The healthy population–high disability paradox
The healthy population–high disability paradox
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健康人群——高残疾悖论
DOI：
10.1136/oemed-2013-101945
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发表时间：
2014
影响因子：
4.9
通讯作者：
M. Kivimaki
中科院分区：
文献类型：
--
作者：
J. Ferrie;M. Virtanen;M. Kivimaki
斯堪的纳维亚半岛与欧洲和美国大部分地区一样，面临着一个难题：尽管健康状况更好、自动化程度更高、体力工作更少，但越来越多的劳动年龄人口在经济上不活跃并领取残疾福利。1 ,2 与这种增加大部分相关的诊断是精神障碍，特别是抑郁症，尽管精神障碍的患病率在普通人群中并未显着增加。2 年轻人残疾养老金的增加尤其令人震惊；例如，1990 年至 2005 年间，瑞典 20-29 岁女性新发放的精神障碍养老金增加了五倍多（约 50/100 000 至 250/100 000 以上）。
Van Rijn 等人在本版 OEM 中进行了系统回顾和荟萃分析，研究了三个健康指标（自我感知健康状况不佳、心理健康状况不佳和自我报告的慢性疾病）与三种后续劳动力退出途径之间的关联；失业、残疾养老金和提前退休。本综述中的大多数研究（29/44）来自斯堪的纳维亚半岛；其余来自欧洲和美国。4
这项荟萃分析的结果为健康人群高残疾悖论提供了一些线索。虽然患有精神疾病的员工领取残疾养老金的相对风险比没有精神疾病的员工高出 80%，但平均人口归因分数 (PAF) 为 11%，这表明精神健康状况不佳对决策的影响不大……
Scandinavia, in common with much of Europe and the USA, is facing a conundrum: despite better health, more automation and less manual work, an increasing proportion of the working-age population is economically inactive and in receipt of disability benefits.1 ,2 The diagnosis associated with much of this increase is mental disorders, depression in particular, although the prevalence of mental disorders has not increased significantly among the general population.2 Increasing rates of disability pension in the young are particularly alarming; in Sweden, for example, newly granted pensions for mental disorders rose over fivefold (approximately 50/100 000 to over 250/100 000) in women aged 20–29 between 1990 and 2005.3
The systematic review and meta-analyses of Van Rijn et al in this edition of OEM examine associations between three health indicators (poor self-perceived health, poor mental health and self-reported chronic disease) and three subsequent routes of labour force exit; unemployment, disability pension and early retirement. The majority (29/44) of studies in this review are from Scandinavia; the rest from Europe and the USA.4
The results of this meta-analysis shed some light on the healthy population–high disability paradox. While the pooled relative risk of a disability pension was 80% higher among employees with pre-existing mental ill-health compared with those without, the mean population attributable fraction (PAF) was 11%, indicating that poor mental health made only a modest contribution to the decision …