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A 7-year prospective cohort study of 34,754 employed men and women was conducted.To determine the relative contribution of occupational risk factors, lifestyle factors, comorbidity, and psychological and social factors to the incidence of disability retirement because of back pain in the general working population.Permanent occupational disability is a serious consequence of a disabling process. Although this condition is a great burden to the individual and extremely costly for society, few population-based studies exist on risk factors for obtaining disability pension because of back pain.Patients granted back pain disability pension were ascertained from the national disability register. The exposure variables were taken from a health screening of all the inhabitants in one county: Norway. The participation rate was 72% to 90%.During the follow-up period, 715 individuals (2.1%) were granted a back pain disability pension. In the final combined multivariate model, the strongest predictors for future back pain disability were the occupational risk factor “physically demanding work” (odds ratio [OR], 4.1; 95% confidence interval [CI], 2.7–6.4) and the comorbidity factor “poor general health” (OR, 3.7; 95% CI, 2.4–5.8). “Feeling of being worn out” (OR, 1.7; 95% CI, 1.1–2.4), current smoking (OR, 1.4; 95% CI, 1.2–1.7), and body mass index in the upper percentile (OR, 1.6; 95% CI, 1.2–2) also predicted back pain disability pension.In a broad public health perspective within a European welfare system, subjects at high risk for future back pain disability pension perceived their work as constantly physically demanding, had health complaints other than back pain, and mostly felt generally tired and worn out. The results indicate that interventions directed toward the painful back alone may be unsuccessful in preventing disability pensions.