© 2004 by European Journal of Public Health
Sickness absence and work disability |
The importance of social characteristics of communities for the medically based disability pension
Steinar Krokstad1,*, Per Magnus2, Anders Skrondal2 and Steinar Westin11 Department of Community Medicine and General Practice, Norwegian University of Science and Technology, Trondheim, Norway, 2 The Norwegian Institute of Public Health
Background: The aim of this study was to look for any possible contextual effect of deprivation at municipality level on the risk of being granted the medically based disability pension, controlled for compositional effects due to spatial concentration of people with a high risk of disability. Methods: The material consists of the residentiary part of a total Norwegian county population aged 20–54 years without disability pension at baseline, n=40,083. This study was performed as a 10-year follow-up study. The relative risk of being granted a disability pension was estimated by logistic regression analyses as odds ratios (OR) between people living in different municipalities according to a municipality deprivation index at three levels, adjusted for individual factors. Results: The OR of disability pension was 1.36 (1.22, 1.51) for people residing in intermediate deprived municipalities and 1.48 (1.31, 1.67) for people residing in the most deprived municipalities compared to the most affluent municipalities, adjusted for gender and age. After adjustment for individual risk factors the OR was 1.26 (1.12, 1.41) and 1.18 (1.04, 1.35) respectively. Analyses stratified by gender showed that the increased risk of receiving a disability pension for men in the most deprived municipalities was explained by individual factors alone. Conclusion: Relative municipality deprivation seems to account for an increase in the incidence of disability pension. This effect contributes to marginalization of people living in less affluent areas out of employment and thus to widening socioeconomic inequalities in the population.
Keywords: cohort study, disability pension, ecology, multilevel analysis, psychosocial deprivation, social epidemiology
Received 10 September 2002. Accepted 23 June 2003.
* Correspondence: Steinar Krokstad, MD, PhD, HUNT Research Centre, Department of Community Medicine and General Practice, Norwegian University of Science and Technology, Neptunveien 1, 7650 Verdal, Norway, tel. +47 74075180, fax +47 74075181, e-mail: steinar.krokstad{at}medisin.ntnu.no
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