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.