Objectives: In addition to individual-level characteristics also contextual factors may contribute to the large regional variation seen in disability retirement. We examined the associations of municipality-level characteristics and disability retirement due to all causes, musculoskeletal diseases, mental disorders and other diseases.
Methods: A register-based study was conducted with a 20% random sample of the Finnish population aged 25-62 years. Municipalities were separately divided into quintiles by their proportion of manual workers, unemployed and industrial employees. Multilevel Poisson regression analysis was applied to examine associations between the three municipality characteristics and disability retirement during a 5-year follow-up.
Results: All three municipality-level indicators were associated with disability retirement, but the association between the proportion of industrial workers and disability retirement disappeared after adjustment for age, gender, marital status, socioeconomic position, unemployment and industrial employee status at the individual level. The associations were particularly strong for disability retirement due to musculoskeletal diseases: in the municipalities with the highest proportion of manual workers, the risk for disability retirement due to musculoskeletal diseases was 2.5 times higher than in the municipalities with least manual workers. After adjustment for the individual-level factors, the risk was 1.5 times higher. Cross-level interactions showed that the risk of disability retirement increased with the increasing proportion of unemployment in the municipality only among those who had not experienced unemployment themselves.
Conclusions: Municipality-level characteristics made an independent contribution to the probability of disability retirement in particular due to musculoskeletal diseases. Also, area-level characteristics should be considered when targeting disability retirement.