Determinants of disability pension following sickness absence in French private-sector employees.

Abstract

Disability pension represents a major public health challenge in France, with 843 000 beneficiaries and €8.5 billion expenditure in 2022. The transition from sickness absence to disability pension remains insufficiently documented in the French context. This study identifies risk factors for disability pension among French private-sector employees to inform targeted prevention strategies. We conducted a retrospective cohort study of 228 514 employees from a complementary health insurer (2018-23), encompassing 364 762 sickness absence episodes. Risk factors for transition to disability pension were analyzed using Kaplan-Meier survival and Cox proportional hazards models stratified by absence duration, adjusting for sociodemographic, employment, organizational, and health-related factors. Of all episodes, 6404 (1.8%) progressed to disability pension. Risk was particularly high among individuals aged ≥50 years and among those in higher-risk socio-professional groups, notably executives and individuals belonging to the "Other" category (including farmers, merchants, and business owners), compared with employees. Increased risk was also observed among workers in the lowest income quartile and among employees in large companies. Long-term sickness absence (>180 days) was associated with a higher risk of disability pension. Therapeutic part-time work reduced risk only for short absences. Most risk factors lost predictive power beyond 12 months, with declining effect sizes over time. This study identifies a critical 12-month intervention window. Early interventions should prioritize therapeutic part-time work and strengthen targeted support for older workers, executives, and large company employees to reduce disability pension transitions and curb rising costs.