Self-reported health problems in a health risk appraisal predict permanent work disability: a prospective cohort study of 22,023 employees from different sectors in Finland with up to 6-year follow-up

Int Arch Occup Environ Health. 2020 May;93(4):445-456. doi: 10.1007/s00420-019-01497-2. Epub 2019 Nov 30.


Purpose: Work disability (WD) as a medico-legal concept refers to disability benefits (DB) that are granted due to diseases that permanently reduce work ability. We studied whether an occupational healthcare instrument for the prediction of sickness absence (SA) risk-a health risk appraisal (HRA)-also predicts permanent WD.

Methods: HRA results were combined with registry data on DB of 22,023 employees from different industry sectors. We analysed how the HRA risk categories predict DB and considered occupational group, gender, age, and prior SA as confounding variables. Cumulative incidence function illustrates the difference between the HRA risk categories, and the Fine-Gray model estimates the predictors of WD during 6-year follow-up.

Results: The most common primary reasons for permanent WD were musculoskeletal (39%) and mental disorders (21%). Self-reported health problems in the HRA, labelled as "WD risk factors", predicted DB when controlling for age and prior SA. Hazard ratios were 10.9 or over with the lower limit of the 95% confidence interval 3.3 or over among those with two simultaneous WD risk factors. 14% of the females and 17% of the males with three or more simultaneous WD risk factors had received a DB, whereas the respective figures among those without findings were 1.9% and 0.3%.

Conclusions: Self-reported health problems in the HRA, especially multiple simultaneous WD risk factors, predict permanent WD among both genders across occupational groups. Screening WD risk with a self-administered questionnaire is a potential means for identifying high-risk employees for targeting occupational healthcare actions.

Keywords: Cumulative incidence function; Disability retirement; Health risk appraisal; Work disability.

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Disabled Persons / statistics & numerical data*
  • Female
  • Finland
  • Follow-Up Studies
  • Health Status Indicators*
  • Humans
  • Male
  • Mental Disorders / epidemiology
  • Middle Aged
  • Musculoskeletal Diseases / epidemiology
  • Occupations / classification
  • Prospective Studies
  • Sick Leave / statistics & numerical data*
  • Surveys and Questionnaires