Aims: This cohort study on urban middle-aged men investigates the association between the use of analgesics and hypnotics, self-rated health (SRH) and disability pension. Methods: Five birth-year cohorts of middle-aged, urban, Swedish men were invited to a screening programme and were followed for approximately 11 years. Results: Out of all the subjects (n=5798), 12.4% received a disability pension during follow-up, 27.0% rated their health as less than perfect, 10.6% used analgesics and 2.9% used hypnotics. Compared with non-users of analgesics and hypnotics, the adjusted hazard ratio of disability pension for the simultaneous use of both drugs was 7.0 (95% CI: 4.3, 11.6) and the adjusted odds ratio of poor SRH was 16.5 (6.3, 43.5). Thus, the use of analgesics and hypnotics was positively related to poor SRH and predicted award of a disability pension within an 11-year follow-up. This may reflect that the use of analgesics and hypnotics is a proxy of disease but an independent negative effect on health cannot be excluded. Conclusions: Information on the use of these drugs could be used to predict the award of a disability pension, such as in different geographical areas or population groups.
Bue-Bjorner J., Søndergaard-Kristensen T., Orth-Gomér K., Tibblin G., Sullivan M., Westerholm P.Self-rated health - a useful concept in research, prevention and clinical medicine. Uppsala: Swedish Council for Planning and Coordination of Research, 1996.
2.
Månsson N-O. , Råstam L.Self-rated health as a predictor of disability pension and death: a prospective study of middle-aged men. ScandJ Public Health2001 (in press).
3.
Rosholm JU, Christensen K.Relationship between drug use and self-reported health in elderly Danes. Eur J Clin Pharmacol1997; 53: 179-83.
4.
Svärdh C., Isacsson D., Pedersen NLSelf-rated health among cardiovascular drug users in a study of Swedish twins . Scand J Soc Med1998; 26: 223-31.
5.
Merlo J., Östergren P-O., Hanson BSPerceived health and use of drugs. In: Swedish Medical Association , Annual Meeting. Göteborg: Sörmlands Grafiska AB, Katrineholm1998.
6.
Månsson N-O.Disability pension. Epidemiological and financial aspects (Thesis). Department of Community Medicine, MalmöUniversity Hospital, Lund University, 1997.
7.
National Social Insurance Board.Statistical information Is-I 1997:3. Stockholm: Riksförsäkringsverket, 1997. (In Swedish.)
8.
Trell E.Community-based preventive medical department for individual risk factor assessment and intervention in an urban population. Prev Med1983; 12: 397-402.
9.
Månsson N-O. , Råstam L., Eriksson K-F., Israelsson B., Melander A.Incidence of and reasons for disability pension in a Swedish cohort of middle-aged men. Eur J Public Health1994; 4: 22-6.
10.
Bray GADefinition, measurement and classification of the syndromes of obesity. Int J Obes1978; 2: 99-112.
11.
Statistics Sweden.Health and medical care 1980-1989. Report No. 76. Örebro: Statistiska centralbyrån , 1992. (In Swedish.)
12.
Selzer M.The Michigan Alcoholism Screening Test. The quest for a new diagnostic instrument . Am J Psychiatry1971; 127: 1653-8.
13.
Pokorny AD, Miller BA, Kaplan HBThe Brief MAST. A shortened version of the Michigan Alcoholism Screening Test . Am J Psychiatry1972; 129: 342-5.
14.
Kristenson H., Trell E.Indicators of alcohol consumption: comparisons between a questionnaire (Mm-MAST), interviews and serum γ-glutamyl transferase (GGT) in a health survey of middle-aged males. Br J Addict1982; 77: 297-304.
15.
National Labour Market Board.Nordic Classification of Occupation, 4th ed. Helsingborg : Arbetsmarknadsstyrelsen, 1978. (In Swedish.)
16.
Statistics Sweden.Population and housing census 1980. Stockholm: Statistiska centralbyrån, 1983. (In Swedish.)
17.
Statistics Sweden.Swedish socioeconomic classification. (Reports on statistical coordination1982:4.) Stockholm : Statistiska centralbyrån, 1982 . (In Swedish.)
18.
Sundquist J. , Ekedahl A., Johansson SESales of tranquillizers, hypnotics/sedatives and antidepressants and their relationship with underprivileged area score and mortality and suicide rates. Eur J Clin Pharmacol1996; 51: 105-9.
19.
Merlo J., Hedblad B., Ögren M., Ranstam J., Östergren P-O., Ekedahl A., et al. Increased risk of ischaemic heart disease in elderly men using anxiolytics-hypnotics and analgesics. Eur J Clin Pharmacol1996; 49: 261-5.
20.
Malone DC, Billups SJ, Valuck RJ, Carter BLDevelopment of a chronic disease indicator score using a veterans affairs medical center medication database. J Clin Epidemiol1999; 52: 551-7.
21.
Lannerstad O.Morbidity related to smoking and other risk factors. Scand J Soc Med1980; 8: 25-31.
22.
Månsson N-O. , Råstam L., Eriksson K-F., Israelsson B.Socioeconomic inequalities and disability pension in middle-aged men. Int J Epidemiol1998; 27: 1019-25.
23.
Hörnquist JOAbuse of alcohol and disability pension. The effect of the liberalization in Sweden 1977. Scand J Soc Med1982; 10: 113-18.
24.
Elton M., Hörnquist JOAbusers of alcohol granted disability pension. Prospective longitudinal and multidisciplinary studies (Thesis). Department of Psychiatry, Preventive and Social Medicine, Linköping University, Linköping, 1983.
25.
Månsson N-O. , Israelsson B.Middle-aged men before and after disability pension. Health screening profile with special emphasis on alcohol consumption . Scand J Soc Med1987; 15: 185-9.
26.
Månsson N-O. , Råstam L., Eriksson K-F., Israelsson B.Alcohol consumption and disability pension among middle-aged men. Ann Epidemiol1999; 9: 341-8.
27.
Månsson N-O. , Eriksson K-F., Israelsson B., Ranstam J., Melander A., Råstam L.Body mass index and disability pension in middle-aged men - non-linear relations. Int J Epidemiol1996; 25: 80-5.
28.
Kristensen TSUse of medicine as a coping strategy among Danish slaughterhouse workers. J Soc Adm Pharm1991; 8: 53-64.
29.
Folkman S., Lazarus RSThe relationship between coping and emotion: implications for theory and research . Soc Sci Med1988; 26: 309-17.
30.
Borg S., Blennow G., Sandberg P., Tönne U., Wikander B.Benzodiazepine dependence and other long term secondary effects-a review. Läkartidningen1986; 83: 321-6 (In Swedish.)
31.
Colsher PL, Wallace RBEpidemiologic considerations in studies of cognitive functions in the elderly: methodology and nondementing acquired dysfunction. Epidemiol Rev1991; 13: 1-27.
32.
Ranstam J., Merlo J., Blennow G., Hanson BS, Östergren P-O., Melander A.Impaired cognitive function in elderly men exposed to benzodiazepines or other anxiolytics. Eur J Public Health1997; 7: 149-53.
33.
Aro S., Hasan J.Occupational class, psychosocial stress and morbidity. Ann Clin Res1987; 19: 62-8.
34.
Barsky AJ, Cleary PD, Klerman GLDeterminants of perceived health status of medical outpatients. Soc Sci Med1992; 34: 1147-54.
35.
Møller L., Kristensen TS, Hollnagel H.Self rated health as a predictor of coronary heart disease in Copenhagen, Denmark. J Epidemiol Community Health1996 ; 50: 423-8.
36.
Mossey JM, Shapiro E.Self-rated health: a predictor of mortality among the elderly. Am J Public Health1982; 72: 800-8.
37.
Kaplan GA, Camacho T.Perceived health and mortality: a nine-year follow-up of the human population laboratory cohort. Am J Epidemiol1983; 117: 292-304.
38.
Idler EL, Angel RJSelf-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study . Am J Public Health1990; 80: 446-52.
39.
Wannamethee G., Shaper AGSelf-assessment of health status and mortality in middle-aged British men. Int J Epidemiol1991; 20: 239-45.
40.
Idler EL, Benyamini Y.Self-rated health and mortality: a review of twenty-seven community studies . J Health Soc Behav1997; 38: 21-37.
41.
Sundquist J. , Johansson S-E.Self reported poor health and low educational level predictors for mortality: a population based follow up study of 39156 people in Sweden. J Epidemiol Community Health1997; 51: 35-40.
42.
Miilunpalo S., Vuori I., Oja P., Pasanen M., Urponen H.Self-rated health status as a health measure: the predictive value of self-reported health status on the use of physician services and on mortality in the working-age population. J Clin Epidemiol1997; 50: 517-28.
43.
West SL, Strom BLValidity of pharmacoepidemiology drug and diagnosis data. In: Strom BL, editors. Pharmacoepidemiology , 2nd ed. Chichester: John Wiley & Sons Ltd, 1994: 549-80.
44.
Hartzema AG, Perfetto EMSources and effects of drug exposure and unintended effect misclassification in pharmacoepidemiologic studies. In: Hartzema AG, Porta MS and Tilson HH, editors. Pharmacoepidemiology, an introduction, 2nd ed. Cincinnati : Harvey Whitney Books Co, 1991: 176-206.
45.
Tibblin G.A population study of 50-year-old men. An analysis of the non-participation group. Acta Med Scand1965; 178: 453-9.
46.
Janzon L., Hanson B., Isacsson S-O., Lindell S-E., Steen B.Factors influencing participation in health surveys. Results from prospective population study `Men born in 1914' in Malmö, Sweden. J Epidemiol Community Health1986; 40: 174-7.
47.
Rosengren A. , Wilhelmsen L., Berglund G., Elmfeldt D.Non-participants in a general population study of men, with special reference to social and alcoholic problems. Acta Med Scand1987; 221: 243-51.
48.
Swedish Drug Statistics.Yearly Series, 1982-93. Stockholm: National Corporation of Pharmacies.
49.
Blennow G., Romelsjö A., Leifman H, Leifman A, Karlsson G. Sedatives and hypnotics in Stockholm: social factors and kinds of use. Am J Public Health1994; 84: 242-6.
