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Recent studies indicate that early retirement per se may have a negative effect on health to such an extent that it increases mortality risk. One type of early retirement often referred to in these studies is retirement with disability pension/benefit. Given the overall objective of disability benefit programmes – to help the disabled live socially and economically satisfactory lives, freed from exposure to employment health hazards and thus avoid further declines in health – the finding is challenging. This paper examined the relationship between timing of retirement and mortality using a cohort of Swedish construction workers. The mortality risk of disability pensioners – excluding those with diagnoses normally connected to increased mortality – was compared with the risk of those continuing to work. Although initial indications were in line with earlier results, it became obvious that the increased mortality risk of disability pensioners did not depend on early retirement per se but on poor health before early retirement not explicitly recognized in the diagnosis on which the disability pension rested. The results indicate that there are no general differences in mortality depending on timing of retirement. Future studies of mortality differences arising from working or not working must sufficiently control for health selection effects into the studied retirement paths.

Health selection, as one of the several possible explanations for social inequities in health, has been receiving more attention recently but few researchers turn the issue into a question of discrimination. The aim of the study was to analyse the impact of health in young age for social position in adult age and to discuss health selection in terms of discrimination from a gender-theoretical perspective. A prospective cohort study was conducted, in which all pupils (N = 1083) in the last year of compulsory school in a middle-sized municipality in northern Sweden were followed for 14 years. The response rate was high, with 96.6% still participating after 14 years. The data were collected through repeated comprehensive self-administered questionnaires as well as through teacher interviews and register data. Health selection was analysed in a multiple logistic regression model, with working-class position at age 30 as a dependent variable and different measures of health/health behaviour at age 16 and 21 as independent variables. Overall, the impact of early health/health behaviour on future socioeconomic position was small or non-existent. However, even after correction for possible mediating and moderating mechanisms, being overweight at age 16 and at age 21 was related to future working-class position among women only. Possible mediating mechanisms were feeling looked down upon, not being active in associations and not reading cultural/political events in daily newspapers. Early menarche together with early motherhood and low education could not explain the correlations. Our results indicate that overweight girls and young women are exposed to gendered discrimination which probably occurs in many arenas, based on the societal norms for female bodies in our society. There is a need to redirect research on health selection into gender research in order to further explore the subject as well as the possible mechanisms of gendered discrimination.

Comparing mortality rates and recognizing health selection bias : A response to Wallman and Svardsudd

A prospective study was started in 1981, including all 1083 pupils in the last year of compulsory school in a municipality in the northern part of Sweden. All pupils were followed up after 2 years. They were investigated with a comprehensive self-administered questionnaire as well as studies of records and interviews with teachers and school nurses. The total non-participation rate in the study was less than 1%. The main results of the study are the following: unemployment leads to increased psychosomatic and psychological symptoms, decreased social activities in clubs, increased abuse of alcohol and narcotics and increased utilization of health care services. The effects of unemployment are somewhat different among girls and among boys. Girls are more exposed to unemployment and unemployment also leads to more negative effects among them. Hidden unemployment has the same effects as unemployment but the effects are less pronounced.