Role of diagnoses and socioeconomic status in mortality among disability pensioners in Norway - A population-based cohort study

Abstract

Objectives: Several studies have shown increased mortality among disability pensioners. This study attempted to determine the causes of such an increase. Methods: A population-based study was carried out with 148 942 persons followed between 1990 and 1996 in Norway. There were 6285 women, of whom 4113 were on a disability pension at baseline. A Cox proportional hazards analysis was carried out separately for the women and men in which all-cause mortality was the outcome variable. Disability pension status, disability pension diagnosis, age, educational level, and mean annual income were entered as explanatory variables. Results: Persons on a disability pension had a strongly increased mortality rate. The age-adjusted hazard ratio was 3.0 [95% confidence interval (95% CI) 2.4-3.8] for the women and 3.4 (95% CI 2.8-4.1) for the men on a disability pension, when they were compared with those not on a disability pension. When adjusted for education and income levels, the hazard ratios (HR) decreased significantly for the men, to 2.0 (95% CI 1.8-2.4), but not so for women (HR 2.5, 95% CI 2.2-2.9). Except for the men with musculoskeletal diagnoses, all of the diagnostic groups had hazard ratios above unity also after the adjustments were made. Conclusions: The study confirmed high early mortality among Norwegian disability pensioners in the period 1990-1996. The medical condition seemed to contribute more to the increased mortality among the women, whereas a low socioeconomic status was more important for the men.