Division of Social Medicine and Global Health, Department of Clinical Sciences Malmö, Malmö University Hospital, Lund University, 205 02 Malmö, Sweden.
Int Arch Occup Environ Health. 2013 Apr;86(3):307-19. doi: 10.1007/s00420-012-0766-4. Epub 2012 Apr 5.
The aim of this study was to investigate whether job strain, psychological demands, and decision latitude are independent determinants of disability pension rates over a 12-year follow-up period.
We studied 3,181 men and 3,359 women, all middle-aged and working at least 30 h per week, recruited from the general population of Malmö, Sweden, in 1992. The participation rate was 41 %. Baseline data include sociodemographics, the Job Content Questionnaire, lifestyle, and health-related variables. Disability pension information was obtained through record linkage from the National Health Insurance Register.
Nearly 20 % of the women and 15 % of the men were granted a disability pension during the follow-up period. The highest quartile of psychological job demands and the lowest quartile of decision latitude were associated with disability pensions when controlling for age, socioeconomic position, and health risk behaviours. In the final model, with adjustment also for health indicators and stress from outside the workplace, the hazard ratios for high strain jobs (i.e. high psychological demands in combination with low decision latitude) were 1.5 in men (95 % CI, 1.04-2.0) and 1.7 in women (95 % CI, 1.3-2.2). Stratifying for health at baseline showed that high strain tended to affect healthy but not unhealthy men, while this pattern was reversed in women.
High psychological demands, low decision latitude, and job strain were all confirmed as independent risk factors for subsequent disability pensions. In order to increase chances of individuals remaining in the work force, interventions against these adverse psychosocial factors appear worthwhile.
本研究旨在探讨工作压力、心理需求和决策自由度是否为 12 年随访期间残疾养老金率的独立决定因素。
我们研究了 3181 名男性和 3359 名女性，他们均为中年，每周至少工作 30 小时，来自瑞典马尔默的普通人群，参与率为 41%。基线数据包括社会人口统计学、工作内容问卷、生活方式和与健康相关的变量。残疾养老金信息通过与国家健康保险登记处的记录链接获得。
在随访期间，约 20%的女性和 15%的男性获得了残疾养老金。在控制年龄、社会经济地位和健康风险行为后，心理工作需求最高四分位数和决策自由度最低四分位数与残疾养老金相关。在最终模型中，还调整了健康指标和工作场所外的压力，高压力工作（即高心理需求与低决策自由度相结合）的危险比为男性 1.5（95%CI，1.04-2.0）和女性 1.7（95%CI，1.3-2.2）。按基线健康状况分层显示，高压力工作对健康的男性而不是不健康的男性有影响，而这种模式在女性中则相反。
高心理需求、低决策自由度和工作压力均被确认为随后残疾养老金的独立风险因素。为了增加个人继续工作的机会，针对这些不利的社会心理因素的干预似乎是值得的。
