Diagnosis-specific disability pension and risk of all-cause and cause-specific mortality – a cohort study of 4.9 million inhabitants in Sweden

BACKGROUND The incidence of disability pension (DP) is high in several European countries. However, knowledge on associations of cause-specific DP and premature death is limited. The aims were to: 1) investigate the association between cause-specific DP and all-cause and cause-specific mortality among women and men and 2) examine period effects of this association. METHODS Three prospective population-based cohort studies were conducted, the first including all individuals aged 16-64 years who lived in Sweden all of 1995 and who were not on DP before 1995 (N = 5,006,523, 48.8% women). Those granted DP in 1995 were compared to those not granted DP regarding mortality during 1996-2009. Two other cohorts were created in a similar fashion, for 2000 and 2005, respectively, and in comparisons each of the three cohorts were followed up for four years with regard to all-cause mortality as well as death due to cancer, circulatory disorders, or suicide. All analyses were stratified by sex and we controlled for a number of socio-demographic factors and inpatient care. RESULTS Individuals with granted DP had a higher mortality risk, women (HR 1.75; 95% CI 1.68-1.82) and men (HR 1.66; 95% CI 1.61-1.71) and highest for cancer. People on DP with some diagnoses had higher risk of premature death in other causes of death than their DP diagnoses. All-cause mortality risk varied with DP-diagnosis and was lowest for musculoskeletal diagnoses. The mortality HR decreased among women with DP between the cohort 1995, HR 2.07 (1.92-2.24) and the cohort 2005, 1.84 (1.71-1.99). Here, temporal decreases in mortality risk occurred particularly in DP due to mental diagnoses and cancer. CONCLUSIONS All DP diagnoses were associated with a higher mortality risk. Even individuals granted DP due to diagnoses with low mortality risk displayed a higher risk for premature death. This warrants close monitoring of disability pensioners and further studies on consequences of being on disability pension.