Self-Rated Health as a Predictor of Disability Retirement – The Contribution of Ill-Health and Working Conditions

OBJECTIVE Self-rated health is a generic health indicator predicting mortality, many diseases, and need for care. We examined self-rated health as a predictor of subsequent disability retirement, and ill-health and working conditions as potential explanations for the association. METHODS Self-rated health and the covariates were obtained from the Helsinki Health Study baseline mail surveys in 2000-2002 conducted among municipal employees aged 40-60 years (n = 6525). Data for disability retirement events (n = 625) along with diagnoses were linked from the Finnish Centre for Pensions, with a follow-up by the end of 2010. Hazard ratios (HR) and their 95% confidence intervals (CI) were calculated using competing risks models. RESULTS Less than good self-rated health predicted disability retirement due to all causes among both women (HR = 4.60, 95% CI = 3.84-5.51) and men (HR = 3.83, 95% CI = 2.64-5.56), as well as due to musculoskeletal diseases (HR = 5.17, 95% CI = 4.02-6.66) and mental disorders (HR = 4.80, 95% CI = 3.50-6.59) among women and men pooled. Ill-health and physical working conditions partly explained the found associations, which nevertheless remained after the adjustments. Among the measures of ill-health limiting long-standing illness explained the association most in all-cause disability retirement and disability retirements due to musculoskeletal diseases, whereas common mental disorders explained the association most in disability retirements due to mental health disorders. Among working conditions physical work load and hazardous exposures at work explained the association most, although much less than ill-health. CONCLUSIONS Self-rated health is a strong predictor of disability retirement. This can be partly explained by ill-health and working conditions. Poor self-rated health provides a useful marker for increased risk of work disability and subsequent disability retirement.