Women’s higher likelihood of disability pension: the role of health, family and work. A 5–7 years follow-up of the Hordaland Health Study

Abstract

BackgroundWomen’s higher risk of disability pension compared with men is found in countries with high female work participation and universal welfare schemes. The aim of the study was to examine the extent to which self-perceived health, family situation and work factors explain women’s higher risk of disability pension. We also explored how these factors influenced the gender difference across educational strata.MethodsThe population-based Hordaland Health Study (HUSK) was conducted in 1997–99 and included inhabitants born in 1953–57 in Hordaland County, Norway. The current study included 5,959 men and 6,306 women in paid work with valid information on education and self-perceived health. Follow-up data on disability pension, for a period of 5–7 years, was obtained by linking the health survey to a national registry of disability pension. Cox regression analyses were employed.ResultsDuring the follow-up period 99 (1.7%) men and 230 (3.6%) women were awarded disability pension, giving a twofold risk of disability pension for women compared with men. Except for a moderate impact of self-perceived health, adjustment for family situation and work factors did not influence the gender difference in risk. Repeating the analyses in strata of education, the gender difference in risk of disability pension among the highly educated was fully explained by self-perceived health and work factors. In the lower strata of education there remained a substantial unexplained gender difference in risk.ConclusionsIn a Norwegian cohort of middle-aged men and women, self-perceived health, family situation and work factors could not explain women’s higher likelihood of disability pension. However, analyses stratified by educational level indicate that mechanisms behind the gender gap in disability pension differ by educational levels. Recognizing the heterogeneity within gender may contribute to a deeper understanding of women’s higher risk of disability pension.

Long-term cervical cancer survivors on disability pension: a subgroup in need of attention from health care providers

“…In contrast to that study, we found the demographic factors of older age and shorter education to be significantly associated with DP. As in studies of the general female population, our study of LSCCs replicated short education, poor self-rated health, comorbidity, and increased levels of mental distress as factors associated with holding DP [4,21]. We also confirmed the relevance of somatic comorbidities reported in previous registry studies of DP among female breast cancer survivors [22,23].…”

Influence of poor health on exit from paid employment: a systematic review

“…Self-perceived health was evaluated in 12 studies,7–9 23 24 26 30 36 37 43 46 48 presenting 13 associations. In all 12 studies self-perceived poor health was a significant risk factor for transition into disability pension (table 1) with a pooled RR of 3.61 (95% CI 2.44 to 5.35), table 2 and figure 2.…”

“…Poor health was measured on a 5-point Likert scale,7–9 26 43 46 a 4-point Likert scale23 24 48 or with the short-form health survey (SF-12 or SF-36) 30 36. In eight studies poor health was defined as ‘less than good health’,7–9 24 30 43 46 48 whereas the other studies defined poor health as ‘less than fair health’,23 ‘less than moderate health’26 or as a cut-off value <40 on the SF-36 36. Explorative analysis showed no influence of different cut-off values on pooled estimates of self-perceived poor health (‘less than good health’: RR 3.08, 95% CI 1.94 to 4.88; ‘less than fair/moderate health’: RR 4.07, 95% CI 1.70 to 9.71).…”

Prognostic Factors for Return to Work, Sickness Benefits, and Transitions Between These States: A 4-year Follow-up After Work-Related Rehabilitation

“…In the Oslo Health study, the higher rates of DP among women were attributable to self-reported health, level of mental distress, working conditions, and income [34]. This is in contrast to the population-based study in Hordaland (HUSK), where self-perceived health, work factors and family situation did not explain women’s higher likelihood of DP [17]. Thus, results seem to differ between populations and studies and there is still no consensus in how to understand the gender divide in sick leave and DP.…”

“…Norwegian women have a higher rate of sick leave and DP than men, and still little is known on this gender divide [16, 17]. Female gender [1, 4, 18] and higher age [1, 19, 20] predict lack of RTW.…”