Effort-reward imbalance as a risk factor for disability pension: The Finnish public sector study

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Abstract

Objectives Job strain has previously been shown to predict disability pension, but it is unknown whether effort-reward imbalance (ERI), another major stress model, is also associated with disability pension. Methods We examined ERI as a risk factor for diagnosis-specific disability pension in a cohort of 51 874 public-sector employees in Finland. To control for reporting bias, work unit-level scores of ERI (based on the survey responses of 35 260 employees in 2000-2002) were constructed and linked to all eligible employees. A sub-cohort of the respondents was analyzed also with individual-level ERI. Disability pension data were derived from national pension registers with no loss to follow-up. The outcomes were all-cause disability pension and disability pension due to depression, musculoskeletal diseases, and ischemic heart diseases (IHD). Multivariate Cox proportional hazard models (adjusted for sociodemographic factors, baseline health, and work-related characteristics) were used for analyses. Results During a mean 8.9 years of follow-up, 4542 participants were granted disability pension. An increased risk for disability pension due to depression was detected for both high work unit- and individual-level ERI [hazard ratio (HR) 1.63, 95% confidence interval (95% CI) 1.31-2.04 and HR 1.90, 95% CI 1.51-2.40, respectively]. High individual-level ERI increased the risk of disability pension due to musculoskeletal diseases (HR 1.32, 95% CI 1.13-1.53), but no association was observed for work unit-level ERI (HR 1.02, 95% CI 0.88-1.19). ERI was not associated with disability pension due to IHD. Conclusion The present study showed a consistent association between high ERI and an increased risk of disability pension due to depression.

Figures

  • Table 1. Baseline characteristics of the sample. [ERI=effort–reward imbalance; SD=standard deviation.]
  • Table 2. Work unit- and individual-level effort–reward imbalance (ERI) and all-cause disability pension. Hazard ratios (HR) and their 95% confidence intervals (95% CI) derived from Cox proportional hazard models.
  • Table 3. Work unit-level effort–reward imbalance (ERI) and cause-specific disability pension. Hazard ratios (HR) and their 95% confidence intervals (95% CI) derived from Cox proportional hazard models.
  • Table 4. Individual-level effort–reward imbalance (ERI) and cause-specific disability pension. Hazard ratios (HR) and their 95% confidence intervals (95% CI) derived from Cox proportional hazard models.
  • Figure 1. Cumulative hazard curves of disability pension due to depression by quartile of work unit-level effort–reward imbalance.
  • Table 5. Work unit- and individual-level effort and reward [components of effort–reward imbalance (ERI)] and cause-specific disability pension. Hazard ratios (HR) and their 95% confidence intervals (95% CI) derived from Cox proportional hazard models.

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CITATION STYLE

APA

Juvani, A., Oksanen, T., Salo, P., Virtanen, M., Kivimäki, M., Pentti, J., & Vahtera, J. (2014). Effort-reward imbalance as a risk factor for disability pension: The Finnish public sector study. Scandinavian Journal of Work, Environment and Health, 40(3), 266–277. https://doi.org/10.5271/sjweh.3402

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