Contextual factors and social consequences of incident disease

Background
Even within countries with a universal welfare state large
differences in the incidence of disability pension between
geographical areas have been reported. Disentangling the causes
for these regional differences is confounded by both contextual
factors (e.g. unemployment rates) and by differences in
incidence of longstanding illness which varies according to
the different kind of diseases. Few studies have investigated the
geographical variation on the effect of specific diseases on the
risk of labour market exclusion. The aim of this study is to
analyse the risk of labour market exclusion following incident
hospitalization for coronary heart disease (CHD) and how this
rate may be modified by contextual factors on municipality
level.
Methods
Register-based study with a longitudinal design, using a register
of a 10% sample of the Danish population aged 44–59 in 1996–
2000, representing a study base of 516 455 person-years.
Individual socio-demographic data and data on hospitalization
are linked to information on employment and a set of social
indicators ranging the 275 Danish municipalities.
Results
Crude OR for leaving the labour market 2 years after CHD was
2.87 (95% CI ¼ 2.38–3.45). Adjusting for age, gender, marital
status, ethnicity, education, and all-cause hospitalization
(including CHD and co-morbidity) showed an OR ¼ 2.57
(95% CI ¼ 2.12–3.11). Including municipal indicators of social
deprivation (average equalized income) in the analyses did not
change the estimates, and there was no indication of effect
modification, synergy index ¼ 1.47 (not significant).
Conclusion
Our preliminary findings indicate that the large variation in
disability pension incidence is not primarily an effect of
differential social consequences across municipal levels of
affluence