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PubMed2001

[Rehabilitation and pensioning. Social network assimilates the HIV patient poorly].

For HIV patients, the social security net contains considerable gaps; for example, more than one-half of the unemployed patients under 55 receive no pension; in the case of those who go on to develop AIDS, the figure is 30%. Apparently, recognition of inability to work depends on the severity of the disability. Nor does the statutory regulation of rehabilitation measures do justice to those infected with HIV. Despite their higher morbidity, they are under-represented by a factor of 10 in comparison with the average in the general population when it comes to medical rehabilitation. While formerly, the HIV-infected were granted a disablement pension relatively quickly, today the pension insurance carriers appear to be adopting a more restrictive attitude, and often grant a pension for only a limited period. Furthermore, the legislation took effect at the beginning of 2001, has also made early pensioning more difficult.

Disability Evaluation↗
PubMed2002

[Intergenerational relations and intragenerational conditions. Observations from the viewpoint of statutory pension insurance].

The future development of all German pension systems will be determined by decisive challenges. The demographic development, the increasing number and length of interruptions of the employment period and the change in the distribution of functions in partnerships are just three aspects. The statutory pension insurance organizes the relationship between the generations as well as the balancing within one generation. The structure of statutory pension insurance must guarantee a fair equalization of burdens in both regards. The following article describes the challenges and the contribution of statutory pension insurance to stable social relationships.

Aged↗
PubMed2005

[Upgrade, expand, systematize--an analysis of the status of, the need for reform in, as well as innovative projects for follow-up care in rehabilitation under the German pension insurance scheme].

Rehabilitation benefits provided under the German Pension Insurance scheme are of central importance to insureds, in terms of protection in cases of loss or reduction of their earning capacity. Due to this safeguarding effect for the gainfully employed population, rehabilitation benefits at the same time are important to the insured community and to society as a whole. In 2003, some 846 000 insured persons had received medical and other benefits for rehabilitation. Designing these benefits to be as effective as possible is among the pre-eminent goals of the statutory pension insurance scheme. To this end, the statutory pension insurance institutes have initiated a quality assurance programme designed to enable utmost quality of the benefits provided. This programme in the first line covers inpatient medical rehabilitation of, as a rule, three weeks duration. An issue hardly investigated so far is sustainability of the effects achieved by these rehabilitation measures. Among the possibilities for ensuring lasting success are follow-up measures or benefits arranged for already during the in-patient stay, a service field which until recently had hardly been known in Germany. A stock-taking carried out in 2004 by the author and supported by LVA Schleswig-Holstein, a regional pension insurance institute, has for the first time realized an overview of this kind. Its essential findings are presented in this article, supplemented by a partial update vis-à-vis completion of the initial investigation.

Disability Evaluation↗
PubMed2004

Disqualified for disability pension--a case/referent study.

OBJECTIVES: To analyse medical and other determinants for decisions about rejection or acceptance of applications for disability pension. METHODS: A register-based retrospective case-control study was carried out in the area of a county in mid-Sweden. Cases were all individuals rejected a full disability pension 1999-2000, in all 99 cases. Controls were every tenth person granted a full disability pension during the same period, 198 individuals. Determinants were recorded from the protocols at the Social Insurance Office. RESULTS: Unemployment (OR=7.1, CI=3.1 - 16.4), living in the main municipality, (OR=2.8, CI=1.4 - 5.8) and age below 50 years (OR=0.4, CI=0.2 - 0.8) were determinants for rejection of disability pension. Medical status, as described in the Social Insurance act, had no association with the outcome. CONCLUSIONS: There appear to be variations in praxis of rejection of applicants between Social Insurance boards in different geographical areas due to reasons other than medical. Socio-economic situation of the applicant may have an influence. Established criteria for determining work ability are needed.

Age Factors↗
PubMed2006

Health, quality of life, social network and use of health care: a comparison between those granted and those not granted disability pensions.

PURPOSE: The aim was to compare self-rated health, health-related quality of life (HRQoL), social networks and health care utilisation of those granted disability pension (DP) and those not granted disability pension (nDP). METHOD: Demographic data and medical diagnoses were obtained from the records of the social insurance office. Data concerning self-reported health, HRQoL social networks, and use of health care were collected by a postal questionnaire. The nDP group included all those not granted full DPs between 1999 and 2000 (n = 99). The DP group were a random sample of those granted full DPs, during the same period (n = 197). RESULTS: The nDP group had more often multiple diagnoses, and lower self-reported health and HRQoL compared to those granted DP. In particular, their average scores were lower on the SF-36 scales social functioning, role limitations due to physical problems and mental health. The nDP group also had significantly smaller social networks. CONCLUSIONS: Contrary to expectations, those not granted a disability pension do not seem to have better health, but rather to suffer from more sickness than those who were granted a disability pension.

Adult↗
PubMed2002

An explorative, population-based study of female disability pensioners: the role of childhood conditions and alcohol abuse/dependence.

AIMS: This study investigates the association in women between conditions during childhood and adolescence and alcohol dependence or abuse in adulthood on the one hand, and disability pensions and long-term sickness absence on the other. METHODS: A stratified population-based sample of women in Göteborg was interviewed. For analyses in this study the following variables were selected from the interview protocol: childhood and adolescence, education, employment, social class, self-rated physical health and alcohol dependence or abuse (ADA), with diagnoses assessed according to DSM-III-R. Information on disability pension and sickness absence was obtained from the local Social Insurance Office. RESULTS: Unfavourable conditions during childhood and adolescence and school difficulties as well as early deviant behaviours predicted disability pension and long-term sickness absence in adulthood. For most risk factors ADA could explain only a minor part of the odds ratios found in crude and age-adjusted analyses. CONCLUSION: It is concluded that conditions early in life are predictors in women of disability pension and long-term incapacity to work. There are similarities in the pattern of early risk factors for later alcohol dependence or abuse and for disability pension/long-term sickness absence.

Adult↗
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

Variations in the risk of disability pension in Norway 1970-99. A gender-specific age-period-cohort analysis.

AIMS: A study was undertaken to investigate whether cohort or period effects could explain the varying and generally increasing incidence of disability pension in Norway between 1970 and 1999. METHODS: The study used data from a complete national register of new disability cases in Norway, including all cases of disability pension in the 16-60 age group categorized according to age and gender for each year from 1970 to 1999. The population at risk was defined for each year from census data and number of individuals already receiving disability pension. Data were organized in five-year age groups, five-year time periods and corresponding overlapping nine-year birth cohorts. Age- and gender-specific rates were displayed graphically for periods and cohorts. Separate Poisson regression models were fitted for age periods and age cohorts. Finally a combined age, period, and cohort model was applied. RESULTS: The overall incidence was 7.4/1,000 non-disabled persons per year for women and 6.0/1,000 for men. For women 52.1% of the cases were in the 51-60 age group, whereas the corresponding figure for men was 57.6%. Statistical analysis showed an increasing trend for both genders, more pronounced for women than men. All time periods deviated significantly from the trend, either upwards or downwards. Age-cohort models showed less variation, but recent cohorts had higher than expected rates, especially for men. CONCLUSIONS: Further studies should investigate why Norwegian women were more affected by the period effects than men. An increasing incidence of disability pension among recent cohorts is a major challenge for the Norwegian welfare system.

Adolescent↗
PubMed1995

A study of disability pensions in Spain (1971-1987).

In the region of Murcia (in the south-east of Spain), which has one million inhabitants, the prevalence rate of severe disability pensions, 68.92 per 1000, is much higher than that of old-age pensions, 43.50 per 1000, the reverse of what is seen in Spain in general. The administrative procedure followed in order to obtain a severe disability pension has been studied with the aim of identifying the nature of its components. A random sample of 1948 case records has been analysed from the overall number of 98,485 requests arising between 1971 and 1987. The average annual rate of disability applications was 5.4 per 1000 inhabitants, increasing with time from 1971 to 1982, and decreasing from 1983 onwards due to the creation and functioning of a new official controlling body. In the great majority of cases, 89.5%, the evaluating commission gave a disability pension, mainly at the higher grade ('total disability') until 1982 and at an inferior grade ('severe disability') from 1983 onwards. Those applicants working in hotel services, domestic services and so on, mainly women, had the highest rates of disability applications.

Adult↗
PubMed1995

A cohort study of disability pensioning among Norwegian painters, construction workers, and workers in food processing.

The debate on the potentially adverse effects of long-term occupational exposure to organic solvents has mainly been based on observations in cross-sectional studies. We present results from a retrospective cohort study of three cohorts: 11,542 industrial and house painters, 36,899 construction workers, and 9,314 workers in food processing, all identified by the 1970 Norwegian census. The cohorts were followed to the end of 1987 for registration of disability pensioning by linkage of the census files to the files of the National Insurance Administration. The analysis revealed an increased risk for disability pensioning due to neurosis among the painters, compared with construction workers (rate ratio = 1.62; 95% confidence interval = 1.36-1.93) and compared with the workers in food processing (rate ratio = 1.84; 95% confidence interval = 1.42-2.38). The painters were also at increased risk of disability pensioning due to alcoholism. We found no major differences in ischemic heart diseases, disability pensioning due to all causes, or overall mortality. These results support the hypothesis that occupational exposure to organic solvents is a risk factor for disabling effects on the central nervous system.

Adult↗
PubMedDate not supplied

Disability pensions for epilepsy with or without mental retardation: a 15-year Swedish survey.

The disability pensions of the Swedish National Social Insurance Board to persons with epilepsy from January 1, 1971 to December 31, 1985 were studied. On the latter date 6,658 individuals in the register were receiving disability pensions. This corresponds to an age-specific prevalence (16-64 years) of 1.2 per 1,000. Female and male patients were about equally represented. Four diagnostic categories were specified: I: 34% with epilepsy as the main diagnosis; II: 43% with epilepsy as a complementary diagnosis; III: 4% with epilepsy as a main and mental retardation (MR) as a complementary diagnosis; and IV: 19% with MR as a main and epilepsy as a complementary diagnosis. Overall 43% had both epilepsy and MR. The crude prevalence per county ranged from 0.25 to 1.23 per 1,000. Age on entry was 1.8-63.8 (mean, 36.7) years, and pension duration was 0.1-15 (mean, 7.4) years. Mean age on prevalence day was 43.9 years. During the 15-year period annual pension costs were 20-380 million Swedish kronor (SEK) ($3-60 million), and the total costs were 2,370 million SEK ($365 million). Adjusted to 1989, the costs would be 84-463 million SEK ($13-71 million) and 4,258 million SEK ($655 million), respectively.

Adolescent↗
PubMed1983

Predictors of the outcome of disability pension for alcohol abusers.

A multi-variate multiple regression analysis was carried out to screen the crucial characteristics of alcohol abusers immediately prior to pension in order to indicate their subsequent trends. Stepwise multiple regression analyses were performed in the younger and older subgroups, as well as in 56 first-time pension applicants, in a region of the county of Ostergötland in Sweden. In the analyses, changes, over a 2-year interval, of composite scores on overall well-being, psychiatric status, need satisfaction and intellectual capacity, together with changes in alcohol consumption and gamma-GT-value, functioned as dependent variables. Eighty-five parameters of the abusers' quality of life at pension served as independent variables. The features that were seen, in various constellations, to be significantly related to non-improvement rather than to improvement were: an abrupt change-over from a previously active life, longer education, middle age, tendencies to passivity and to social confinement, worse observed psychiatric status in contrast to less bad reported status, relatively better self-rated well-being, remaining intellectual resources, black-outs, a lower current alcohol consumption, lower gamma-GT, S-NAP, S-ALAT- and S-protein-values together with more elevated P-IgA, P-ALP-, S-creatinine- and S-Ca-corrected values. The results are discussed with reference to their general applicability, plausible mechanisms in a pension situation, previously launched hypotheses, and the methodological limitations of the study. It is concluded that a literal application of the results in practice must be made with caution.

Adult↗
PubMed2005

Sense of coherence and disability pensions. A nationwide, register based prospective population study of 2196 adult Finns.

BACKGROUND: Strong sense of coherence (SOC) has been shown to be associated with good, perceived health both in cross sectional and longitudinal studies. STUDY OBJECTIVE: To find out if level of SOC was associated to incidence of disability pension. STUDY DESIGN: A prospective cohort study based on survey data on sense of coherence in 1989 or 1993 and data on disability pensions in 1990-1996 from national registers. PARTICIPANTS: 2196 identifiable subjects derived from a representative sample (n = 5000) in 1989 of male and female Finns between 15 and 64 years of age. Initial health was categorised on the basis of number of long term illnesses reported on entry into the study (no illnesses; one illness or several illnesses resulting in only mild or moderate functional limitation; one illness or several illnesses resulting in severe or very severe functional limitation). MAIN RESULTS: In an interindividual comparison a decrease in initial SOC score by one point was significantly (hazard ratio 1.56, 95% confidence intervals 1.15 to 2.12) associated with receipt of a disability pension by subjects who had been 50 years of age or less on entry into the study. Sex was not associated with outcome once initial level of health, level of occupational training, level of engagement in physical exercise, and alcohol consumption were taken into consideration. No similar significant association was seen in relation to people who had been more than 50 years of age on entry into the study. CONCLUSIONS: It seems probable that a weak SOC in people of 50 years or younger increases the likelihood of grant of a disability pension.

Adaptation, Psychological↗
PubMed1999

Longitudinal, population-based study of self reported alcohol habits, high levels of sickness absence, and disability pensions.

STUDY OBJECTIVE: To analyse the relation between self reported hazardous drinking on the one hand and high sickness absence and/or disability pensions in both sexes on the other hand. DESIGN: The study is based on data from a health survey, Stockholm Health of the Population Study, conducted in 1984. The mailed questionnaire covered alcohol consumption. Three different measures of alcohol habits were used: usual alcohol consumption, consumption during the previous week, and answers to the four CAGE questions on problem drinking. Information from the health survey and data from a subsequent health examination were related to information from the National Swedish Social Insurance Board for the year 1984 and the years 1986 to 1991 concerning sick leave and disability pensioning. SETTING: Four primary health care districts in Stockholm County. PARTICIPANTS: The study group included persons who were aged 20 to 52 years in 1984, who answered the questionnaire (by mail or by telephone), and who participated in the health examination. The study group comprised 985 women and 870 men fulfilling the criteria for inclusion out of 6217 subjects aged 18 years and over randomly drawn. MAIN RESULTS: In both sexes, a consistent pattern of increased sickness absence was seen for high consumers and for those with indications of problem drinking. In most comparisons, a clearly increased relative risk, although not always statistically significant, for an average of at least 60 sick days per year or for a disability pension during follow up was found. In multivariate analysis, controlling for age, socioeconomic group, smoking habits, and self reported health, a small reduction in the relative risks was found, suggesting that these factors could explain only a small part of the relative risks. The risks for abstainers were higher than for low and moderate consumers. CONCLUSIONS: The effects of alcohol on subsequent high levels of sickness absence five to seven years after baseline as well as on the occurrence of disability pensions suggested that there is an effect on working incapacity independent of baseline health status, smoking, and socioeconomic group.

Adult↗
PubMed1982

The incidence of disability pensions and mortality among semi-skilled construction workers in Copenhagen. A retrospective cohort study with two control groups.

The aim of the present study was to discover whether the incidence of disability pensions and mortality was higher amongst semi-skilled construction workers (SCW) in Copenhagen than in two control groups from the same geographic area. The population investigated consisted of a fixed cohort of 3537 SCW from Copenhagen as per 1/5/1975. The two control groups comprised 3818 Copenhagen members of the Warehouse Workers' union and a group of Copenhagen members of the Semi-skilled Worker's Union age-matched to the SCW cohort, both as per 1/5/75. Up to 31/12/79, a total of 102 SCW were granted disability pensions, compared with 89 and 77 in the two control groups respectively, i.e. a significantly higher frequency of award of disability pension among SCW than among warehouse workers (p less than 0.05). This was due especially to a higher frequency of disability pensions granted because of musculoskeletal diseases and cancer in SCW. The number of deaths was recorded from 1/5/75 to 30/11/78. No differences in overall mortality were found among the three groups, although slightly fewer deaths from lung cancer and ischaemic heart diseases and more suicides were observed among the construction workers. Selection bias and the effect of the working environment are discussed against the background of a concurrent investigation of the state of health and working conditions of SCW.

Adult↗
PubMed1987

Middle-aged men before and after disability pension. Health screening profile with special emphasis on alcohol consumption.

A total of 5,950 male Malmö residents (from five cohorts, 1926-30) were health screened on two occasions, with an interval of 4-8 years. Disability pensions were granted to 215, of whom 123 were screened both before and after being pensioned. Those 123 constitute the study group reported on here. Among answers to the questionnaire, back and joint pain were the most common complaints mentioned. However, the most striking distinction between the study group and controls was the values of gamma-GT (gamma glutamyltransferase), indicating overconsumption of alcohol in the group of prospective pensioners. Complaints concerning the back were also an outstanding feature of those belonging to the highest deciles of gamma-GT after--but not before--the disability pension had been granted.

Alcohol Drinking↗
PubMed1994

Immigration and socio-economy as predictors of early retirement pensions.

The purpose of this study, performed in a Swedish municipality, was to obtain a view of early retirement pensioners, focusing on immigration and socio-economy as predictors of early retirement pensions. A questionnaire was sent to 453 early retirement pensioners with disorders of the musculoskeletal system. A corresponding questionnaire was sent to a randomly selected, age- and sex-matched control group of the same size. The response rate was 83%. The study concludes that immigration and low socio-economy are predictors of early retirement pension (ERP). The rate of immigrants was 19% among the ERPs compared to 5% among the controls. The early retired immigrants were comparatively young, and some of them were overqualified for their previous jobs. Of the ERPs 74% were blue-collar workers compared to 39% of the controls. Neither work satisfaction nor unemployment was found to predict ERP.

Adult↗
PubMed1998

Discrimination and pension income among aging women.

Using data from the National Longitudinal Survey of Labor Market Experience, Mature Women's Cohort, this study examined the extent to which discrimination influenced pension receipt and levels of pension income among women aged 55-69 in 1992. It found that discrimination affected the level of pension income beyond that of demographic and human capital variables, when controlling for wage-related income, only among moderate-to-affluent near-elderly women. No relation was found between discrimination and receipt of pension income.

Aged↗