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Disability Pensions Due to Spinal Disorders: Nationwide Finnish Register-Based Study, 1990–2010

Asklöf, Tom MD*; Kautiainen, Hannu BA; Järvenpää, Salme MSc; Haanpää, Maija PhD§; Kiviranta, Ilkka PhD; Pohjolainen, Timo PhD

doi: 10.1097/BRS.0000000000000183
Occupational Health/Ergonomics

Study Design. A register-based national study.

Objective. To describe the occurrence of spinal disorders (SDs) resulting in disability pension (DP) in Finland during 1990–2010.

Summary of Background Data. The indirect cost of SD is excessive. The most significant indirect cost is due to DP. There are no nationwide long-term studies of DP trends caused by SDs.

Methods. The study setting consisted of Finnish working population (20–64 yr). All new cases were identified from the nationwide register maintained by the Finnish Centre of Pensions from the beginning of 1990 to the end of 2010. The data included sex, age group, year of the DP decision, and the main cause of incapacity (diagnosis) leading to DP. Main outcome measure was DPs due to SDs.

Results. A total of 84,375 individuals (40,415 females; 43,960 males) received DP during the study period. Age- and sex-adjusted incidence rate ratio was 0.45 (95% CI: 0.44–0.46) between time periods of 1990–1994 and 2005–2010. In males, crude incidence in 1990–1994 was 21.0 (95% CI: 20.6–21.3) per 10,000 person-years and in 2005–2010, it was 11.1 (10.9 to 11.3). In females, it was 18.8 (95% CI: 18.5–19.1) and 11.4 (95% CI: 11.1–11.6). During the study period, the overall DP rate also decreased. Age- and sex-adjusted incidence rate ratio was 0.66 (95% CI: 0.65–0.67) between the time periods 1990–1994 and 2005–2010. However, the proportion of DPs due to the SDs of all new DPs was higher in the first half of 1990s than in 2005–2010 (adjusted proportion 19.6% [95% CI: 19.4–19.8] vs. 14.4% [95% CI: 14.2–14.6]).

Conclusion. The occurrence of DPs due to SDs has decreased significantly during the period of 1990–2010 in Finland. On the basis of the register data, nonmedical factors and legislative reforms may explain the decrease of DPs more than treatments provided by health care.

Level of Evidence: 3

A register-based national study to describe the occurrence of spinal disorders resulting in disability pension in Finland was conducted during 1990–2010. A total of 84,375 individuals received disability pension. In males, crude incidence in 1990–1994 was 21.0 per 10,000 person-years and in 2005–2010, it was 11.1. In females, it was 18.8 and 11.4, respectively.

*Department of Orthopedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland

Unit of Family Practice, Central Finland Central Hospital, Jyvaskyla, Finland

Medcare Foundation, Aanekoski, Finland

§Department of Neurosurgery, Helsinki University Central Hospital, Finland

Department of Orthopedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland; and

ORTON Rehabilitation Centre, Helsinki, Finland.

Address correspondence and reprint requests to Tom Asklöf, MD, Toolo Hospital, University of Helsinki, Topeliuksenkatu 5, Helsinki, PO Box 266, FIN-00029 HUS, Finland; E-mail: tom.asklof@hus.fi

Acknowledgment date: September 10, 2013. First revision date: December 9, 2013. Acceptance date: December 16, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Etera Mutual Pension Insurance funds were received to support this work (first author and data analysis).

Relevant financial activities outside the submitted work: fees for participation in review activities and payment for writing or reviewing the manuscript.

© 2014 by Lippincott Williams & Wilkins