Darlings and Disability - Perceived Health in Couples and Disability Pension Receipt

摘要

BackgroundudIn Norway, almost 10% of the working age population receive a disability pension. Spousesudtend to have similar health and lifestyle, and they also tend to coordinate their retirements.udSpousal similarities can be explained by similarities existing before marriage, spousaludinfluence and shared resources. Sickness is the social role related to disease and illness,udsickness is therefore also a social construct. There are thus both medical and non-medicaluddeterminants of work related disability, and there might be temporal changes in the illnessudexperienced by people who receive a disability pension.udAimsudThe aims of this thesis were to assess disability pension receipt in Norway in the context ofudthe married or cohabitating couple, and to consider how the health around time of receiving auddisability pension might have changed over time.udMethodsudWe conducted three studies based on the second and third wave of the Nord-Trøndelag HealthudStudy (HUNT2 1995-97 and HUNT3 2006-08), linked to data on households and families,udretirements and education from national registries. In the first study, we assessed theudclustering of disability pensions received within couples, as well as the hazard of receiving auddisability pension dependent on the spouse’s disability status. We adjusted for baseline health,uddiseases, illness, health-related behaviours and education. In the second study, we examinedudthe associations of health, disease, illness, lifestyle and education in couples with disabilityudpension receipt and mortality. We estimated association both within and between couples. Inudthe third study, we examined the self-rated health, insomnia and mental symptoms of peopleudwho received a disability pension in the 1990s and 2000s and their spouses, depending onudtime before or after receiving a disability pension.udResultsudIn the first paper, we identified a substantial clustering of disability pensions in couples andudan increased risk of receiving a disability pension for more than six years after the spouse’suddisability pension for both men and women. The hazard of receiving disability pensionsudincreased by about a third after the spouse had received a disability pension.udIn the second paper, we found indication of an association between the couple’sudexposures and the individual’s risk of receiving a disability pension. This association appeared for poor self-rated health, illness and education, but not for somatic diseases. Suchudassociations could indicate influence from the burden of a partner with poor health, but alsoudshared confounding in the couple. We did not find corresponding association between poorudhealth in the couple and the individual’s mortality. There were, however, associationsudbetween couple’s smoking and education and the individual’s mortality.udIn the third paper, we found a peak in prevalence of poor self-rated health around timeudof disability pension, and similar prevalence of poor self-rated health among those whoudreceived a disability pension in the 1990s and 2000s. Symptoms of depression peaked the yearudbefore a disability pension in the 1990s, while the prevalence was similar before and afterudreceiving a disability pension in the 2000s. Estimated prevalence of insomnia increasedudbetween the 1990s and 2000s. On the other hand, the association between time before or afterudreceiving a disability pension and insomnia was stronger in the 1990s compared to the 2000s.udWe did not find statistical evidence of associations between time before or after receiving auddisability pension and the spouse’s health and illness.udConclusionsudWe found a substantial clustering of disability pensions within couples. Some of this could beudattributed to pre-existing similarities between partners. Living with an ill spouse could have audnegative impact on work related disability, but we did not find that it affected all-causeudmortality. A negative impact on the spouse’s health could still not explain the higher risk ofudreceiving a disability pension when the spouse after the spouse had received a disabilityudpension. Other contributing mechanisms could include social influence on illness behaviourudand self-efficacy. udFurthermore, our results indicate that the health and illness experienced by individualsudwho received a disability pension did not change much from the 1990s to the 2000s. Thisudsuggests that the National Labour and Welfare Administration treated requests for disabilityudpensions in similar manners in the two time periods. However, the stress related to theuddisability process seemed to be lower in the 2000s compared to the 1990s. This could be dueudto faster case handling or fewer stigmas.udOur findings of possible associations between couple’s health and individual workudrelated disability should be examined further. In the clinical setting, spouses could be includedudin the discussions about opportunities and limitations regarding return-to-work.