Scandinavian Journal of Public Health, 2011; 39: 830–838 ORIGINAL ARTICLE Association between hand grip/body weight ratio and disability pension due to musculoskeletal disorders: A population-based cohort study of 1 million Swedish men ANNINA ROPPONEN 1 , KARRI SILVENTOINEN 2 , PER TYNELIUS 3 & FINN RASMUSSEN 3 1 Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland, 2 Department of Social Research, University of Helsinki, Helsinki, Finland, and 3 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden Abstract Aims: To investigate the predictive value of hand grip/body weight ratio and hand grip strength in early adulthood for obtaining a disability pension (DP) due to musculoskeletal disorders in later life. Methods: A nationwide population-based sample of men born 1951–76 (n ¼ 1,387,166) in Sweden and anthropometric and strength indicators from their conscription examination. Register data on the date and diagnoses of granted DP between the years 1971–2006. Cox proportional hazards regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI). Results: The lowest quintile of hand grip/body weight ratio predicted a greatly increased risk (HR 2.51, 95% CI 2.40–2.63) for DP due to musculoskeletal disorders compared to the mid-quintile. The highest quintile of hand grip/body weight ratio predicted a decreased risk (HR 0.80, 95% CI 0.75–0.84). Stratification of the hand grip/body weight ratio with body mass index confirmed the results. However, the highest quintiles of hand grip strength adjusted for height and weight predicted a somewhat increased risk for DP due to musculoskeletal disorders (HR 1.25, 95% CI 1.18–1.32). Conclusions: This study indicates that the hand grip/body weight ratio in young adulthood is strongly and inversely associated with men’s risk of obtaining a disability pension due to musculoskeletal disorders in later life. However, the risk seems to be mediated through the body weight. The properties of hand grip/body weight ratio should be further evaluated before it can be recommended for use in clinical and epidemiological studies. Key Words: Disability pension, hand grip strength, musculoskeletal disorders Background Increasing rates of disability pensions (DP) create severe economic burden on the society and also profoundly affect the lives of an increasing number of individuals [1,2]. Musculoskeletal disorders are among the most common causes of these long-term absences from work, but the knowledge about life course risk factors for DP due to musculoskeletal disorders is scarce [3]. So far, muscle strength has not been widely studied as a predictor of consequences of musculoskeletal disorders, such as disability pension. However, muscle strength has been shown to be important for physical functioning and ability to work among middle-aged people [4,5]. One study showed that muscle strength is associated with walking impairment after 22 years of follow up among initially middle-aged individuals [6]. Moreover, a study exists to show an association between muscle strength and coronary heart and cerebrovascular diseases [7]. An explanation why muscle strength has not been widely used for the prediction of consequences of musculoskeletal disorders may be that pain is a very common characteristic of musculoskeletal disorders and is also known to play an important role in physical function tests. Therefore, a physical function test not to be very likely influenced by pain would be an alternative. Hand grip strength is seemingly a promising trait, both relatively highly heritable (52% of variance is due to additive genetic effects [8]) well predictive for vitality and functional limitations [9] Correspondence: Finn Rasmussen, Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institute, Norrbacka, SE-171 76 Stockholm, Sweden. E-mail: finn.rasmussen@ki.se (Accepted 4 September 2011) ß 2011 the Nordic Societies of Public Health DOI: 10.1177/1403494811424610