Unemployment vs. sickness absence as predictors of disability retirement: a follow-up study of working-age Finns

Jenni Blomgren, Kela – The Social Insurance Institution of Finland

Mikko Laaksonen, Finnish Centre for Pensions

TITA research meeting, 15–16 September 2016, Turku

Tackling Inequalities

in Time of Austerity

Background

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• Many studies on sickness absence as an early

predictor of disability retirement

• Little knowledge on the role of unemployment

Risk markers of disability retirement

Not established:

unemployment as a risk marker

Risk of ?disability retirement

Length of unemployment

Established:

sickness absence as a risk marker

Risk of disability retirement

Length of sickness absence

Finnish benefits compensating for loss of income due to disability

• Sickness allowance: short-term loss of work ability

• up to one year’s inability to work

• waiting period normally 1+9 working days (employer pays salary)

• normally, an approximately one-year-long sickness allowance

period is required before a disability pension can be granted

• Disability pension: long-term loss of work ability

• disability lasting more than one year

• permanently granted disability pension

or fixed-term pension (”rehabilitation subsidy”)

• full-time or part-time

• earnings-related scheme + national pension scheme

(basic level pensions)

4

Unemployment in the disability process?

• Unemployment associated with weaker work ability,

especially related to mental conditions

• Many of those who are granted a disability pension

have considerable unemployment background

• However, the unemployed often do not use the

“sickness allowance route” to disability pension

• No work – no need to apply for sickness allowance

• Lack of knowledge on the predictive role of

unemployment spells in the disability retirement

process

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Research questions

• How does increasing exposure to unemployment

predict disability retirement?

• Are the results different according to the diagnosis of the

disability pension?

• How well do unemployment spells predict disability

retirement compared to similar lengths of sickness

allowance spells?

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Materials and methods

Design of the study

• A prospective cohort study in 2005–2011

• A follow-up of the non-retired working-age

population at the end of 2005

• age 18–62

• residents of Finland

• not on any pensions

• A 50% sample of the defined population

• N=1,382,385

• Register-based data gathered from registers

• Kela (The Social Insurance Institution of Finland)

• Finnish Centre for Pensions

• Statistics Finland 8

Data on disability retirement

• First entry into disability pension during 2007–2011

• Both earnings-related and basic level pensions

• Both permanent and fixed-term pensions

• Only full-time disability pensions

• 48 323 first retirements in the data (3.5% of popul.)

• Diagnoses classified into three groups:

• Mental and behavioural disorders (33% of retirements)

• Musculoskeletal diseases (29%)

• Other diagnoses (38%)

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Data on unemployment

• Total accumulated length of benefit periods in

calendar days, calculated from all compensated

unemployment spells during 2005

• Classification into time bands measured in days

10

Unemployment days Distr.

(%)

N % retired

0 = No spells 82,1 1 134 401 2,7

1–30 = >0-1 months 1,9 26 458 3,8

31–60 = 1-2 months 1,8 24 660 4,1

61–90 = 2-3 months 1,5 20 202 4,7

91–180 = 3-6 months 3,8 51 998 5,6

181+ = Over 6 months 9,0 124 666 9,3

Total 100 1 382 385 3,5

Data on sickness allowance

• Total accumulated length of benefit periods in

calendar days, calculated from all compensated

sickness allowance spells during 2005

• Classification into time bands measured in days

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Sickness allowance days Distr.

(%)

N % retired

0 = No spells 89,7 1 240 219 2,8

1–30 = >0-1 months 6,4 88 019 6,8

31–60 = 1-2 months 2,0 27 619 10,2

61–90 = 2-3 months 0,8 11 071 13,4

91–180 = 3-6 months 0,8 10 731 15,7

181+ = Over 6 months 0,3 4 726 24,0

Total 100 1 382 385 3,5

Covariates

• Analyses separately for women and men

• Adjusted variables in all models:

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• age

• education

• socio-economic status

• marital status

• municipality type

• region

• unemployment days

• sickness allowance days

Survival analysis methods

• Kaplan–Meier curves

• Cox proportional hazards models

• Follow-up 1 Jan 2007 – 31 Dec 2011

• Observations are right-censored on (=followed until):

− the first date of disability retirement / date of death /

the age of 63 / 31 Dec 2011

--- whichever date comes first

• Time is counted in days

• Cox results shown as hazard ratios (HR)

with their 95% confidence intervals

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A one-year waiting period is applied

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• In order to avoid confounding attributable to

sickness absence and unemployment immediately

prior to disability pension (related to an already

ongoing disability retirement process),

the follow up of retirement starts in 2007 − removal of those who retired / reached old age retirement age /

died during 2006

Measurements of Waiting period Follow-up of new

* unemployment spells ignoring disability disability retirement

* sickness allowance retirement cases cases

* covariates

2005 2006 2007–2011

Results

Kaplan-Meier curves for cumulative probability of disability retirement according to number of unemployment days in 2005

16

0.00

0.10

0.20

1.1

.20

07

1.1

.20

08

1.1

.20

09

1.1

.20

10

1.1

.20

11

31

.12

.20

11

0 d 1-30 d

31-60 d 61-90 d

91-180 d 181+ d

Men

0.00

0.10

0.20

1.1

.20

07

1.1

.20

08

1.1

.20

09

1.1

.20

10

1.1

.20

11

31

.12

.20

11

0 d 1-30 d

31-60 d 61-90 d

91-180 d 181+ d

Women

Kaplan-Meier curves for cumulative probability of disability retirement according to number of sickness allowance days in 2005

17

0.00

0.10

0.20

0.30

0.40

0.50

1.1

.20

07

1.1

.20

08

1.1

.20

09

1.1

.20

10

1.1

.20

11

31

.12

.20

11

0 d 1-30 d

31-60 d 61-90 d

91-180 d 181+ d

Men

0.00

0.10

0.20

0.30

0.40

0.50

1.1

.20

07

1.1

.20

08

1.1

.20

09

1.1

.20

10

1.1

.20

11

31

.12

.20

11

0 d 1-30 d

31-60 d 61-90 d

91-180 d 181+ d

Women

18

1

1,5

2

2,5

3

0 (ref.) 1-30 31-60 61-90 91-180 181+ 0 (ref.) 1-30 31-60 61-90 91-180 181+

Women Men

HR

Hazard ratios (HR) for incidence of disability pensions in 2007–2011 according to the number of unemployment days in 2005 (adjusted for all covariates)

All diagnoses Mental Musculoskeletal Other

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1

2

3

4

5

6

7

8

9

0 (ref.) 1-30 31-60 61-90 91-180 181+ 0 (ref.) 1-30 31-60 61-90 91-180 181+

Women Men

HR

Hazard ratios (HR) for incidence of disability pensions in 2007–2011 according to the number of sickness allowance days in 2005 (adjusted for all covariates)

All diagnoses Mental Musculoskeletal Other

Discussion

Summary of the results

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Sickness absence as a risk marker

Risk of disability retirement

Length of sickness absence

Unemployment as a risk marker

Risk of

disability retirement

Length of unemployment

Conclusion

• Loss of work ability incurs high costs for the individual

and for the society prevention is important

• Early prevention of work ability problems is currently

based on monitoring the accumulation of SA days

• Screening/intervention points: 30–60–90 days

• The unemployed are left outside this screening since the

disabled unemployed do not necessarily apply for SA

• Gradual losses of work ability are not noticed;

timely prevention not possible

• Preventive efforts should be more specifically targeted

especially to the long-term unemployed,

and especially concerning mental work ability

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Thank you!

jenni.blomgren@kela.fi

Tackling Inequalities

in Time of Austerity