Academic journal article Scandinavian Journal of Work, Environment & Health

Disability Pension Due to Musculoskeletal Diagnoses: Importance of Work-Related Factors in a Prospective Cohort Study of Finnish Twins

Academic journal article Scandinavian Journal of Work, Environment & Health

Disability Pension Due to Musculoskeletal Diagnoses: Importance of Work-Related Factors in a Prospective Cohort Study of Finnish Twins

Article excerpt

Kärkkäinen S, Pitkäniemi J, Silventoinen K, Svedberg P, Huunan-Seppälä A, Koskenvuo K, Koskenvuo M, Alexanderson K, Kaprio J, Ropponen A. Disability pension due to musculoskeletal diagnoses: importance of work-related factors in a prospective cohort study of Finnish twins. Scand J Work Environ Health. 2013;39(4):343-350. doi:10.5271/sjweh.3345

Objectives The aim of this study was to investigate the impact of work-related risk factors for future disability pension (DP) due to musculoskeletal diagnoses and for a subgroup of these, namely, DP due to osteoarthritis.

Methods For this prospective study of 16 028 Finnish twins born in 1911-1957 and employed at baseline, a postal questionnaire collected information in 1975 on work-related factors; follow-up data on DP was gathered through register linkages up to 2004. A series of proportional hazards (Cox) regression models were used to analyze the associations between work-related factors and the incidence of DP.

Results During the 30-year follow-up, 1297 participants (8%) were granted DP due to musculoskeletal diagnoses, 376 of which were due to osteoarthritis. High stress of daily activities, monotonous work, physical workload (namely work including lifting and carrying or physically heavy work), several workplace changes, and unemployment displayed a strong association with DP due to musculoskeletal diagnoses that was not affected by familial factors, including genetics and shared environment. Additionally, standing work increased the risk for DP due to osteoarthritis.

Conclusions Uninfluenced by family background or other confounding factors, several work-related factors were identified as being strong and direct risk factors for DP due to musculoskeletal diagnoses.

Key terms Finland; MSD; musculoskeletal disorder; sick leave; sickness absence; work.

Disability pension (DP) due to musculoskeletal diagnoses is a common cause for early exit from the labor market (1). In Finland, 24% of DP in 2010 were attributable to musculoskeletal diagnoses, with the largest subgroups being osteoarthritis, low-back disorders, and rheumatoid arthritis (2). Similar patterns have been reported in other western countries (1). An earlier study of Finnish twins has shown that risk factors for DP due to musculoskeletal diagnoses, and specifically for osteoarthritis, may differ although being identifiable in the individual's lifespan (3).

Physical workload has been identified as a risk factor for musculoskeletal disorders (MSD) (4), osteoarthritis (5) and DP due to musculoskeletal diagnoses (6-8). There are also factors that may be indirectly related to work. For example, both work-related stress (9) and stress related to other aspects of life (10) seem to play a role in DP due to musculoskeletal diagnoses. Fur1 thermore, there appears to be an association between unemployment and DP due to rheumatoid arthritis (11).

In addition to these work-related factors, genetic factors and shared family environment contribute to the risk for DP (12, 13). These familial factors (that is both genetics and shared environment mainly in childhood) may therefore confound some observed epidemiological associations since these familial effects may influence the characteristics influencing DP due to musculoskeletal diagnoses. Until now, most previous studies have investigated work-related risk factors for chronic conditions, or if DP has been involved, with relatively short follow-up time (3, 6, 14, 15). However, studies with a life-course perspective would be needed if one wished to investigate work-related factors during life stages as identification of work-related risk factors would facilitate prevention of exposures and diagnoses leading to DP. This study investigates work-related factors as predictors for DP due to musculoskeletal diagnoses and separately for a subgroup of these, namely, DP due to osteoarthritis. In addition, we aimed to investigate the effect of familial factors (genetics and environmental factors shared by family members) in the associations between work-related factors and DP. …

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