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Job strain and the risk of disability pension due to musculoskeletal disorders, depression or coronary heart disease: a prospective cohort study of 69 842 employees
  1. Anne Mäntyniemi1,
  2. Tuula Oksanen2,3,
  3. Paula Salo2,
  4. Marianna Virtanen4,
  5. Noora Sjösten2,
  6. Jaana Pentti2,
  7. Mika Kivimäki4,5,6,
  8. Jussi Vahtera2,7
  1. 1Occupational Health Care Unit of Vihti, Federation of Municipalities for Social and Health Services, Nummela, Finland
  2. 2Finnish Institute of Occupational Health, Turku, Finland
  3. 3Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA
  4. 4Finnish Institute of Occupational Health, Helsinki, Finland
  5. 5Department of Epidemiology and Public Health, University College London, London, UK
  6. 6Department of Behavioral Sciences, University of Helsinki, Helsinki, Finland
  7. 7Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
  1. Correspondence to Anne Mäntyniemi, Occupational Health Care Unit of Vihti, Federation of Municipalities for Social and Health Services, Ritalantie 4 E 6, 03100 Nummela, Finland; anne.mantyniemi{at}


Objectives Observational studies suggest that high job strain is a risk factor for retirement on health grounds, but few studies have analysed specific diagnoses. We examined job strain's association with all-cause and cause-specific disability pensions.

Methods Survey responses to questions about job strain from 48 598 (response rate, 68%) public sector employees in Finland from 2000 to 2002 were used to determine work unit- and occupation-based scores. These job strain scores were assigned to all the 69 842 employees in the same work units or occupations. All participants were linked to the disability pension register of the Finnish Centre of Pensions with no loss to follow-up. Cox proportional hazard models were used to calculate HRs and their 95% CIs for disability pensions adjusted by demographic, work unit characteristics and baseline health in analyses stratified by sex and socioeconomic position.

Results During a mean follow-up of 4.6 years, 2572 participants (4%) were granted a disability pension. A one-unit increase in job strain was associated with a 1.3- to 2.4-fold risk of requiring a disability pension due to musculoskeletal diseases in men, women and manual workers, depending on the measure of job strain (work unit or occupation based). The risk of disability pension due to cardiovascular diseases was increased in men with high job strain but not in women nor in any socioeconomic group. No consistent pattern was found for disability pension due to depression.

Conclusion High job strain is a risk factor for disability pension due to musculoskeletal diseases.

  • Disability pension
  • job strain
  • work
  • musculoskeletal disorders
  • occupational health practice
  • stress
  • public health
  • sickness absence
  • ageing
  • psychology
  • epidemiology
  • sleep
  • retired
  • longitudinal studies
  • disability
  • cardiovascular
  • psychology
  • mortality studies
  • fitness for work
  • workload
  • healthcare workers
  • epidemiology
  • health and safety
  • mental health
  • workload
  • epidemiology
  • longitudinal studies

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  • Funding The study was supported by grants from the Academy of Finland (projects 124271, 124322, 126602, 129262, and 132944), the Social Insurance Institution of Finland, the Finnish Association of Occupational Health Physicians, the Finnish Medical Foundation and the participating organisations.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by The Ethics Committee of the Finnish Institute of Occupational Health and The Ethics Committee of the Hospital District of Helsinki and Uusimaa.

  • Provenance and peer review Not commissioned; externally peer reviewed.