Sociodemographic, work- and health-factors predict rejection of vocational rehabilitation in Finland

Abstract Background Vocational rehabilitation (VR) decreases the number of premature retirements. Pension insurance companies operate private sector employees’ VR in Finland. In 2022, some 15,500 individuals received rehabilitation in this earnings-related pension system. However, the rejection rate was 46%. Similar systems exist throughout OECD. VR facilitates finding suitable work despite an illness. A person is eligible if a threat of disability exists within the next few years and non-medical requirements are met. Currently VR is underused. Thus, it is important to understand which sociodemographic, work- and health-related factors predict a VR rejection. Methods We had full application data from a Finnish insurer for 2015-20. Our data cover roughly 40% of the 2.7M person Finnish working population. We excluded applicants with preceding VR and only included under 58-year-old applicants rejected due to ‘no risk for disability’. Our data comprised age, region of residence, salary, doctor’s assessment grades, diagnosis, industry, and data on preceding sickness, unemployment and rehabilitation benefits. For analysis, we used logistic regression. Results After adjustment, younger age and mental disorders showed largest effects on rejection. Features associated with a less severe medical condition as well as decreased employment were significantly connected to rejection. Industry and place of residence showed no effect. Of note, stable employment and higher pay predict entry possibly due to more possible rehabilitation options and better health in general. Interestingly, people with multiple diagnoses are more likely to be rejected. Conclusions The work-ability of aging European populations could benefit from vocational rehabilitation that better suits mental disorders and younger people. Key messages • Vocational rehabilitation (VR) is an underused method to maintain work ability. • Our study identified groups that could benefit from tailored solutions in VR that decrease barriers to entry.