Disability pensioning: Can ethnic divides be explained by occupation, income, mental distress, or health?

Background: We aimed to test the hypothesis that differences in disability pensioning among different ethnic groups were attributable to differences in occupation, income, health, and mental distress. Methods: In a health survey conducted between 2000 and 2001 in Oslo, nearly half (48.7%; 11,072) of all inhabitants aged 40, 45 and 59-60 years participated. Survey data related to work, general health and mental distress were linked to disability pension data from the National Insurance Administration, and to income and country of origin data from Statistics Norway. A total of 9195 persons were eligible for disability pension at the end of 2000. Results: Approximately 5% received a disability pension in the 4 years following the health survey. An age-and gender-adjusted odds ratio of 2.27 (95% confidence interval (CI) 1.55-3.23) among immigrants from developing countries and Eastern Europe as compared to ethnic Norwegians was reduced to 0.88 (95% CI 0.46-1.67) after adjusting for occupation, working conditions, and income. The odds ratio was further reduced to 0.63 (95% CI 0.32-1.25) when self-reported health and mental distress were added to the model. Conclusions: The higher risk of receiving a disability pension among immigrants from developing countries and Eastern Europe than among ethnic Norwegians was largely explained by work factors and level of income. The addition of mental distress and self-reported health to the multivariate model further reduced the risk, although not significantly different from ethnic Norwegians.