Occupational class inequalities in disability retirement after hospitalisation

AIMS

This study aimed to investigate whether hospitalisation is associated with increased risk of disability retirement differently across four occupational classes.

METHODS

170,510 employees of the City of Helsinki, Finland were followed from 1990 to 2013 using national registers for hospitalisations and disability retirement. Increases in the risk of disability retirement after hospitalisation for any cause, cardiovascular diseases, musculoskeletal disorders, mental disorders, malignant neoplasms, respiratory diseases and injuries were assessed across four occupational classes: professional, semi-professional, routine non-manual and manual, using competing risks models.

RESULTS

In general, hospitalisation showed a slightly more increased risk of disability retirement in the lower ranking occupational classes. Hospitalisation among women for mental disorders showed a more increased risk in the professional class (hazard ratio 14.73, 95% confidence interval 12.67 to 17.12) compared to the routine manual class (hazard ratio 7.27, 95% confidence interval 6.60 to 8.02). Occupational class differences were similar for men and women. The risk of disability retirement among women increased most in the routine non-manual class after hospitalisation for musculoskeletal disorders and injuries, and most in the professional class after hospitalisation for cardiovascular diseases. The corresponding risks among men increased most in the two lowest ranking classes after hospitalisation for injuries.

CONCLUSIONS

Ill-health as measured by hospitalisation affected disability retirement in four occupational classes differently, and the effects also varied by the diagnostic group of hospitalisation. Interventions that tackle work disability should consider the impact of ill-health on functioning while taking into account working conditions in each occupational class.

Changes in leisure-time physical activity and subsequent common mental disorders among ageing employees

The aim of this study was to examine whether changes in leisure-time physical activity are associated with subsequent common mental disorders. Follow-up survey data were collected from 40 to 60-year-old employees of the City of Helsinki, Finland, at three time points: 2000-2002 (rr 67%), 2007 (rr 83%) and 2012 (rr 79%). We excluded those with common mental disorders at phase 1 (n = 1162) and in total 4681 respondents (81% women) were available for the analyses. Compared with those persistently active, those persistently inactive had an increased risk of subsequent common mental disorders. Promoting leisure-time physical activity may prove useful for preventing common mental disorders.

Occupational class differences in long sickness absence: a register-based study of 2.1 million Finnish women and men in 1996-2013

OBJECTIVES

Sickness absence is consistently higher in lower occupational classes, but attempts to analyse changes over time in socioeconomic differences are scarce. We examined trends in medically certified sickness absence by occupational class in Finland from 1996 to 2013 and assessed the magnitude and changes in absolute and relative occupational class differences.

DESIGN

Population-based, repeated cross-sectional study.

SETTING

A 70% random sample of Finns aged between 25 and 63 years in the years 1996-2013.

PARTICIPANTS

The study focused on 25- to 63 year-old female (n between 572 246 and 690 925) and male (n between 525 698 and 644 425) upper and lower non-manual and manual workers. Disability and old age pensioners, students, the unemployed, entrepreneurs and farmers were excluded. The analyses covered 2 160 084 persons, that is, 77% of the random sample.For primary and secondary outcome measures, we examined yearly prevalence of over 10 working days long sickness absence by occupational class. The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were used to assess the magnitude and changes in occupational class differences.

RESULTS

Compared with mid-1990s, sickness absence prevalence was slightly lower in 2013 in all occupational classes except for female lower non-manual workers. Hierarchical occupational class differences in sickness absence were found. Absolute differences (SII) peaked in 2005 in both women (0.12, 95% CI 0.12 to 0.13) and men (0.15, 95% CI 0.14 to 0.15) but reached the previous level in women by 2009 and decreased modestly in men until 2013. Relative differences narrowed over time (p<0.001) but levelled off by 2013.

CONCLUSIONS

Sickness absence prevalence is currently slightly lower in almost all occupational classes than in the mid-1990s, but occupational class differences have remained large. Ill health and poor working conditions especially in the lower occupational classes should be targeted in order to reduce sickness absence and to achieve longer working lives.

Changes in psychosocial and physical working conditions and psychotropic medication in ageing public sector employees: a record-linkage follow-up study

OBJECTIVES

To investigate whether changes in psychosocial and physical working conditions are associated with subsequent psychotropic medication in ageing employees.

METHODS

Data were from the Helsinki Health Study, a cohort study of Finnish municipal employees, aged 40-60 years at phase 1 (2000-2002). Changes in psychosocial and physical working conditions were measured between phase 1 and phase 2 (2007). Survey data were longitudinally linked to data on prescribed, reimbursed psychotropic medication purchases (Anatomical Therapeutic Chemical) obtained from the registers of the Social Insurance Institution of Finland between the phase 2 survey and December 2013 (N=3587; 80% women). Outcomes were any psychotropic medication; antidepressants (N06A); anxiolytics (N05B); and sedatives and hypnotics (N05C). Cox regression analyses were performed.

RESULTS

During the follow-up, 28% of the participants were prescribed psychotropic medication. Repeated exposures to low job control, high job demands and high physical work load were associated with an increased risk of subsequent antidepressant and anxiolytic medication. Increased and repeated exposure to high physical work load, increased job control and repeated high job demands were associated with subsequent sedative and hypnotic medication. Age and sex-adjusted HR varied from 1.18 to 1.66. Improvement in job control was associated with a lower risk of anxiolytic, but with a higher risk of sedatives and hypnotic medication. Decreased physical work load was associated with a lower risk of antidepressant and anxiolytic medications.

CONCLUSION

Improvement in working conditions could lower the risk of mental ill-health indicated by psychotropic medication.

The Magnitude of Occupational Class Differences in Sickness Absence: 15-Year Trends among Young and Middle-Aged Municipal Employees

Background: Our aim was to examine the magnitude of relative occupational class differences in sickness absence (SA) days over a 15-year period among female and male municipal employees in two age-groups. Methods: 18-34 and 35-59-year-old employees of the City of Helsinki from 2002 to 2016 were included in our data (n = ~37,500 per year). Occupational class was classified into four groups. The magnitude of relative occupational class differences in SA was studied using the relative index of inequality (RII). Results: The relative occupational class differences were larger among older than younger employees; the largest differences were among 35-59-year-old men. Among women in both age-groups the relative class differences remained stable during 2002-2016. Among younger and older men, the differences were larger during the beginning of study period than in the end. Among women in both age-groups the RII values were between 2.19 (95% confidence intervals (CI) 1.98, 2.42) and 3.60 (95% CI 3.28, 3.95). The corresponding differences varied from 3.74 (95% CI 3.13, 4.48) to 1.68 (95% CI 1.44, 1.97) among younger and from 6.43 (95% CI 5.85, 7.06) to 3.31 (95% CI 2.98, 3.68) among older men.

CONCLUSIONS

Relative occupational class differences were persistent among employees irrespective of age group and gender. Preventive measures should be started at young age.

Statutory retirement and changes in self-reported leisure-time physical activity: a follow-up study with three time-points

BACKGROUND

Retirement is a key life event, which is associated with changes in physical activity, however, there is limited evidence with regard to changes in physical activity that take place in post-retirement years. The aim of this study was to examine how leisure-time physical activity changes shortly after the transition to retirement and during the post-retirement years.

METHODS

The phase 1 data were collected in 2000-2002 (n = 8960, response rate 67%) among 40-60-year-old employees of the City of Helsinki, Finland. Phase 2 was carried out in 2007 (n = 7332, response rate 83%) and phase 3 in 2012 (n = 6814, response rate 79%). Disability retirees and those under the age of 50 at baseline were excluded. This yielded 2902 participants. Most of the participants (79%) were women. The mean age of the participants was 54.4 in phase 1. Negative binomial models for repeated measurements with generalized estimating equations (GEE) were used to calculate the incidence rate ratios (IRR) and 95% confidence intervals (CI). These indicated the changes in time spent in self-reported leisure-time physical activity among the retired compared with the continuously employed.

RESULTS

Of the participants, 851 retired on the grounds of old age during the first period (phases 1-2), and 948 during the second period (phases 2-3). Change in physical activity was positive among those who retired during the first (IRR = 1.10, 95% CI 1.04-1.17) and second (IRR = 1.10, 95% CI 1.04-1.16) periods compared to the continuously employed. During the second period, there was little difference between those who had retired during the first one (IRR = 0.96, 95% CI 0.91-1.02) and the continuously employed.

CONCLUSIONS

The transition to statutory retirement was associated with an immediate increase in leisure-time physical activity, which nevertheless diminished during post-retirement years.

10-year trends of educational differences in long sickness absence due to mental disorders

OBJECTIVES

Mental disorders are a key cause of sickness absence (SA) and challenge prolonging working careers. Thus, evidence on the development of SA trends is needed. In this study, educational differences in long SAs due to mental disorders were examined in two age groups among employees of the City of Helsinki from 2004 to 2013.

METHODS

All permanently and temporarily employed staff aged 18-34 and 35-49 were included in the analyses (n=~27800 per year). SA spells of ≥14 days due to mental disorders were examined annually. Education was classified to higher and lower levels. Joinpoint regression was used to identify major turning points in SA trends.

RESULTS

Joinpoint regression models showed that lower educated groups had more long SAs spells due to mental disorders than those groups with higher education. SA trends decreased during the study period in all studied age and educational groups. Lower educated age groups had similar SA trends. Younger employees with higher education had the fewest SAs.

CONCLUSIONS

A clear educational gradient was found in long SAs due to mental disorders during the study period. SA trends decreased from 2004 to 2013.

Trends in educational inequalities in obesity in 15 European countries between 1990 and 2010

BACKGROUND

The prevalence of obesity increased dramatically in many European countries in the past decades. Whether the increase occurred to the same extent in all socioeconomic groups is less known. We systematically assessed and compared the trends in educational inequalities in obesity in 15 different European countries between 1990 and 2010.

METHODS

Nationally representative survey data from 15 European countries were harmonized and used in a meta-regression of trends in prevalence and educational inequalities in obesity between 1990 and 2010. Educational inequalities were estimated by means of absolute rate differences and relative rate ratios in men and women aged 30-64 years.

RESULTS

A statistically significant increase in the prevalence of obesity was found for all countries, except for Ireland (among men) and for France, Hungary, Italy and Poland (among women). Meta-regressions showed a statistically significant overall increase in absolute inequalities of 0.11% points [95% CI 0.03, 0.20] per year among men and 0.12% points [95% CI 0.04, 0.20] per year among women. Relative inequalities did not significantly change over time in most countries. A significant reduction of relative inequalities was found among Austrian and Italian women.

CONCLUSION

The increase in the overall prevalence aligned with a widening of absolute but not of relative inequalities in obesity in many European countries over the past two decades. Our findings urge for a further understanding of the drivers of the increase in obesity in lower education groups particularly, and an equity perspective in population-based obesity prevention strategies.

The association between alcohol drinking and self-reported mental and physical functioning: a prospective cohort study among City of Helsinki employees

OBJECTIVES

Alcohol drinking is associated with ill health but less is known about its contribution to overall functioning. We aimed to examine whether alcohol drinking predicts self-reported mental and physical functioning 5-7 years later.

DESIGN

A prospective cohort study.

SETTING

Helsinki, Finland.

PARTICIPANTS

40-year-old to 60-year-old employees of the City of Helsinki (5301 women and 1230 men) who participated in a postal survey in 2000-2002 and a follow-up survey in 2007.

PRIMARY AND SECONDARY OUTCOME MEASURES

Mental and physical functioning measured by the Short Form 36 Health Survey.

RESULTS

Alcohol drinking was differently associated with mental and physical functioning. Heavy average drinking, binge drinking and problem drinking were all associated with subsequent poor mental functioning except for heavy average drinking among men, whereas only problem drinking was associated with poor physical functioning. Also, non-drinking was associated with poor physical functioning. Problem drinking was the drinking habit showing most widespread and strongest associations with health functioning. The associations between problem drinking and poor mental functioning and with poor physical functioning among women remained after adjusting for baseline mental functioning, sociodemographic factors, working conditions and other health behaviours.

CONCLUSIONS

Alcohol drinking is associated especially with poor mental functioning. Problem drinking was the drinking habit strongest associated with poor health functioning. The results call for early recognition and prevention of alcohol problems in order to improve health functioning among employees.

Physical and mental health functioning after all-cause and diagnosis-specific sickness absence: a register-linkage follow-up study among ageing employees

Background

Sickness absence has been shown to be a risk marker for severe future health outcomes, such as disability retirement and premature death. However, it is poorly understood how all-cause and diagnosis-specific sickness absence is reflected in subsequent physical and mental health functioning over time. The aim of this study was to examine the association of all-cause and diagnosis-specific sickness absence with subsequent changes in physical and mental health functioning among ageing municipal employees.

Methods

Prospective survey and register data from the Finnish Helsinki Health Study and the Social Insurance Institution of Finland were used. Register based records for medically certified all-cause and diagnostic-specific sickness absence spells (>14 consecutive calendar days) in 2004–2007 were examined in relation to subsequent physical and mental health functioning measured by Short-Form 36 questionnaire in 2007 and 2012. In total, 3079 respondents who were continuously employed over the sickness absence follow-up were included in the analyses. Repeated-measures analysis was used to examine the associations.

Results

During the 3-year follow-up, 30% of the participants had at least one spell of medically certified sickness absence. All-cause sickness absence was associated with lower subsequent physical and mental health functioning in a stepwise manner: the more absence days, the poorer the subsequent physical and mental health functioning. These differences remained but narrowed slightly during the follow-up. Furthermore, the adverse association for physical health functioning was strongest among those with sickness absence due to diseases of musculoskeletal or respiratory systems, and on mental functioning among those with sickness absence due to mental disorders.

Conclusions

Sickness absence showed a persistent adverse stepwise association with subsequent physical and mental health functioning. Evidence on health-related outcomes after long-term sickness absence may provide useful information for targeted interventions to promote health and workability.

Short sickness absence and subsequent sickness absence due to mental disorders - a follow-up study among municipal employees

Background

Mental disorders are common diagnostic causes for longer sickness absence and disability retirement in OECD-countries. Short sickness absence spells are also common, and neither trivial for health and work ability. We studied how prior short sickness absence spells and days are associated with subsequent longer sickness absence due to mental disorders in two age-groups of municipal employees during a 2-, 5- and 9-year follow-up.

Methods

The analyses covered 20–34 and 35–49-year-old employees of the City of Helsinki in 2004. Those with prior ≥14 day sickness absence in 2002, 2003 or 2004 were excluded. Women and men were pooled together. Short, 1–13-day sickness absence spells and days were calculated per the actual time of employment during 2004. Logistic regression analysis was used to calculate odds ratios (OR) and their 95% confidence intervals (CI) for the subsequent long (≥14 days) sickness absence due to mental disorders during three follow-ups.

Results

The risk for long sickness absence due to mental disorders increased with increasing amount of short sickness absence spells and days. 3 or more short sickness absence spells and 8–14 sickness absence days from short spells in 2004 were strongly associated with subsequent long sickness absence in all three follow-ups. The associations were strongest for the 2-year follow-up; the younger employees tended to have higher risks than the older ones.

Conclusions

Three spells or 8 days of short sickness absence per year constitutes a high risk for subsequent long sickness absence due to mental disorders and preventive measures should be considered.

The joint contribution of cardiovascular disease and socioeconomic status to disability retirement: A register linkage study

BACKGROUND

Whether low occupational class amplifies the risk of disability retirement among employees with cardiovascular disease (CVD) is unknown. We examined this issue in two prospective cohort studies.

METHODS

In the Finnish Public Sector Study and the Helsinki Health Study (n=50.799 employees), prevalent CVD (coronary heart disease or stroke, n=1269) was ascertained using records from national health registers, self-reported doctor-diagnosed diseases, and Rose Angina Questionnaire. Data linkage to national pension registers allowed the follow up of disability retirement among the participants for a mean of six years. We analysed the associations of occupational class and CVD with disability retirement using Cox regression, tested interactions between occupational class and prevalent CVD in predicting disability retirement by calculating the Synergy Index, and pooled the results from the two studies using fixed-effect meta-analysis.

RESULTS

Compared with the participants from high occupational class and no CVD, the participants from the low occupational class without CVD had a 2.13-fold (95% CI 1.97-2.30), those with high occupational class and CVD a 2.18-fold (1.73-2.74); and those with both low occupational class and CVD a 4.49-fold (3.83-5.26) risk of disability retirement. A Synergy Index of 1.55 (1.16-2.06) suggested a greater than additive effect for low occupational class and CVD in combination.

CONCLUSIONS

Individuals with both low occupational class and CVD are at a particularly high risk of premature exit from the labour market due to work disability. These findings suggest that better preventive strategies are needed to improve prognosis in this risk group.

Mental symptoms and cause-specific mortality among midlife employees

BACKGROUND

Mental symptoms are prevalent among populations, but their associations with premature mortality are inadequately understood. We examined whether mental symptoms contribute to cause-specific mortality among midlife employees, while considering key covariates.

METHODS

Baseline mail survey data from 2000-02 included employees, aged 40-60, of the City of Helsinki, Finland (n = 8960, 80 % women, response rate 67 %). Mental symptoms were measured by the General Health Questionnaire 12-item version (GHQ-12) and the Short Form 36 mental component summary (MCS). Covariates included sex, marital status, social support, health behaviours, occupational social class and limiting long-standing illness. Causes of death by the end of 2013 were obtained from Statistics Finland (n = 242) and linked individually to survey data pending consent (n = 6605). Hazard ratios (HR) and 95 % confidence intervals (95 % CI) were calculated using Cox regression analysis.

RESULTS

For all-cause mortality, only MCS showed a weak association before adjustments. For natural mortality, no associations were found. For unnatural mortality (n = 21), there was a sex adjusted association with GHQ (HR = 1.96, 95 % CI = 1.45-2.64) and MCS (2.30, 95 % CI = 1.72-3.08). Among unnatural causes of death suicidal mortality (n = 11) was associated with both GHQ (2.20, 95 % CI = 1.47-3.29) and MCS (2.68, 95 % CI = 1.80-3.99). Of the covariates limiting long-standing illness modestly attenuated the associations.

CONCLUSIONS

Two established measures of mental symptoms, i.e. GHQ-12 and SF-36 MCS, were both associated with subsequent unnatural, i.e. accidental and violent, as well as suicidal mortality. No associations were found for natural mortality due to diseases. These findings need to be corroborated in further populations. Supporting mental health through workplace measures may help counteract subsequent suicidal and other unnatural mortality among midlife employees.

Insomnia symptoms and mortality: a register-linked study among women and men from Finland, Norway and Lithuania

Evidence on the association between insomnia symptoms and mortality is limited and inconsistent. This study examined the association between insomnia symptoms and mortality in cohorts from three countries to show common and unique patterns. The Finnish cohort comprised 6605 employees of the City of Helsinki, aged 40-60 years at baseline in 2000-2002. The Norwegian cohort included 6236 participants from Western Norway, aged 40-45 years at baseline in 1997-1999. The Lithuanian cohort comprised 1602 participants from the City of Palanga, aged 35-74 years at baseline in 2003. Mortality data were derived from the Statistics Finland and Norwegian Cause of Death Registry until the end of 2012, and from the Lithuanian Regional Mortality Register until the end of 2013. Insomnia symptoms comprised difficulties initiating sleep, nocturnal awakenings, and waking up too early. Covariates were age, marital status, education, smoking, alcohol, physical inactivity, obesity, diabetes, cardiovascular diseases, depression, shift work, sleep duration, and self-rated health. Cox regression analysis was used. Frequent difficulties initiating sleep were associated with all-cause mortality among men after full adjustments in the Finnish (hazard ratio 2.51; 95% confidence interval 1.07-5.88) and Norwegian (hazard ratio 3.42; 95% confidence interval 1.03-11.35) cohorts. Among women and in Lithuania, insomnia symptoms were not statistically significantly associated with all-cause mortality after adjustments. In conclusion, difficulties initiating sleep were associated with mortality among Norwegian and Finnish men. Variation and heterogeneity in the association between insomnia symptoms and mortality highlights that further research needs to distinguish between men and women, specific symptoms and national contexts, and focus on more chronic insomnia.

Changes in leisure time physical activity and subsequent disability retirement: A register-linked cohort study

Background

Disability retirement is an economic, public health and work life issue causing costs for employees, workplaces and society. Adopting physical activity at middle-age has been associated with reduced risk of sickness absence and mortality. The aim of this study was to examine how changes over time in leisure time physical activity are associated with subsequent disability retirement among midlife employees.

Methods

The Helsinki Health Study cohort baseline (phase 1) mail questionnaire survey data were collected in 2000, 2001 and 2002 among 40–60-year-old employees of the City of Helsinki, Finland. A phase 2 survey was conducted in 2007 (N = 3943). Respondents were classified into three groups: 1. low-active (<14 MET-hours/week), 2. moderately active (> = 14 MET-hours/week in moderate-intensity physical activity) and 3. vigorously active (> = 14 MET-hours/week including vigorous physical activity) at both phases. This yielded nine groups for describing stability and change of leisure time physical activity. Disability retirement data were derived from the registry of the Finnish Centre for Pensions until the end of 2013. A Cox regression analysis was used to calculate hazard ratios (HR) and their 95 % confidence intervals (CI) adjusting for covariates.

Results

During the follow-up, 264 (6.7 %) participants retired due to disability. Compared with those who were persistently low-active, those who increased their physical activity from low to vigorous had a lower risk of subsequent disability retirement (HR = 0.38, 95 % CI = 0.15–0.97) when adjusting for age, gender, occupational social class, strenuousness of work, smoking and binge drinking. Similarly, compared with those who were persistently moderately active, those increasing from moderate to vigorous (HR = 0.50, 95 % CI = 0.28–0.86) had a reduced risk. In contrast, those decreasing their physical activity from vigorous to low (HR = 2.42, 95 % CI = 1.32–4.41) or moderate (HR = 1.70, 95 % CI = 1.03–2.82) had an increased risk, compared with those who were persistently vigorously active. Adjusting for BMI, limiting longstanding illness and prior sickness absence somewhat attenuated the associations.

Conclusions

Adopting vigorous physical activity was associated with a reduced risk of disability retirement. Promoting vigorous physical activity among midlife employees may help prevent disability retirement.

Mental health functioning (SF-36) and intentions to retire early among ageing municipal employees: The Helsinki Health Study

Aims: To examine the associations of mental health functioning with intentions to retire early among ageing municipal employees. Methods: Cross-sectional survey data (n=7,765) from the Helsinki Health Study in 2000, 2001, and 2002 were used. Intentions to retire early were sought with a question: ``Have you considered retiring before normal retirement age?'' The dependent variable was divided into three categories: 1=no intentions to retire early; 2=weak intentions; 3=strong intentions. Mental health functioning was measured by the Short Form 36 (SF-36) mental component summary (MCS). Other variables included age, sex, physical health functioning (SF-36), limiting longstanding illness, socioeconomic status, and spouse's employment status. Multinomial regression analysis was used to examine the association of mental health functioning with intentions to retire early. Results: Employees with the poorest mental health functioning were much more likely to report strong intentions to retire early (OR 6.09, 95% CI 4.97—7.47) than those with the best mental health functioning. Adjustments for physical health, socioeconomic status, and spouse's employment status did not substantially affect this association. Conclusions: The findings highlight the importance of mental health for intentions to retire early. Strategies aimed at keeping people at work for longer should emphasize the importance of mental well-being and the prevention of poor mental health. More evidence is needed on why mental problems among ageing baby-boomer employees are giving rise to increasing social consequences, although the overall prevalence of mental problems has not increased.

Sociodemographic determinants of multiple unhealthy behaviours

Background: Although behaviours regarded as unhealthy are widespread, behaving in an unhealthy manner in several respects is relatively uncommon. However, people with multiple unhealthy behaviours exist and their number is larger than expected if the behaviours were not related to each other. The aim of this study was to examine sociodemographic determinants of multiple unhealthy behaviours, with special reference to independent and combined effects of the determinants. Methods : Data on unhealthy behaviours were derived from nationwide surveys among Finnish adults. The mean number of unhealthy behaviours practised on a daily basis and the probability of reporting three or four of these behaviours was examined across sociodemographic groups.

Results: Age, educational level and marital status predicted reporting of three or four unhealthy behaviours. Interactions were observed between education and age in both genders as well as between marital status and age in men and educational level and living area in women. Mean numbers of unhealthy behaviours showed similar patterns to having three or four unhealthy behaviours but few differences between the means were statistically significant and there were no interactions. Conclusion: The influence of each sociodemographic determinant on multiple unhealthy behaviours was relatively independent from the other sociodemographic determinants. As the effect of these determinants tends to be cumulative, engaging in multiple unhealthy behaviours is common in population subgroups with several unfavourable characteristics. In health promotion initiatives special attention should be paid to such population groups and their social circumstances.

Sense of coherence and its determinants: A comparative study of the Finnish-speaking majority and the Swedish-speaking minority in Finland

Background: Despite similar living conditions among the Finnish-speaking majority and the Swedish-speaking minority in Finland, the latter is a more advantaged group e.g. in terms of socioeconomic status and health. This study investigated (1) the level of sense of coherence (SOC), (2) the structure of generalized resistance resources (GRRs), and (3) associations of GRRs with SOC among Finnish- and Swedish-speaking Finns. Methods: The data derived from the Health and Social Support (HeSSup) Study. The sample comprised 22,937 Finnish men and women aged 20—54, including an additional sample from the Swedish-speaking population (n=2,967). The response rate was 40%. Ordinary regression analysis was used. Results: Swedish-speaking women scored 0.9 (p=0.005) and men 0.6 (p=0.05) points higher on SOC scale compared with Finnish-speaking respondents. The minor difference in the SOC level between the language groups was explained by Finnish speakers' worse psychosocial living conditions in childhood and working conditions in adulthood. Only one interaction was found: parents' divorce during childhood was associated with a significant decrease of SOC scores only for Finnish speakers. Otherwise the same GRRs had similar effects on both Finnish- and Swedish-speaking men's and women's SOC. Conclusion: The only key difference between Finnish- and Swedish-speaking Finns concerned the unequal distribution of GRRs. An increase in GRRs among Finnish speakers would probably strengthen their SOC. However, the slightly stronger level of SOC among Swedish-speaking compared with Finnish-speaking Finns is unlikely to explain the possible differences in well-being between the two language groups.

Trends in socioeconomic differences in sickness absence among Finnish municipal employees 1990—99

Aims: This study examined the associations of key dimensions of socioeconomic status and long sickness absence spells as well as their changes over time from 1990 to 1999. Methods: Municipal employees of the City of Helsinki, Finland, aged 25— 59 were studied. The number of participants varied yearly from 24,029 women and 6,523 men to 27,861 women and 7,521 men. Socioeconomic status was assessed by education, occupational class, and individual income. The outcome was the number of over three days' sickness absence spells/100 person years, for which the employer requires medical certification.

Results: Low education, occupational class, and individual income were consistently associated with a 2—3 times higher sickness absence rates among both men and women. The age-adjusted sickness absence rates were relatively stable from 1990 to 1994 but increased from 1994 to 1999 among men and women. Socioeconomic differences in sickness absence rates tended to increase. Conclusions: The increase in the level of socioeconomic differences in sickness absence took place during a period of declining unemployment and staff increases at the City of Helsinki, which indicates that labour market conditions play a role in sickness absence.

Determinants of daily smoking in Estonia, Latvia, Lithuania, and Finland in 1994—2002

Aims: To investigate time trends in the smoking prevalence and the sociodemographic and psychosocial background of smoking in the Baltic countries in comparison with Finland during 1994—2002. Methods: Differences in daily smoking according to age, education, urbanization, and psychological distress in the Baltic countries and Finland were studied using postal surveys in 1994, 1996, 1998, 2000, and 2002 among adults (20—64 years old) in Estonia (n=6,271), Latvia (n=6,106), Lithuania (n=9,824), and Finland (n=15,764). Results: In 1994, 1996, 1998, 2000, and 2002 the prevalence of smoking in Estonia, Latvia, Lithuania, and Finland was 47%, 54%, 46%, and 29% among men, and 21%, 19%, 11%, and 19% among women, respectively. Smoking increased among Lithuanian women from 6% in 1994 to 13% in 2002, but decreased among Estonian men and women. Smoking was generally more common among younger individuals, the less educated, and people with distress in all four countries. The odds ratios for smoking for those with low education compared with those with high education were 2.18 (1.69—2.81), 3.32 (2.55—4.31), 2.20 (1.79—2.70) and 2.80 (2.40—3.27) in men, and 1.90 (1.42—2.52). 3.09 (2.28—4.18), 0.86 (0.59—1.26), and 3.00 (2.53—3.55) in women, in Estonia, Latvia, Lithuania, and Finland, respectively. There were indications of increasing educational differences in Latvian men. Smoking was less common among rural women in all countries except Estonia. Conclusions: Estonia, Latvia, and Finland show characteristics of the ``mature'' phase of a smoking epidemic, and smoking may not increase in these countries. In Lithuanian women smoking may increase. Smoking may be increasingly unequally distributed in the future in all the studied countries.

The association of employment status and family status with health among women and men in four Nordic countries

Aims: The Nordic countries have relatively equal employment participation between men and women, but some differences between countries exist in labour market participation. The aim was to examine the association between employment status and health among women and men in Denmark, Finland, Norway, and Sweden, and analyse whether this association is modified by marital status and parental status. Methods: The data come from nationally representative cross-sectional surveys carried out in Denmark (n=2,209), Finland (n=4,604), Norway (n=1,844) and Sweden (n=5,360) in 1994—95. Women and men aged 25—49 were included. Employment status was categorized into full-time employed, part-time employed, unemployed, and housewives among women and into employed and unemployed among men. Health was measured by perceived health and limiting longstanding illness. Logistic regression analysis was used, adjusting for age and education. Marital status and parental status were analysed as modifying factors. Results: The non-employed were more likely to report perceived health as below good and limiting longstanding illness than the employed among both women and men. The association between employment status and perceived health remained unchanged when marital status and parental status were adjusted for among all men and Finnish women, but the association was slightly strengthened among Danish and Swedish women, with the housewives becoming more likely to report ill health than employed women. The association between employment status and limiting longstanding illness was slightly strengthened among women, and slightly weakened among Norwegian men when marital and parental status were adjusted for. Conclusions: Non-employment was associated with poorer health in all countries, although there are differences in the employment patterns between the countries. Among women marital status and parental status showed a modest or no influence on the association between employment status and health. Among men there was no such influence.

Did the English strategy reduce inequalities in health? A difference-in-difference analysis comparing England with three other European countries

BACKGROUND

Between 1997 and 2010, the English government pursued an ambitious programme to reduce health inequalities, the explicit and sustained commitment of which was historically and internationally unique. Previous evaluations have produced mixed results. None of these evaluations have, however, compared the trends in health inequalities within England with those in other European countries. We carried out an innovative analysis to assess whether changes in trends in health inequalities observed in England after the implementation of its programme, have been more favourable than those in other countries without such a programme.

METHODS

Data were obtained from nationally representative surveys carried out in England, Finland, the Netherlands and Italy for years around 1990, 2000 and 2010. A modified difference-in-difference approach was used to assess whether trends in health inequalities in 2000-2010 were more favourable as compared to the period 1990-2000 in England, and the changes in trends in inequalities after 2000 in England were then compared to those in the three comparison countries. Health outcomes were self-assessed health, long-standing health problems, smoking status and obesity. Education was used as indicator of socioeconomic position.

RESULTS

After the implementation of the English strategy, more favourable trends in some health indicators were observed among low-educated people, but trends in health inequalities in 2000-2010 in England were not more favourable than those observed in the period 1990-2000. For most health indicators, changes in trends of health inequalities after 2000 in England were also not significantly different from those seen in the other countries.

CONCLUSIONS

In this rigorous analysis comparing trends in health inequalities in England both over time and between countries, we could not detect a favourable effect of the English strategy. Our analysis illustrates the usefulness of a modified difference-in-difference approach for assessing the impact of policies on population-level health inequalities.

Obesity and psychotropic medication: a prospective register linkage study among midlife women and men

BACKGROUND

Both obesity and mental health are major public health issues. This study aimed to examine whether overweight and obesity among midlife employees are associated with subsequent psychotropic medication. A further aim was to examine the potential effect of key covariates on the association.

METHODS

The Helsinki Health Study baseline survey was conducted in 2000-2002 among 40-60-year-old employees of the City of Helsinki, Finland (n = 8960). The participants were classified as of normal weight (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), obese (30-34.9 kg/m(2)) or severely obese (≥35 kg/m(2)) based on self-reported body mass index. Data on psychotropic medication purchases from baseline to 2009 were derived from registers of the Social Insurance Institution of Finland. The final analysis included 4760 women and 1338 men. Antidepressants and sedatives were examined separately. Covariates included socio-demographic factors, workload, health behaviours, physical functioning, somatic ill-health and psychotropic medication prior to baseline. Hazard ratios (HR) for the first psychotropic medication purchase were calculated using Cox regression analysis.

RESULTS

Third of women and quarter of men made at least one psychotropic medication purchase during the follow-up. Adjusting for age, obese (HR = 1.57; 95 % CI = 1.10-2.24) and severely obese (HR = 2.15; 95 % CI = 1.29-3.56) men were at risk of having psychotropic medication compared to men of normal weight. These associations disappeared after further adjustment. Severe obesity remained associated with subsequent sedative medication among the men even after full adjustment (HR = 2.12; 95 % CI = 1.17-3.84). No associations were found among the women.

CONCLUSIONS

Obese and severely obese men, but not women, were at risk of psychotropic medication. Further studies are needed to deepen understanding of the relationship between obesity and mental ill-health, and the possible protecting effects of age, employment, and living environment.

The contribution of smoking to mortality during working age at different levels of leisure-time physical activity

BACKGROUND

Smoking and physical inactivity are linked to mortality, but it is not known whether the association between smoking and mortality is affected by the amount and intensity of physical activity. We examined the joint associations of smoking and physical activity with mortality, while taking key covariates into account.

METHODS

We linked survey data, collected in 2000-2002 from among 40-60-year-old employees of the City of Helsinki, Finland, with complete register data on all-cause mortality from Statistics Finland (n = 6390, 79% women, response rate 67%). Smoking, leisure-time physical activity and covariates (sociodemographic factors, problem drinking, body mass index and self-rated health) were measured at baseline. We fitted Cox regression models (hazard ratios, HR, 95% confidence intervals, CI), and the follow-up continued until the end of 2013. No gender interactions were found.

RESULTS

A total of 228 deaths occurred during the follow-up. Smokers were at an increased risk of mortality after full adjustments, but the risk was higher among inactive (HR 3.27, 95% CI 2.05-5.22) and moderately active smokers (HR 2.37, 95% CI 1.49-3.79) than among vigorously active non-smokers. The excess risk for vigorously active smokers, or for inactive or moderately active non-smokers, could not be confirmed.

CONCLUSION

The highest mortality risk was found among physically inactive or moderately active smokers. Prevention of smoking and engaging in vigorous physical inactivity among smokers might prevent mortality during working age.

Educational differences in sickness absence trends among young employees from 2002 to 2013 in Helsinki, Finland

OBJECTIVE

Socioeconomic differences in sickness absence (SA) are well established among older employees but poorly understood among the young. Our aim was to examine 12-year trends in educational differences in SA among young female and male employees, and to assess the magnitude of the differences.

DESIGN

We examined annual SA spells. The data were obtained from the employer's registers and linked to Statistics Finland's register data on completed education and qualifications. Education was classified into four hierarchical groups. Joinpoint regression models were used to identify turning points in SA trends. The magnitude of the relative educational differences was estimated in accordance with the relative index of inequality for 2002, 2008 and 2013.

SETTING

Employees of the City of Helsinki, Finland, in 2002-2013.

PARTICIPANTS

The analyses covered female and male employees aged 25-34 years: employees aged 35-54 years were used as a reference group.

OUTCOME

SA spells.

RESULTS

An educational gradient emerged among younger and older women and men. SA spells increased in the early 2000s, and downward turning points were located in 2007-2010 in all educational groups among women and in most groups among men. The magnitude of the differences remained broadly stable among younger women from 2002 to 2013, and decreased slightly among older women and more strongly among younger and older men. The educational differences were greater among men than women in the early 2000s, but similar among both at the end of the study period.

CONCLUSIONS

The changes in SA spells may reflect the economic downturn started in 2008 and resulting job insecurity. Early preventive measures aimed at reducing educational differences in SA should be focused at an early stage on those with low levels of education in particular.

Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010

BACKGROUND

Between the 1990s and 2000s, relative inequalities in all-cause mortality increased, whereas absolute inequalities decreased in many European countries. Whether similar trends can be observed for inequalities in other health outcomes is unknown. This paper aims to provide a comprehensive overview of trends in socioeconomic inequalities in self-assessed health (SAH) in Europe between 1990 and 2010.

METHODS

Data were obtained from nationally representative surveys from 17 European countries for the various years between 1990 and 2010. The age-standardised prevalence of less-than-good SAH was analysed by education and occupation among men and women aged 30-79 years. Socioeconomic inequalities were measured by means of absolute rate differences and relative rate ratios. Meta-analysis with random-effects models was used to examine the trends of inequalities.

RESULTS

We observed declining trends in the prevalence of less-than-good SAH in many countries, particularly in Southern and Eastern Europe and the Baltic states. In all countries, less-than-good SAH was more prevalent in lower educational and manual groups. For all countries together, absolute inequalities in SAH were mostly constant, whereas relative inequalities increased. Almost no country consistently experienced a significant decline in either absolute or relative inequalities.

CONCLUSIONS

Trends in inequalities in SAH in Europe were generally less favourable than those found for inequalities in mortality, and there was generally no correspondence between the two when we compared the trends within countries. In order to develop policies or interventions that effectively reduce inequalities in SAH, a better understanding of the causes of these inequalities is needed.

Changes Over Time in Absolute and Relative Socioeconomic Differences in Smoking: A Comparison of Cohort Studies From Britain, Finland, and Japan

INTRODUCTION

Socioeconomic differences in smoking over time and across national contexts are poorly understood. We assessed the magnitude of relative and absolute social class differences in smoking in cohorts from Britain, Finland, and Japan over 5-7 years.

METHODS

The British Whitehall II study (n = 4350), Finnish Helsinki Health Study (n = 6328), and Japanese Civil Servants Study (n = 1993) all included employed men and women aged 35-68 at baseline in 1997-2002. Follow-up was in 2003-2007 (mean follow-up 5.1, 6.5, and 3.6 years, respectively). Occupational social class (managers, professionals and clerical employees) was measured at baseline. Current smoking and covariates (age, marital status, body mass index, and self-rated health) were measured at baseline and follow-up. We assessed relative social class differences using the Relative Index of Inequality and absolute differences using the Slope Index of Inequality.

RESULTS

Social class differences in smoking were found in Britain and Finland, but not in Japan. Age-adjusted relative differences at baseline ranged from Relative Index of Inequality 3.08 (95% confidence interval 1.99-4.78) among Finnish men to 2.32 (1.24-4.32) among British women, with differences at follow-up greater by 8%-58%. Absolute differences remained stable and varied from Slope Index of Inequality 0.27 (0.15-0.40) among Finnish men to 0.10 (0.03-0.16) among British women. Further adjustment for covariates had modest effects on inequality indices.

CONCLUSIONS

Large social class differences in smoking persisted among British and Finnish men and women, with widening tendencies in relative differences over time. No differences could be confirmed among Japanese men or women.

IMPLICATIONS

Changes over time in social class differences in smoking are poorly understood across countries. Our study focused on employees from Britain, Finland and Japan, and found relative and absolute and class differences among British and Finnish men and women. Key covariates had modest effects on the differences. Relative differences tended to widen over the 4- to 7-year follow-up, whereas absolute differences remained stable. In contrast, class differences in smoking among Japanese men or women were not found. Britain and Finland are at the late stage of the smoking epidemic model, whereas Japan may not follow the same model.

Changes in working conditions and physical health functioning among midlife and ageing employees

OBJECTIVES

The aim this study was to examine the effect of changes in physical and psychosocial working conditions on physical health functioning among ageing municipal employees.

METHODS

Follow-up survey data were collected from midlife employees of the City of Helsinki, Finland, at three time points: wave 1 (2000-2002), wave 2 (2007), and wave 3 (2012). Changes in physical and psychosocial working conditions were assessed between waves 1 and 2. Physical health functioning was measured by the physical component summary (PCS) of the Short-Form 36 questionnaire at each of the three waves. In total, 2784 respondents (83% women) who remained employed over the follow-up were available for the analyses. Linear mixed-effect models were used to assess the associations and adjust for key covariates (age, gender, obesity, chronic diseases, and health behaviors).

RESULTS

Repeated and increased exposure to adverse physical working conditions was associated with greater decline in physical health functioning over time. In contrast, decrease in exposures reduced the decline. Of the psychosocial working conditions, changes in job demands had no effects on physical health functioning. However, decreased job control was associated with greater decline and repeated high or increased job control reduced the decline in physical health functioning over time.

CONCLUSIONS

Adverse changes in physical working conditions and job control were associated with greater decline in physical health functioning over time, whereas favorable changes in these exposures reduced the decline. Preventing deterioration and promoting improvement of working conditions are likely to help maintain better physical health functioning among ageing employees.

Sickness absence among young employees: trends from 2002 to 2013

OBJECTIVES

Young adults entering employment are a key group in extending work careers, but there is a lack of research on trends in work ability among young employees. Prolonged sickness absence (SA) constitutes a risk for permanent work disability. We examined 12-year trends in SA spells among young female and male municipal employees.

METHODS

The data were obtained from the employers' registers in the City of Helsinki, Finland. The data included employees aged 18-24, 25-29, 30-34, and 35-54 from 2002 to 2013 (the average number for each year was 31,600). Self-certified (1-3 days) and medically certified intermediate (4-14 days) and long (15+ days) SAs were examined. Joinpoint regression models were used to identify major changes in SA trends.

RESULTS

Younger employees had more short SAs but fewer long SAs than older employees. During the study period, SAs of almost any length first increased and later decreased among both genders, except for young men. The turning points for short SA were in 2007-2011 among younger and older employees. In intermediate and long SAs the respective turning points were in 2008-2009 and 2005-2009. Women had more SAs in all categories.

CONCLUSIONS

Age is related to the length of absences. Given the relatively low chronic morbidity among younger employees, it is likely that reasons other than ill health account for increased SA. More evidence on factors behind the changing trends is needed in order to reduce SA and extend the working careers of young people.

Joint associations of smoking and physical activity with disability retirement: a register-linked cohort study

OBJECTIVES

We examined the risk of disability retirement by smoking and physical activity, and particularly whether the risk due to smoking is affected by the level of physical activity. Additionally, the contribution of baseline health, sociodemographic and work-related factors to the joint associations of smoking and physical activity with disability retirement was considered.

DESIGN

Cohort study.

SETTING

Helsinki, Finland.

PARTICIPANTS

Employees of the City of Helsinki, aged 40-60 years at baseline in 2000-2002, were followed up using complete register data from the Finnish Centre of Pensions until the end of 2010 (n=6390, with a consent to register linkage from 74%).

PRIMARY OUTCOME MEASURE

All-cause disability retirement (ICD-10).

RESULTS

Altogether, 608 employees (9.5%) retired due to disability during the follow-up. Cox regression models were fitted to examine the joint associations of smoking and physical activity with subsequent disability retirement. Never-smokers, ex-smokers and moderate smokers who were inactive or moderately active had an increased risk of disability retirement, but if they were vigorously active, they had no excess risk. Instead, all heavy smokers (15 or more cigarettes per day among women, and 20 or more among men), irrespective of physical activity, had an increased risk of disability retirement. The examined associations attenuated but remained for ex-smokers and heavy smokers after adjustments for gender, age, socioeconomic position, mental and physical workload, problem drinking, body mass index and self-rated health. No gender interactions were found.

CONCLUSIONS

Vigorous physical activity might help prevent disability retirement not only among never-smokers, but even among ex-smokers and moderate smokers. However, among heavy smokers, physical activity is not sufficient to eliminate the adverse effects of smoking on health and work ability.