Using Administrative Data to Assess the Risk of Permanent Work Disability: A Cohort Study.
Matthias Bethge, Katja Spanier, Marco Streibelt
PMID 32910345WHAT IT FOUND
A score from pension, income and benefit records separated future disability-pension cases well.
At a score of 50 points, it flagged 71.5% of cases and correctly classified 80.6% of people. Most people with high scores stayed employed, so it cannot assign rehabilitation.
Key findings
01The risk score discriminated people who later received a disability pension from those who did not, with an area under the receiver operating curve of 0.839 and internal-validation optimism below 0.001.
02At the optimal threshold of 50 points, the score identified 71.5% of future disability-pension cases and correctly classified 80.6% of all individuals.
03A score of 60 points or more was associated with a 10.1% probability of a disability pension and a hazard ratio of 17.32, but most people with high scores remained employed.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The data were collected to calculate pensions, not to assess rehabilitation needs, so diagnosis and illness type were missing. The model was only internally validated, so accuracy in other populations may be worse. The positive predictive value was low, and most people with high risk scores were still employed at follow-up. Employment and income data were not real time; they were available only after the end of the year, so the score may lag current status. Temporary and permanent disability pensions were combined because temporary pensions usually turn into permanent pensions after 9 years.
Declared interests
The study was supported by Deutsche Rentenversicherung Bund and Universität zu Lübeck. The supplied text gives no author conflict-of-interest disclosures.
The easy way to misread this
Do not conclude that a high risk score means a patient should be referred to rehabilitation. Most people with high risk scores remained employed at follow-up, and the paper reports that the low positive predictive value makes the score unsuitable for directly assigning rehabilitation services.