Smokers’ increased risk for disability pension: social confounding or health-mediated effects? Gender-specific analyses of the Hordaland Health Study cohort

Haukenes, Inger; Riise, Trond; Haug, Kjell; Farbu, Elisabeth; Mæland, John Gunnar

doi:10.1136/jech-2012-202182

Cited by 13 publications

(14 citation statements)

References 30 publications

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“…Some studies have shown smoking to be a significant risk factor for disability pension [37,38]. Haukness et al, however, found that especially among men, this association is mainly explained by the different socioeconomic status of smokers and non-smokers [39]. In our study, only a high serum cotinine level, proving current active smoking, associated with a slightly increased risk of disability pension (Table 3).…”

Section: Discussioncontrasting

confidence: 52%

Does lung function predict the risk of disability pension? An 11-year register-based follow-up study

et al. 2020

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Background: Spirometry is widely used in medical surveillance in occupational health and as a diagnostic test for obstructive and restrictive lung disease. We evaluated the effect of spirometry parameters on the risk of all-cause disability pension in a follow-up study of an occupationally active general population-based cohort. Methods: We measured the pulmonary function of 3386 currently working participants of the Health 2000 Survey in the clinical phase at baseline using spirometry. We obtained the retirement events of the cohort from the nationwide register for 2000-2011. Cox proportional hazards models were used to determine disability pensions. Results: At baseline, we identified 111 (3.3%) participants with obstructive spirometry, 95 (2.8%) with restrictive spirometry, and 3180 controls without restriction or obstruction. The age, sex, educational level, body-mass index, co-morbidities (1 or ≥ 2), and the smoking-adjusted hazard ratio of disability pension was 1.07 (95% confidence interval, CI 0.64-1.78) for those with obstructive spirometry, and 1.44 (95% CI 0.89-2.32) for those with restrictive spirometry. As continuous variables, and divided into quartiles, the risk of the lowest quartile of forced ventilation capacity (FVC)% of predicted was 1.49 (95%CI 1.10-2.01) and forced expiratory volume in one second (FEV 1)% of predicted 1.66 (95%CI: 1.23-2.24) in comparison to the highest quartile in the adjusted models. Conclusions: Obstructive or restrictive spirometry did not predict disability pension when dichotomized classified variables (normal compared to abnormal) were used. As continuous variables and when divided into quartiles, lower lung volumes showed an increase in the risk of disability pension. Physicians should take this into account when they use spirometry as a prognostic factor of work disability.

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Section: Discussioncontrasting

confidence: 52%

Does lung function predict the risk of disability pension? An 11-year register-based follow-up study

et al. 2020

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“… 13–15 The association between smoking and disability retirement appears to be dose-dependent, that is, the risk of disability retirement tends to increase with heavier smoking. 6–8 12 However, some studies have only examined current smoking, 9 16 and in a large study comprising 11 European countries, current smoking was unassociated with exit from the labour market due to disability. 17 Studies focused on smoking have sometimes considered physical activity.…”

Section: Introductionmentioning

confidence: 99%

“…For example, an earlier study found that heavy smoking is associated with the risk of disability retirement among women even after adjusting for physical activity, while the association attenuated among men after adjusting for socioeconomic position and further by physical activity. 12 Both smoking and physical inactivity independently increase the risk of disability retirement, while physical activity could decrease the risk of disability retirement. Although some studies have had only self-reported data on work disability, 14 15 a recent meta-analysis further supported the importance of physical inactivity to the risk of disability retirement.…”

Section: Introductionmentioning

confidence: 99%

Joint associations of smoking and physical activity with disability retirement: a register-linked cohort study

et al. 2015

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ObjectivesWe examined the risk of disability retirement by smoking and physical activity, and particularly whether the risk due to smoking is affected by the level of physical activity. Additionally, the contribution of baseline health, sociodemographic and work-related factors to the joint associations of smoking and physical activity with disability retirement was considered.DesignCohort study.SettingHelsinki, Finland.ParticipantsEmployees of the City of Helsinki, aged 40–60 years at baseline in 2000–2002, were followed up using complete register data from the Finnish Centre of Pensions until the end of 2010 (n=6390, with a consent to register linkage from 74%).Primary outcome measureAll-cause disability retirement (ICD-10).ResultsAltogether, 608 employees (9.5%) retired due to disability during the follow-up. Cox regression models were fitted to examine the joint associations of smoking and physical activity with subsequent disability retirement. Never-smokers, ex-smokers and moderate smokers who were inactive or moderately active had an increased risk of disability retirement, but if they were vigorously active, they had no excess risk. Instead, all heavy smokers (15 or more cigarettes per day among women, and 20 or more among men), irrespective of physical activity, had an increased risk of disability retirement. The examined associations attenuated but remained for ex-smokers and heavy smokers after adjustments for gender, age, socioeconomic position, mental and physical workload, problem drinking, body mass index and self-rated health. No gender interactions were found.ConclusionsVigorous physical activity might help prevent disability retirement not only among never-smokers, but even among ex-smokers and moderate smokers. However, among heavy smokers, physical activity is not sufficient to eliminate the adverse effects of smoking on health and work ability.

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“…The analyses were based on a 5-year observation period for medication adherence, including 2 years before and 2 years after the year of retirement. Data were stratified by gender because of gender differences in cardiovascular disease rates[ 1 ], in adherence to cardiovascular medication[ 6 , 19 ], in early and old-age retirement[ 20 – 22 ], and in the effects of illnesses and life transitions on adherence to some cardio-preventive medications. [ 11 , 23 ] Analyses were performed separately for those with at least one statin dispensation during a calendar year (continuers) and those with no dispensations (discontinuers).…”

Section: Methodsmentioning

confidence: 99%

Influence of Retirement on Adherence to Statins in the Insurance Medicine All-Sweden Total Population Data Base

et al. 2015

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BackgroundRetirement has been suggested to reduce medication adherence, but no evidence is available for statins. We investigated changes in adherence to statins among Swedish adults after retirement.MethodsA prospective cohort study was carried out on all individuals living in Sweden on 31 December 2004, alive in 2010, having purchased statins in the second half of 2005, and retired in 2008 (n=11 718). We used prescription dispensing data in 2006–2010 to determine nonadherence (defined as <80% of days covered by filled prescriptions) before and after old-age or disability retirement. Using multiple repeat measurements of filled statin prescriptions, we calculated the annual prevalence rates of nonadherence for those who continued therapy. Discontinuation was defined as no statin dispensations during a calendar year.ResultsAfter adjustment for age at retirement, the prevalence ratio (PR) of nonadherence after retirement in comparison with those before retirement was 1.23 [95% confidence interval (CI) 1.17–1.29] for the men and 1.19 (95% CI 1.13–1.26) for the women. A post-retirement increase in nonadherence was consistently observed across the strata of age at retirement, marital status, education, income, type of retirement, and participants with and without cardiovascular disease, the largest increases being observed for statin use in secondary prevention (men: PR 1.38, 95% CI 1.26–1.54; women: PR 1.43, 1.18–1.72). For primary prevention, the corresponding prevalence ratios were 1.18 (95% CI 1.13‒1.25) and 1.18 (95% CI 1.11–1.24), respectively.InterpretationRetirement appears to be associated with increased nonadherence to statin therapy among Swedish men and women.

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Smokers’ increased risk for disability pension: social confounding or health-mediated effects? Gender-specific analyses of the Hordaland Health Study cohort

Cited by 13 publications

References 30 publications

Does lung function predict the risk of disability pension? An 11-year register-based follow-up study

Does lung function predict the risk of disability pension? An 11-year register-based follow-up study

Joint associations of smoking and physical activity with disability retirement: a register-linked cohort study

Influence of Retirement on Adherence to Statins in the Insurance Medicine All-Sweden Total Population Data Base

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