O8D.6 High physical workload and disability pension: a follow-up study of swedish men until 59 years of age

Background In Sweden, the proportion of the population that remains in paid employment until normal retirement age of 65 years is less than 50% in blue-collar groups, compared to 60%–75% in white-collar occupations. High physical workload has been associated with early exits from the labor market through disability pensions (DP) in many studies. However, identified risk factors for DP from early life may be more prevalent among men in heavy manual occupations than in others. The aim was to investigate the association between high physical work load in middle age and DP before age 59, adjusting for social background, physical ability, psychological characteristics, lifestyle and education measured before labour market entrance. Methods The study is based on a Swedish conscription cohort of 49 321 men born 1949–1951. At enlistment 1969/1970 information was collected about cardiorespiratory fitness, social background, psychological characteristics and health behaviours, e.g. smoking. Physical workload was estimated with a job exposure matrix based on questions concerning heavy lifting, strenuous work postures, repetitive work and physically strenuous work from the Swedish Work Environment Surveys 1989–97. Mean values for men of a composite physical exposure variable were grouped into quartiles; high, medium-high, medium-low and low physical workload, and assigned to occupational titles from the census 1990. The study group was followed regarding DP from age 40 to 59. Results Exposure to high (HR 2.67, CI 95% 2.42–2.95), medium-high (HR 2.43, CI 95% 2.20–2.69) and medium-low (HR 1.31, CI 95% 1.18–1.47) physical workload, compared with low, were associated with DP up to age 59. The increased risks remained, but were clearly attenuated after adjustments for pre-labour market factors, especially psychological characteristics and education. Conclusion The results are in line with a major effect of high physical work load on disability pension, even though adjustments for pre-labour market factors clearly attenuated the risks.