with Disabilities↗