Interrelationships between education, occupational class and income as determinants of sickness absence among young employees in 2002-2007 and 2008-2013

Background

A low socioeconomic position (SEP) is consistently associated with ill health, sickness absence (SA) and permanent disability, but studies among young employees are lacking. We examined the interrelationships between education, occupational class and income as determinants of SA among 25-34-year-old employees. We also examined, whether the association between SEP and SA varied over time in 2002–2007 and 2008–2013.

Methods

The analyses covered young, 25-34-year-old women and men employed by the City of Helsinki over the time periods 2002–2007 and 2008–2013. Four-level education and occupational class classifications were used, as well as income quartiles. The outcome measure was the number of annual SA days.

Results

Education had the strongest and most consistent independent association with SA among women and men in both periods under study. Occupational class had weaker independent and less consistent association with SA. Income had an independent association with SA, which strengthened over time among the men. The interrelationships between the SEP indicators and SA were partly explained by prior or mediated through subsequent SEP indicators. Socioeconomic differences followed only partially a gradient for occupational class and also for income among men.

Conclusions

Preventive measures to reduce the risk of SA should be considered, especially among young employees with a basic or lower-secondary education.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1718-1) contains supplementary material, which is available to authorized users.

Changes in alcohol drinking and subsequent sickness absence

Aims: The aim was to examine whether changes in alcohol drinking are associated with sickness absence. Methods: Repeated postal questionnaires on alcohol drinking were conducted among employees of the City of Helsinki in 2000–2 and 2007 to assess changes in drinking habits between these two time points. Data on the number of self-certified and medically confirmed sickness absences were derived from the employer’s register. Sickness absences were followed from 2007 until the end of 2010 among employees participating in both questionnaire surveys. The study includes 3252 female and 682 male employees 40–60 years old at baseline. Poisson regression was used in the data analysis and population attributable fractions (PAFs) were calculated. Results: Alcohol drinking was associated especially with self-certified sickness absence. Rate ratios (RRs) and 95% confidence intervals (CIs) for increasing weekly average drinking were 1.38, 1.18–1.62 among women and 1.58, 1.18–2.12 among men. Also stable problem drinking (for women 1.39, 1.26–1.54, for men 1.44, 1.10–1.87) and among women stable heavy drinking (1.53, 1.20–1.94) increased self-certified sickness absence. There were associations between alcohol drinking and medically confirmed sickness absence but these were mainly explained by health and health behaviours. Also, a decrease in weekly average drinking was associated with sickness absence among women whereas among men former problem drinking increased sickness absence. According to the PAF values, problem drinking had a stronger contribution to sickness absence than weekly average drinking. Conclusions: Alcohol drinking is particularly associated with self-certified sickness absence. Reducing adverse drinking habits is likely to prevent sickness absence.

Economic difficulties and subsequent disability retirement

BACKGROUND

This study examined whether economic difficulties are associated with subsequent disability retirement while controlling for covariates.

METHODS

Survey data among middle-aged employees of the City of Helsinki in 2000-2002 were linked with the Finnish Centre for Pensions register data on all-cause disability retirement among women (n=4816) and men (n=1354) until the end of 2010. Additionally, disability retirement due to musculoskeletal diseases and mental disorders (ICD-10) was examined among women. Frequency in difficulties paying pills and buying food and clothes, and covariates (occupational class, income, housing tenure, and work- and health-related covariates) were self-reported at baseline. Hazard ratios (HR) and their 95% confidence intervals (95% CI) were calculated from Cox regression analysis.

RESULTS

Frequent economic difficulties were associated with all-cause disability retirement after adjusting for age among both women (HR=2.11; 95% CI 1.63-2.73) and men (HR=2.69; 95% CI 1.65-4.41). Adjustment for covariates somewhat attenuated the associations, but they remained. Economic difficulties were also associated with disability retirement due to both mental disorders (HR=3.29; 95% CI 1.98-5.46) and musculoskeletal diseases (HR=1.85; 95% CI 1.24-2.75) among women. Adjustments made a minor contribution to the risk of disability retirement due to mental disorders, whereas the risk of disability retirement due to musculoskeletal diseases reduced after considering socioeconomic circumstances. Conclusions: economic difficulties are independently associated with disability retirement. Thus, they should be considered in attempts to tackle early exit from the labour market due to disability.

Social class inequalities in health among occupational cohorts from Finland, Britain and Japan: a follow up study

We examined whether relative occupational social class inequalities in physical health functioning widen, narrow or remain stable among white collar employees from three affluent countries. Health functioning was assessed twice in occupational cohorts from Britain (1997-1999 and 2003-2004), Finland (2000-2002 and 2007) and Japan (1998-1999 and 2003). Widening inequalities were seen for British and Finnish men, whereas inequalities among British and Finnish women remained relatively stable. Japanese women showed reverse inequalities at follow up, but no health inequalities were seen among Japanese men. Health behaviours and social relations explained 4-37% of the magnitude in health inequalities, but not their widening.

Socioeconomic inequalities in cause-specific mortality after disability retirement due to different diseases

Aims: Socioeconomic inequalities in both disability retirement and mortality are large. The aim of this study was to examine socioeconomic differences in cause-specific mortality after disability retirement due to different diseases. Methods: We used administrative register data from various sources linked together by Statistics Finland and included an 11% sample of the Finnish population between the years 1987 and 2007. The data also include an 80% oversample of the deceased during the follow-up. The study included men and women aged 30-64 years at baseline and those who turned 30 during the follow-up. We used Cox regression analysis to examine socioeconomic differences in mortality after disability retirement. Results: Socioeconomic differences in mortality after disability retirement were smaller than in the population in general. However, manual workers had a higher risk of mortality than upper non-manual employees after disability retirement due to mental disorders and cardiovascular diseases, and among men also diseases of the nervous system. After all-cause disability retirement, manual workers ran a higher risk of cardiovascular and alcohol-related death. However, among men who retired due to mental disorders or cardiovascular diseases, differences in social class were found for all causes of death examined. For women, an opposite socioeconomic gradient in mortality after disability retirement from neoplasms was found. Conclusions: The disability retirement process leads to smaller socioeconomic differences in mortality compared with those generally found in the population. This suggests that the disability retirement system is likely to accurately identify chronic health problems with regard to socioeconomic status.

Insomnia symptoms and subsequent psychotropic medication: a register-linked study with 5-year follow-up

PURPOSE

This study examined the associations of insomnia symptoms with subsequent psychotropic medication, reflecting mental health.

METHODS

Postal baseline surveys among 40- to 60-year-old employees of the city of Helsinki, Finland, were collected in 2000-2002 (N = 6,227, response rate 67%, 78% women) and longitudinally linked with national register data on prescribed reimbursed medication. Insomnia symptoms at baseline comprised difficulties in initiating and maintaining sleep, and non-restorative sleep. All purchased psychotropic medication 5-7 years prior to and 5 years after baseline was included. Outcomes were any psychotropic medication; antidepressants; and anxiolytics, hypnotics, and sedatives. Covariates included socio-demographic and work-related factors, health behaviors, lifetime mental disorders, and prior psychotropic medication. Logistic regression analysis was used to calculate odds ratios (OR) and their 95% confidence intervals (CI).

RESULTS

Insomnia symptoms were associated with higher frequency of subsequent psychotropic medication prescriptions. The associations were strongest for frequent insomnia symptoms (women OR 3.55, 95% CI 2.64-4.77; men OR 4.64, 95% CI 2.49-8.66, adjusted for age and prior medication), but also rare and occasional symptoms were associated with psychotropic medication. Further adjustments had negligible effects.

CONCLUSIONS

Insomnia symptoms were associated with prescribed psychotropic medication during follow-up in a dose-response manner. Attention should be given to the prevention of insomnia symptoms to curb subsequent mental problems.

Common mental disorders and cause-specific disability retirement

OBJECTIVES

Common mental disorders are prevalent among employees and may cause work disability. We aimed to examine the association between common mental disorders and disability retirement, with an emphasis on the severity of disorders and diagnostic causes for retirement.

METHODS

Our data were derived from the Helsinki Health Study cohort on the staff of the City of Helsinki, Finland. The baseline mail surveys were made in 2000-2002 among employees reaching ages 40, 45, 50, 55 and 60 in each year (n=8960, response rate 67%, 80% women). Disability retirement events from national registers (n=628) were followed up by the end of 2010 and linked to the baseline data. After exclusions, the number of participants was 6525. Common mental disorders were measured by the General Health Questionnaire 12-item version (GHQ-12). Covariates at baseline included sociodemographic, work-related and health-related factors. Hazard ratios (HR) and 95% CIs were calculated using Cox proportional hazards models.

RESULTS

Common mental disorders showed a graded association with disability retirement. For disability retirement due to any diagnostic cause, the fully adjusted HR for the GHQ-12 score 7-12 was 2.16, 95% CI 1.63 to 2.85. For disability retirement due to mental disorders the corresponding HR was 7.46, 95% CI 4.46 to 12.49. For disability retirement due to musculoskeletal diseases, the association was weaker and did not survive all adjustments.

CONCLUSIONS

Common mental disorders are an important antecedent of disability retirement in general and due to mental disorders in particular. Successful measures against common mental disorders may prevent disability retirement due to mental disorders.

Leisure-time physical activity and all-cause mortality

Background

Physical inactivity is a major public health problem associated with increased mortality risk. It is, however, poorly understood whether vigorous physical activity is more beneficial for reducing mortality risk than activities of lower intensity. The aim of this study was to examine associations of the intensity and volume of leisure-time physical activity with all-cause mortality among middle-aged women and men while considering sociodemographic and health related factors as covariates.

Methods

Questionnaire survey data collected in 2000-02 among 40–60-year-old employees of the City of Helsinki (N = 8960) were linked with register data on mortality (74% gave permission to the linkage) providing a mean follow-up time of 12-years. The analysis included 6429 respondents (79% women). The participants were classified into three groups according to intensity of physical activity: low moderate, high moderate and vigorous. The volume of physical activity was classified into three groups according to tertiles. Cox regression analysis was used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) for all-cause mortality.

Results

During the follow up 205 participants died. Leisure-time physical activity was associated with reduced risk of mortality. After adjusting for covariates the vigorous group (HR = 0.54, 95% CI 0.34–0.86) showed a reduced risk of mortality compared with the low moderate group whereas for the high moderate group the reductions in mortality risk (HR = 0.72, 95% CI 0.48–1.08) were less clear. Adjusting for the volume of physical activity did not affect the point estimates. Higher volume of leisure-time physical activity was also associated with reduced mortality risk; however, adjusting for the covariates and the intensity of physical activity explained the differences.

Conclusions

For healthy middle-aged women and men who engage in some physical activity vigorous exercise may provide further health benefits preventing premature deaths.

The associations between psychosocial working conditions and changes in common mental disorders: a follow-up study

Background

Common mental disorders (CMD) are prevalent in working populations and have adverse consequences for employee well-being and work ability, even leading to early retirement. Several studies report associations between psychosocial working conditions and CMD. However, there is a lack of longitudinal research within a broad framework of psychosocial working conditions and improvement in CMD. The aim of this study was to examine the associations between several psychosocial working conditions and deteriorating and improving CMD among ageing employees over a five-to-six-year follow-up period.

Methods

The study is based on the Helsinki Health Study baseline survey in 2001–2002 and a follow-up in 2007 (N = 4340, response rate 83%) conducted among 40-60-year-old female and male employees. The General Health Questionnaire (GHQ-12) was used to measure common mental disorders. Psychosocial working conditions were measured in terms of job strain, organisational justice, work-family interface, social support and workplace bullying. The covariates included sociodemographic and health factors.

Results

Following adjustment for all the covariates, family-to-work (OR 1.41, 95% Cl 1.04-1.91) and work-to-family conflicts (OR 1.99, 95% Cl 1.42-2.78) and workplace bullying (OR 1.40, 95% Cl 1.09-1.79) were associated with deterioration, and family-to-work conflicts (OR 1.65, 95% Cl 1.66-2.34) and social support (OR 1.47, 95% Cl 1.07-2.00) with improvement in CMD.

Conclusions

Adverse psychosocial working conditions contribute to poor mental health among employees. Preventing workplace bullying, promoting social support and achieving a better balance between work and family may help employees to maintain their mental health.

The contribution of major diagnostic causes to socioeconomic differences in disability retirement

OBJECTIVES

The aim of this study was twofold: to investigate socioeconomic differences in disability retirement (DR) due to major diseases and find out which diseases contribute most to the overall socioeconomic differences in DR.

METHODS

The data were longitudinal register-based (10% sample of Finns) from Statistics Finland. These data included 258 428 participants aged 35-64 years during the follow-up. The participants were employed or unemployed before the follow-up period 1997-2010. Of all participants, 14 303 men and 13 188 women ended up in DR during the follow-up. Socioeconomic status was categorized into upper- and lower-class non-manual employees, manual workers, and self-employed persons. Cox models were used to estimate hazard ratios for DR due to different diseases.

RESULTS

Compared to upper-class non-manual employees, DR was especially high for manual workers whose retirement diagnoses included psychoactive substance use, musculoskeletal diseases (MSD), or cardiovascular diseases. Socioeconomic differences in DR were stronger for younger age groups and men versus women. For females and males, the largest part of the excess DR among manual workers compared to upper-class non-manual employees was due to MSD. In the age group 54-64 years, the contribution of MSD to the total excess was >50% among male manual workers and 75% among female manual workers. Excess DR due to mental disorders concerned only 35-54-year-old manual workers (among 23% men and 26% women).

CONCLUSION

The contribution of MSD to the total excess DR among lower socioeconomic groups was large. Prevention of MSD among manual workers would likely reduce socioeconomic differences in DR.

Insomnia symptoms and subsequent cardiovascular medication: a register-linked follow-up study among middle-aged employees

Sleep disturbances have been associated with an increased risk of cardiovascular disease outcomes. The associations of insomnia with hypertension and dyslipidaemia, the main modifiable cardiovascular risk factors, are less studied. We especially lack understanding on the longitudinal effects of insomnia on dyslipidaemia. We aimed to examine the associations of insomnia symptoms with subsequent prescribed medication for hypertension and dyslipidaemia using objective register-based follow-up data. Baseline questionnaire surveys among 40-60-year-old employees of the City of Helsinki, Finland, were conducted in 2000-2002 (n = 6477, response rate 67%, 78% women) and linked to a national register on prescribed reimbursed medication 5-7 years prior to and 5 years after baseline. Associations between the frequency of insomnia symptoms (difficulties in initiating and maintaining sleep, non-restorative sleep) and hypertension and dyslipidaemia medication during the follow-up were analysed using logistic regression analysis (odds ratios with 95% confidence intervals). Analyses were adjusted for pre-baseline medication, sociodemographic and work-related factors, health behaviours, mental health, and diabetes. Frequent insomnia symptoms were reported by 20%. During the 5-year follow-up, 32% had hypertension medication and 15% dyslipidaemia medication. Adjusting for age, gender and pre-baseline medication, frequent insomnia symptoms were associated with hypertension medication (odds ratio 1.57, 95% confidence interval 1.23-2.00) and dyslipidaemia medication (odds ratio 1.59, 95% confidence interval 1.19-2.12). Occasional insomnia symptoms were also associated with cardiovascular medication, though less strongly. Further adjustments had negligible effects. To conclude, insomnia should be taken into account in the prevention and management of cardiovascular disease and related risk factors.

Occupational class differences in body mass index and weight gain in Japan and Finland

Background

Occupational class differences in body mass index (BMI) have been systematically reported in developed countries, but the studies have mainly focused on white populations consuming a Westernized diet. We compared occupational class differences in BMI and BMI change in Japan and Finland.

Methods

The baseline surveys were conducted during 1998–1999 among Japanese (n = 4080) and during 2000–2002 among Finnish (n = 8685) public-sector employees. Follow-up surveys were conducted among those still employed, in 2003 (n = 3213) and 2007 (n = 7086), respectively. Occupational class and various explanatory factors were surveyed in the baseline questionnaires. Linear regression models were used for data analysis.

Results

BMI was higher at baseline and BMI gain was more rapid in Finland than in Japan. In Finland, baseline BMI was lowest among men and women in the highest occupational class and progressively increased to the lowest occupational class; no gradient was found in Japan (country interaction effect, P = 0.020 for men and P < 0.0001 for women). Adjustment for confounding factors reflecting work conditions and health behavior increased the occupational class gradient among Finnish men and women, whereas factors related to social life had no effect. No statistically significant difference in BMI gain was found between occupational classes.

Conclusions

The occupational class gradient in BMI was strong among Finnish employees but absent among Japanese employees. This suggests that occupational class inequalities in obesity are not inevitable, even in high-income societies.

Leisure-time physical activity and psychotropic medication: a prospective cohort study

BACKGROUND

Physical inactivity is a major public health problem associated with an increased risk of mental health problems. The aim of this study was to examine the associations of leisure-time physical activity with subsequent psychotropic medication among middle-aged people employed at baseline.

METHODS

Questionnaire survey data collected in 2000-02 among 40-60-year-old employees of the City of Helsinki (N = 8960) were linked with register data on prescribed psychotropic medication (74% gave permission to linkage). The mean follow-up time was 4.2 years. The analysis included 5961 respondents (78% women). The participants were classified into four groups according to physical activity recommendations. Cox regression analysis was used to calculate hazard ratios (HR) for the first psychotropic medication purchase.

RESULTS

Leisure-time physical activity was associated with decreased risk of any psychotropic medication. After adjusting for prior psychotropic medication conditioning exercisers (HR = 0.65, 95% CI, 0.53-0.80), the vigorously active (HR = 0.83, 95% CI, 0.71-0.98) and the moderately active (HR = 0.85, 95% CI, 0.74-0.97) all showed a reduced risk of medication compared with the inactive. The associations were similar for the two main groups of psychotropic medication: antidepressants as well as sedatives and sleep medication.

CONCLUSIONS

Leisure-time physical activity is potentially important for preventing mental health problems among the middle-aged.

Socioeconomic differences in disability retirement in Finland: the contribution of ill-health, health behaviours and working conditions

AIMS

Socioeconomic differences in disability retirement are large. In this study, the main interest was to find out the contribution of diseases, self-rated health, health behaviours and working conditions to socioeconomic differences in disability retirement.

METHODS

The data are from the nationally-representative Health 2000 Survey to which register-based retirement data have been linked. These data include 3674 persons aged 30-62 years who were employed at baseline. Of the participants, 363 ended up in disability retirement during the follow-up period 2000-2009. Cox regression analysis was used to calculate hazard ratios and their 95% confidence intervals.

RESULTS

The risk of all-cause disability retirement was higher among manual workers (HR for men 2.44, 95% CI 1.64-3.63, women 2.33, 1.57-3.44) than upper-grade non-manual employees. Ill-health and physical working conditions contributed to the socioeconomic differences in disability retirement. The importance of physical working conditions was seen in particular among those aged 50 years or over and those in disability retirement due to musculoskeletal diseases. The contribution of self-rated health was stronger in older than younger disability retirees.

CONCLUSIONS

Our findings suggest that preventing ill-health and improving working conditions, especially among the lower socioeconomic classes, would help reduce socioeconomic differences in disability retirement.

Multiple socioeconomic determinants of weight gain: the Helsinki Health Study

BACKGROUND

Socioeconomic differences in weight gain have been found, but several socioeconomic determinants have not been simultaneously studied using a longitudinal design. The aim of this study was to examine multiple socioeconomic determinants of weight gain.

METHODS

Mail surveys were conducted in 2000-2002 among 40 to 60-year old employees of the City of Helsinki, Finland (n = 8,960, response rate 67%). A follow-up survey was conducted among the baseline respondents in 2007 with a mean follow-up of 5 to 7 years (n = 7,332, response rate 83%). The outcome measure was weight gain of 5 kg or more over the follow-up. Socioeconomic position was measured by parental education, childhood economic difficulties, own education, occupational class, household income, home ownership and current economic difficulties. Multivariable logistic regression models were fitted adjusting simultaneously for all covariates in the final model.

RESULTS

Of women 27% and of men 24% gained 5 kg or more in weight over the follow-up. Among women, after adjusting for age, baseline weight and all socioeconomic determinants, those with basic (OR 1.40 95% CI 1.11-1.76) or intermediate education (OR 1.43 95% CI 1.08-1.90), renters (OR 1.18 95% CI 1.03-1.36) and those with occasional (OR 1.19 95% CI 1.03-1.38) or frequent (OR 1.50 95% CI 1.26-1.79) economic difficulties had increased risk of weight gain. Among men, after full adjustment, having current frequent economic difficulties (OR 1.70 95% CI 1.15-2.49) remained associated with weight gain.

CONCLUSIONS

Current economic difficulties among both women and men, and among women low education and renting, were associated with weight gain. Prevention of weight gain among ageing people would benefit from focusing in particular on those with economic difficulties.

Joint association of physical activity and body weight with subsequent physical and mental functioning: a follow-up study

Background

Physical inactivity and overweight are major threats to public health. However, it is not well understood to what extent physical activity might counteract the harmful effects of overweight on functioning. Thus, we examined the joint associations of leisure-time physical activity and body mass index (BMI) with subsequent physical and mental functioning over a follow-up of five to seven years.

Methods

The data were derived from the Helsinki Health Study, which is a cohort study among employees of the City of Helsinki, Finland. The baseline postal survey data were collected among 40-60-year-old employees in 2000–02 (n = 8960, response rate 67%), and the follow-up data in 2007 among all baseline survey respondents (n = 7332, response rate 83%). We divided the participants into six groups according to their amount of physical activity (inactive, moderately active and highly active) and their relative weight (normal weight and overweight). Highly active normal-weight participants were used as a reference group in all the analyses. Poor functioning was defined as the lowest quartile of the Short Form 36 (SF-36) health survey’s physical and mental component summaries, with the follow-up cut-off point also applied at baseline. We used logistic regression analysis adjusted for age, gender, baseline functioning, smoking, alcohol use, marital status, socioeconomic position and working conditions.

Results

At baseline 48% of the participants were overweight and 11% were inactive. After adjustments inactivity was associated with poor physical functioning at follow-up both among the normal-weight (OR 1.51, 95% CI 1.09-2.10) and overweight (OR 2.02, 95% CI 1.56-2.63) groups. Being overweight regardless of activity level was associated with poor physical functioning. Poor physical functioning was practically equally common among the highly active overweight group and the inactive normal-weight group. After adjustments, for mental functioning, only inactivity among the overweight was associated with poor mental functioning (OR 1.39, 95% CI 1.08-1.80).

Conclusions

Physical activity is likely to be beneficial for physical and mental functioning among both those with overweight and normal weight. However, maintaining normal weight is also important for good physical functioning. Therefore, efforts should be made to recommend people to engage in physical activity regardless of weight.

Changes in economic difficulties and subsequent sickness absence: a prospective register-linkage study

OBJECTIVES

People's economic difficulties are associated with their health, but consequences of changes in economic difficulties are less understood. We aimed to examine the associations between changes in economic difficulties and subsequent sickness absence while considering socioeconomic circumstances and other covariates.

DESIGN

A prospective cohort study.

SETTING

Helsinki, Finland.

PARTICIPANTS

Municipal employees of the City of Helsinki, Finland (n=3859), who were respondents to the baseline (2000-2002) and follow-up (2007) questionnaire surveys and had register-based follow-up data on sickness absence until the end of 2010.

PRIMARY AND SECONDARY OUTCOME MEASURES

Self-certified short (1-3 days) and medically certified intermediate (4-14 days) and long (15+ days) sickness absence spells were examined using employer's personnel register data.

RESULTS

Persistent frequent economic difficulties predicted short (rate ratios (RR) 1.66 95% CI 1.49 to 1.86), intermediate (RR 2.13 95% CI 1.85 to 2.45) and long (RR 2.18 95% CI 1.75 to 2.70) sickness absence spells. Increasing economic difficulties similarly predicted sickness absence spells. The risks were somewhat stronger the longer the absence, and remained although attenuated somewhat after full adjustment. Weak risks were found also for persistent occasional economic difficulties and decreasing economic difficulties, and they attenuated further after full adjustments.

CONCLUSIONS

Changes in economic difficulties predict subsequent sickness absence even after considering income, baseline health and other covariates. Thus economic difficulties should be considered when addressing causes of sickness absence.

Working conditions and major weight gain-a prospective cohort study

The objective of this study was to examine the associations of working conditions with major weight gain. Three different groups of work-related factors were examined: (i) work arrangements, (ii) physical working conditions, and (iii) psychosocial working conditions. The data are based on the Helsinki Health Study (HHS) questionnaire surveys. A baseline mail survey was made among middle-aged employees of the City of Helsinki in 2000-2002. A follow-up survey was made in 2007. Regression analyses with odds ratios and 95% confidence intervals were calculated. During the 5- to 7-year follow-up, 26% of women and 24% of men gained in weight 5 kg or more. Working conditions were mostly unassociated with weight gain. However, nighttime shift work, physical threat at work, and hazardous exposures at work were moderately associated with weight gain. More attention should be devoted to the prevention of weight gain in general and among risk groups in particular.

Workplace bullying and subsequent psychotropic medication: a cohort study with register linkages

OBJECTIVES

We aimed to examine longitudinally whether workplace bullying was associated with subsequent psychotropic medication among women and men.

DESIGN

A cohort study.

SETTING

Helsinki, Finland.

PARTICIPANTS

Employees of the City of Helsinki, Finland (n=6606, 80% women), 40-60 years at baseline in 2000-2002, and a register-based follow-up on medication.

PRIMARY AND SECONDARY OUTCOME MEASURES

Workplace bullying comprised questions about current and earlier bullying as well as observing bullying. The Finnish Social Insurance Institution's register data on purchases of prescribed reimbursed psychotropic medication were linked with the survey data. All psychotropic medication 3 years prior to and 5 years after the baseline survey was included. Covariates included age, prior psychotropic medication, childhood bullying, occupational class, and body mass index. Cox proportional hazard models (HR, 95% CI) were fitted and days until the first purchase of prescribed psychotropic medication after baseline were used as the time axis.

RESULTS

Workplace bullying was associated with subsequent psychotropic medication after adjusting for age and prior medication among both women (HR 1.51, 95% CI 1.18 to 1.93) and men (HR 2.15, 95% CI 1.36 to 3.41). Also observing bullying was associated with subsequent psychotropic medication among women (HR 1.53, 95% CI 1.25 to 1.88) and men (HR 1.92, 95% CI 1.23 to 2.99). The associations only modestly attenuated after full adjustment.

CONCLUSIONS

Our findings highlight the significance of workplace bullying to subsequent psychotropic medication reflecting medically confirmed mental problems. Tackling workplace bullying likely helps prevent mental problems among employees.

Different measures of body weight as predictors of sickness absence

AIMS

Excessive weight is associated with increased sickness absence from work due to obesity-linked health problems. However, it is not known which obesity measure best predicts sickness absence. First, we aimed to compare body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) as predictors of sickness absence spells of various lengths. Second, we aimed to compare BMI based on self-reported and measured weight and height as a predictor of sickness absence to assess the validity of self-reported BMI.

METHODS

The participants were 5750 employees of the City of Helsinki, aged 40-60 years, who were followed up on average for 4.8 years using the employer's register. Sickness absence spells were classified as self-certified short (1-3 days), medically certified medium length (4-14 days), and long (>14 days) absence spells.

RESULTS

All measures of body weight predicted sickness absence. The relative rates of long sickness absence in the highest quintile as compared to the lowest quintile varied in women from 1.62 (95% CI 1.35-1.94) to 1.89 (95% CI 1.62-2.23) and in men from 1.40 (95% CI 0.76-2.59) to 2.33 (95% CI 1.32-4.11). Differences in the predictive power of BMI and WC were small: both were more strongly associated with sickness absence than WHR. Self-reported BMI performed equally well as measured BMI.

CONCLUSIONS

BMI - measured or self-reported - is a valid anthropometric indicator of body weight and predictor of obesity-associated health-risks. Its use is feasible for research purposes as well as for the assessment of weight-related risks to work ability.

Changes in leisure-time physical activity and subsequent sickness absence: a prospective cohort study among middle-aged employees

OBJECTIVE

The aim of this study was to examine how changes over time in leisure-time physical activity are associated with subsequent sickness absence.

METHODS

Helsinki Health Study cohort baseline questionnaire survey data were collected in 2000-2002 among 40-60-year-old employees of the City of Helsinki, Finland. A follow-up survey was conducted in 2007. 4182 (83% women) respondents were available for the analyses. Leisure-time physical activity was asked using identical questions in both surveys. Sickness absence data were derived from the employer's registers (mean follow-up time 2.8 years). Associations of changes over time in leisure-time physical activity with self-certified (≤ 3 days) and medically certified (>3 days) sickness absence spells were examined, using Poisson regression analysis.

RESULTS

Inactive women and men who increased their physical activity to vigorously active had a significantly lower risk of both self-certified (RR=0.80, 95% CI 0.65-0.97) and medically certified (RR=0.63, 95% CI 0.49-0.83) subsequent sickness absence spells compared with the persistently inactive. The persistently active with vigorous intensity had the lowest risk of sickness absence. Adjusting for changes in physical health functioning attenuated but did not abolish the lowered risk found.

CONCLUSIONS

For reducing sickness absence more emphasis should be given to the potential contribution of vigorous physical activity.

Drinking habits and disability retirement

AIMS

To examine associations between drinking habits and disability retirement, and to determine whether the associations differ between all-cause disability retirement and the main causes of disability retirement, i.e. musculoskeletal diseases and mental disorders.

DESIGN

A prospective cohort study with a mean follow-up time of 8 years.

SETTING

Middle-aged employees of the City of Helsinki, Finland.

PARTICIPANTS

A total of 6275 municipal employees (78% women) who were 40-60 years old at baseline.

MEASUREMENTS

Data on drinking habits, i.e. quantity and frequency of drinking, binge drinking and problem drinking, were derived from the baseline questionnaire. The data on disability retirement and its diagnoses came from the Finnish Centre for Pensions. The analyses were made using Cox regression analysis.

FINDINGS

Heavy average and frequent drinking were not associated with all-cause disability retirement, but increased the risk of disability retirement due to mental disorders even after adjusting for all covariates [hazard ratios (HR) and 95% confidence intervals (CI) 2.54 (1.26-5.12) and 2.10 (1.23-3.61), respectively]. Binge and problem drinking were both associated with all-cause disability retirement in the base models adjusted for age, gender and marital status. Problem drinking more than doubled the risk of disability retirement due to mental disorders even after all adjustments (HR 2.17, CI 1.53-3.08). Non-drinkers had an increased risk for disability retirement due to all mental and musculoskeletal diagnoses.

CONCLUSIONS

Adverse drinking habits may contribute to disability retirement among the middle-aged working population. Tackling unhealthy drinking habits may lessen the likelihood of early retirement due to poor mental health.

Relative weight and disability retirement: a prospective cohort study

OBJECTIVES

The aims of this study were to examine (i) the association of relative weight with subsequent disability retirement due to any diagnosis and also in two major diagnostic groups (ie, musculoskeletal diseases and mental disorders) and (ii) whether diagnosed diseases, physical and mental functioning, and working conditions explain these associations.

METHODS

This prospective study comprised a cohort of 6542 middle-aged employees of the City of Helsinki, Finland. Questionnaire data were linked with register data on disability retirements, with a mean follow-up time of 7.8 years.

RESULTS

Adjusting for age, body mass index (BMI) was associated with all-cause disability retirement among men and women, the highest risk being for the severely obese and the obese [hazard ratio (HR) 3.45, 95% confidence interval (95% CI) 2.53-4.69; HR 1.94, 95% CI 1.52-2.46, respectively]. Adjusting for age, relative weight was also strongly associated with the main retirement diagnoses, especially musculoskeletal diseases among the severely obese (HR 4.76, 95% CI 3.06-7.40) and obese (HR 2.35, 95% CI 1.62-3.39). The association was attenuated when adjusting for self-reported diseases and physical and mental functioning at baseline. Working conditions had negligible effects on the associations.

CONCLUSIONS

Maintenance of normal weight is likely to reduce the risk of disability retirement. Among obese employees, the focus should be on the improvement of physical functioning and the effective treatment of obesity and its co-morbidities to counteract the heightened risk of disability retirement.