Disability pensions in Finnish farmers based on 5

The Nordic Meeting on Agricultural Occupational Health & Safety,
August 25–27, 2014, Hotel Haikko Manor, Porvoo, Finland
Photo: Sakari Alasuutari
Disability pensions in Finnish farmers based on
5-year insurance records
PhD, Principal Research Scientist Janne P. Karttunen1;
PhD, Professor Risto H. Rautiainen2,3; PhD stud., Research Scientist Jarkko Leppälä3
1 TTS
Work Efficiency Institute, Finland
2 Dept. of Environ., Agric. and Occup. Health, College of Public Health,
University Of Nebraska Medical Center
3 MTT Agrifood Research Finland
Introduction and objectives of the study
● In many western countries including Finland, agriculture ranks among the most
hazardous industries based on occupational injury rates. 1
● In addition to injuries, occupational and other work-related diseases constitute a
major threat to the health of farmers. 2
● A growing body of literature has focused on the characteristics and risk factors for
occupational injuries and diseases in farming. 3–7
● However, there is little current information available on the long-term disability from
work-related and other injuries and diseases in farmers. 8–10
● Severe outcomes may cause major changes in production, premature retirement from
farming, or even death.
● Our study aimed to investigate the characteristics and costs of disability pensions in
the Finnish farming population. Using longitudinal national insurance data, we aimed
to identify medical conditions causing most disabilities and greatest insurance costs.
Materials and methods 1/2:
Study setting, subjects, and insurance system
● Finnish agriculture is mostly based on traditional family farming. The self-employed
farming population includes farmers, spouses, and family members (= farmers).
● The self-employed Finnish farming population declined from 84,063 in 2008 to 73,334
in 2012. Simultaneously, the percentage of male farmers increased from 66 to 67.11
● In Finland, farmers must take a statutory pension insurance and an accident insurance
against occupational injuries and diseases. 12
● The Farmers’ Social Insurance Institution (Finnish acronym: Mela) administers these
pension and accident insurance schemes.
● Disability pensions can be full (> 60% loss of work ability) or partial (> 40%) and
permanent or temporary (= time-limited rehabilitation support). 12
● For brevity, full and partial disability pensions are referred to as ”permanent”, whereas
full and partial rehabilitation support is referred to as ”temporary” disability pensions.
Materials and methods 2/2:
Research data and statistical methods
● Data provided by Mela included all awarded disability pension cases in Finnish farmers
over a five-year period (2008–2012).
● These cases included full and partial as well as permanent and temporary disability
pension cases.
● The dataset consisted of demographic variables (gender, age, native language) and
insurance variables including years covered by insurance, paid pension benefits and the
primary and secondary medical reasons (ICD-10 health outcome code13) for each case.
● The research team had no access to identifiable information on study subjects.
● The data analysis included descriptive statistics of the age and insurance years of
farmers as well as the distribution of awarded disability pensions by pension type
and ICD-10 code.
● The differences (p<0.05) between genders were assessed using the two-tailed t-test
for continuous variables and two-tailed chi-square test for categorical variables.
Results 1/3:
Characteristics of farmers with a disability pension
● During 2008–2012, a total of 4,088 disability pension cases were awarded to Finnish
farmers; an annual average rate of 1.04 cases per 100 person-years (males 0.94/100
and females 1.24/100).
● Out of these cases, 2,493 (61%) were permanent and 1,595 (39.0%) were temporary.
● The total cost of these cases was 60.2 MEUR (82.8 MUSD) in the five-year period.
● The average age of the farmers was 54.5 years (range 23–63) and the average insured
career was 27.0 years (1–43) at the time when the disability pension was awarded.
● Males had longer careers as insured farmers than their female peers at the time when
either permanent or temporary disability pension was awarded (t-test, p=0.131 and
p<0.001, respectively).
● Finnish-speaking farmers (vs. Swedish-speaking) were over-represented in both
outcomes (chi-square tests, p<0.001).
Photo: Janne Karttunen
Results 2/3:
Characteristics and costs of permanent disability pensions
Cases
9%
Diseases of the circulatory
system
6%
46%
Diseases of the nervous
system
Neoplasms
10%
15%
9%
Mental and behavioral
disorders
6%
8%
Costs
Diseases of the
musculoskeletal system
Injury, poisoning and
certain other…
4%
5%
9%
47%
10%
16%
Other outcomes
● Diseases of the musculoskeletal system (MSDs) were typically arthosis of knee or hip,
shoulder lesions, and various conditions in the spine.
● Mental and behavioral disorders were typically depressive episodes or recurrent
depressive disorders.
● The total costs of the permanent disability pensions were almost 43.5 MEUR (59.8 MUSD)
in the five-year period (72.2% of the total insurance costs of the disability pension system).
● MSDs in general and depressive episodes were more common among females, and
diseases of the circulatory system in general were more common among males
(chi-square test, p<0.05).
Results 3/3:
Characteristics and costs of temporary disability pensions
Cases
5%
Diseases of the
musculoskeletal system
6%
Mental and behavioral
disorders
5%
Injury, poisoning and
certain other…
6%
42%
15%
Costs
Neoplasms
4%
4%
5%
5%
6%
44%
Diseases of the circulatory
system
21%
Diseases of the nervous
system
32%
Other outcomes
● MSDs and mental disorders were typically the same as in permanent disability pensions.
Injuries were typically injuries of muscle and tendon at shoulder and upper arm level.
● The total costs of the permanent disability pensions were almost 16.7 MEUR (23.0 MUSD)
in the five-year period (27.8%). In general, mental disorders stand out as relatively costly
outcomes and injuries stand out as relatively inexpensive outcomes.
● MSDs and mental disorders in general were more common among females, and diseases
of the circulatory system in general were more common among males (chi-square test,
p<0.05).
Discussion 1/2:
Comparison with previous studies
● Based on our results, MSDs were the most common primary medical condition for both
pension types among farmers in general and among female farmers in particular.
● In addition, mental disorders such as depression were common among both genders
and especially among females.
● Our results are consistent and add to previous studies5,15,16, which emphasize MSDs and
mental disorders as serious problems in western farming.
● In comparison with the general Finnish working population9, MSDs were more common
(45% vs. 34%) and mental disorders were less common (18% vs. 30%) among farmers.
● Females had significantly shorter career as an insured farmer than males at the time
when pension was awarded. Gender distribution of labor-intensive farm work and
corresponding exposures as reported by a previous study14 could explain our result.
● Finnish-speaking farmers (vs. Swedish-speaking) had elevated risk of both pension types.
Similar finding has been detected earlier regarding occupational injuries and diseases.6
● Relative proportions of the common outcomes and their insurance costs were similar
with few exceptions. There are no earlier (national) studies available on this matter.
Photo: Janne Karttunen
Discussion 2/2:
Strengths and limitations of the study
● Our longitudinal data enabled reliable and accurate identification of the characteristics
and costs of disability pensions in the self-employed Finnish farming population.
● Investigation of disability pensions adds new information to previous knowledge based
on surveys and accident insurance data.
● However, thorough analysis of the secondary ICD-10 codes as well could contribute to
deeper understanding of the complexity of work-related and other medical conditions
resulting in disability.
● Our findings were based on new cases awarded in the five-year period, and may differ
in some respects if compared to a ”snapshot” of active disability pension
characteristics at a given time.
Conclusions and recommendations
● While farmers have high risk of occupational injuries and diseases, they also have a
high risk of work-related and other chronic conditions that affect their work ability.
● The early detection and prevention of the most typical and costly medical conditions,
MSDs and mental disorders, must be stressed.
● Future studies should examine more closely why female farmers and Finnish-speaking
farmers in general have higher risk of various adverse health outcomes.
● Improvements in the working environment and methods to reduce heavy or repetitive
manual labor should be emphasized in vocational and extension education of farmers.
● Young farmers taking over a farm which has a history of adverse health outcomes
indicating potentially high-risk working conditions could be pursued.
● Insurance incentives conditional to defined improvements in the working conditions
could be offered to farmers in general and specifically to young farmers.
● Modern working conditions with meaningful and varied work tasks could enhance
both physical and mental wellbeing of farmers, and thus reinforce their careers.
References
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Rautiainen et al. 2009. Risk factors for serious injury in Finnish agriculture. Am. J. Ind. Med. 52(5): 419-428.
Van den Broucke, S., and A. Colémont. 2011. Behavioral and nonbehavioral risk factors for occupational injuries
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Thank you for your attention!
Any questions?
Photo: Janne Karttunen