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Original Article
Influence of obesity and physical workload on disability benefits among construction workers followed up for 37 years
  1. Suzan J W Robroek1,
  2. Bengt Järvholm2,
  3. Allard J van der Beek3,
  4. Karin I Proper3,
  5. Jens Wahlström2,
  6. Alex Burdorf1
  1. 1 Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
  2. 2 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  3. 3 Department of Public and Occupational Health, EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Suzan JW Robroek, Suzan Robroek, Department of Public Health, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; s.robroek{at}


Objectives The objectives of this study are to investigate the relation between obesity and labour force exit via diagnosis-specific disability benefits, and whether physical workload modifies this association.

Methods A longitudinal analysis was performed among 3 28 743 Swedish construction workers in the age of 15–65 years. Body weight and height were measured at a health examination and enriched with register information on disability benefits up to 37 years later. Diagnoses of disability benefits were categorised into cardiovascular diseases (CVDs), musculoskeletal diseases (MSDs), mental disorders and others. A job exposure matrix, based on self-reported lifting of heavy loads and working in bent forward or twisted position, was applied as a measure of physical workload. Cox proportional hazards regression analyses were performed, and the relative excess risk due to interaction (RERI) between obesity and physical workload was calculated.

Results Obese construction workers were at increased risk of receiving disability benefits (HR 1.70, 95% CI 1.65 to 2.76), mainly through CVD (HR 2.30) and MSD (HR 1.71). Construction workers with a high physical workload were also more likely to receive a disability benefit (HR 2.28, 95% CI 2.21 to 2.34), particularly via MSD (HR 3.02). Obesity in combination with a higher physical workload increased the risk of disability benefits (RERI 0.28) more than the sum of the risks of obesity and higher physical workload, particularly for MSD (RERI 0.44).

Conclusions Obesity and a high physical workload are risk factors for disability benefit. Furthermore, these factors are synergistic risk factors for labour force exit via disability benefit through MSD. Comprehensive programmes that target health promotion to prevent obesity and ergonomic interventions to reduce physical workload are important to facilitate sustained employment.

  • Occupational health
  • disability pension
  • obesity
  • physical workload
  • musculoskeletal diseases
  • cardiovascular diseases
  • mental disorders.

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  • Contributors SJWR contributed to the study design and performed the data analysis and the drafting of the manuscript.

    BJ contributed to the study design, discussed the data analyses and contributed to the drafting of the manuscript. A

    JvdB contributed to the study design and the drafting of the manuscript.

    KIP contributed to the study and the drafting of the manuscript.

    JW contributed to the study design and the drafting of the manuscript.

    AB contributed to the study design, discussed the data analyses and contributed to the drafting of the manuscript.

  • Funding The Swedish Research Council for Health, Working Life and Welfare supported this study (2011-426). The Netherlands Organisation for Health Research and Development (ZonMw, project number: 531005004) partly funded this study. Suzan Robroek is supported by an EUR Fellowship from the Erasmus University Rotterdam.

  • Competing interests None declared.

  • Ethics approval Regional Ethical Review Board in Ume (2011-367-32M).

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

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