Sources of income following a rejected disability pension application: a sequence analysis study.

To identify different income trajectories after a rejected disability pension application and to analyze socio-demographic and disability process related determinants of these trajectories. Finnish residents aged 18-58 years with a first rejected disability pension application in 2010 ( = 3683) were followed for 48 months with register data. We performed a sequence analysis of six income sources (employment, unemployment benefit, sickness allowance, rehabilitation benefit, awarded disability pensions, other/unknown). Multinomial logistic regression was used in analyses. Four clusters were identified, displaying unemployment, awarded disability pension, employment, or unknown source as the primary source of post-rejection income. Transitions between income sources were frequent, especially in the employment and unemployment clusters. Using the awarded pension cluster as the reference group, previous unemployment raised the odds of unemployment cluster membership the most. Similarly, previous employment raised the odds of employment cluster the most. A somatic rather than mental disorder and being under 50 years old raised the odds of being in the unemployment and employment clusters. After a rejected disability pension, main income paths include unemployment benefits, re-applied disability pension, and fragmented employment. Labor market and sickness history and age are associated with the probability of these paths.Implications for RehabilitationRejected disability pension applicants should be offered medical or vocational rehabilitation, to enable sustained labor market participation.Partial disability pension, supported by rehabilitation is one solution when a full-time labor market participation is not a realistic option.