Johnell Kristina, Månsson Nils-Ove, Sundquist Jan, Melander Arne, Blennow Göran, Merlo Juan
Centre for Family Medicine, Karolinska Institutet, Huddinge, Sweden.
Scand J Public Health. 2006;34(1):41-8. doi: 10.1080/14034940510032185.
The increasing number of people on disability pension in Sweden is of concern for Swedish policy-makers, and there is a need for a better understanding of the mechanisms behind disability pension. We investigated (i) whether women living in the same neighborhood have a similar propensity for disability pension that relates to neighborhood social participation, and (ii) whether there is an association between anxiolytic-hypnotic drug (AHD) use and disability pension in women that is modified by the neighborhood context.
We used multilevel logistic regression with 12,156 women aged 45 to 64 (first level) residing in 95 neighborhoods (second level) in the city of Malmö (250,000 inhabitants), Sweden, who participated in the Malmö Diet and Cancer Study (1991-96).
Both AHD use (OR = 2.09, 95% CI 1.65, 2.65) and neighborhood rate of low social participation (OR = 11.85, 95% CI 5.09, 27.58) were associated with higher propensity for disability pension. The interval odds ratio indicated that the influence of neighborhood social participation was large compared with the unexplained variance between the neighborhoods. The association between AHD use and disability pension was not modified by the neighborhood context. The median odds ratio was 1.44 after adjusting for individual characteristics and 1.27 after the additional adjusting for neighborhood social participation.
Women living in the same neighborhood appear to have a similar propensity for disability pension, beyond individual characteristics, and this contextual effect seems largely explained by neighborhood social participation. In addition, AHD use might increase the propensity for disability pension in women.
瑞典领取残疾抚恤金的人数不断增加，这引起了瑞典政策制定者的关注，因此有必要更好地了解残疾抚恤金背后的机制。我们调查了：（i）居住在同一社区的女性是否具有与社区社会参与相关的类似残疾抚恤金倾向；（ii）使用抗焦虑催眠药物（AHD）与女性残疾抚恤金之间的关联是否会因社区环境而改变。
我们对瑞典马尔默市（25万居民）参与马尔默饮食与癌症研究（1991 - 1996年）的12156名45至64岁女性（第一层次）居住在95个社区（第二层次）的数据进行了多水平逻辑回归分析。
使用AHD（比值比[OR]=2.09，95%置信区间[CI]为1.65至2.65）和社区低社会参与率（OR = 11.85，95% CI为5.09至27.58）均与更高的残疾抚恤金倾向相关。区间比值比表明，与社区间无法解释的差异相比，社区社会参与的影响较大。使用AHD与残疾抚恤金之间的关联未因社区环境而改变。在调整个体特征后，中位数比值比为1.44，在进一步调整社区社会参与后为1.27。
居住在同一社区的女性似乎除个体特征外还具有类似的残疾抚恤金倾向，这种背景效应似乎很大程度上由社区社会参与所解释。此外，使用AHD可能会增加女性领取残疾抚恤金的倾向。
