Objectives Job strain has previously been shown to predict disability pension, but it is unknown whether effortreward imbalance (ERI), another major stress model, is also associated with disability pension. Methods We examined ERI as a risk factor for diagnosis-specific disability pension in a cohort of 51 874 public-sector employees in Finland. To control for reporting bias, work unit-level scores of ERI (based on the survey responses of 35 260 employees in 2000-2002) were constructed and linked to all eligible employees. A sub-cohort of the respondents was analyzed also with individual-level ERI. Disability pension data were derived from national pension registers with no loss to follow-up. The outcomes were all-cause disability pension and disability pension due to depression, musculoskeletal diseases, and ischemie heart diseases (IHD). Multivariate Cox proportional hazard models (adjusted for sociodemographic factors, baseline health, and work-related characteristics) were used for analyses. Results During a mean 8.9 years of follow-up, 4542 participants were granted disability pension. An increased risk for disability pension due to depression was detected for both high work unit-and individual-level ERI [hazard ratio (HR) 1.63,95% confidence interval (95% CI) 1.31-2.04 and HR 1.90,95% CI 1.51-2.40, respectively].High individual-level ERI increased the risk of disability pension due to musculoskeletal diseases (HR 1.32,95% CI 1.13-1.53), but no association was observed for work unit-level ERI (HR 1.02, 95% CI 0.88-1.19). ERI was not associated with disability pension due to IHD. Conclusion The present study showed a consistent association between high ERI and an increased risk of disability pension due to depression.