Occupational class inequalities in health across employment sectors: the contribution of working conditions

Does higher education make women sicker? A study of the gender gap in sickness absence within educational groups

This study describes changes in the withdrawal of sickness benefits among men and women in Sweden over a period of three decades (1994-2018), based on administrative data. During this period there was a gender gap in the takeout of sickness benefits to women's disadvantages in all age groups as well as educational groups. The gap was particularly large between men and women with secondary education in the ages 30 to 39. The general gender gap in sickness absence is larger today compared to 1994. The development, after 2010, was mainly driven by a larger increase in sick leave among women with secondary education, both in relation to men with secondary education and in relation to women with both lower and higher levels of education. For women with secondary education, sick leave does not seem to vary according to age. Thus, in this educational group, women of child-rearing age are not more prone to take sick leave than other age groups.

Where do autistic people work? The distribution and predictors of occupational sectors of autistic and general population employees

LAY ABSTRACT

Studies on employment of autistic individuals mainly assessed if they work and what their working conditions are (e.g. weekly hours, salary) while less is known about where they work. We explore this issue in our study, by examining which employment sectors do autistic adults work in, and comparing them to the general workforce in the Netherlands. We also explored the possibility that gender, age, age at diagnosis, level of education, degree of autistic traits and presence of focused interests could lead to a higher likelihood of working in specific sectors. We assessed data from a survey filled in by 1115 employed autistic adults (476 male; 627 female; 12 other; mean age: 40.75). Dutch workforce information was based on data form the Central Bureau of Statistics. Results showed that a higher proportion of autistic employees worked in healthcare & welfare, information technology, and the public-army-charity sectors. These were the three most-common sectors for this group. A lower proportion of autistic employees worked in economics & finances, and industry & construction, compared to the general workforce. Most autistic employees in the healthcare & welfare sector were females while having a higher educational degree and being male increased the chance of working in information technology. In addition to the common impression that most autistic individuals have interests or abilities that align with employment in information technology and technology sectors, we found that autistic employees worked in various sectors. It is important to address individual characteristics and needs of autistic individuals, while encouraging diverse employment opportunities.

Occupational Class Differences in Emotional Exhaustion Among Municipal Employees - The Role of Employment Sector and Psychosocial Working Conditions

Studies examining occupational class differences in burnout symptoms across employment sectors are scarce. The aim of this study was to examine whether occupational class is associated with emotional exhaustion, and whether there are differences in the examined associations between employment sectors. A further aim was to examine to which extent psychosocial working conditions may explain these associations. Survey data were collected in 2017 among 19-39-year-old employees of the City of Helsinki (4630 women and 1267 men, response rate 51.5%). Occupational class included four classes: 1. manuals, 2. routine non-manuals, 3. semi-professionals, 4. managers and professionals. Employment sector was classified into three groups: 1. health and social care, 2. education and 3. 'other'. Linear regression analysis and IBM SPSS 25 statistical program were used. The analytical sample included 4883 participants. The highest occupational class, i.e. managers and professionals, reported the highest emotional exhaustion. In terms of the sector, those working in education had the highest scores of emotional exhaustion. The associations between occupational class and emotional exhaustion differed somewhat between the sectors. Adjustment for job demands attenuated the differences in emotional exhaustion between occupational classes, whereas adjustment for job control and job strain widened the differences. Attention should be paid to occupations with excess mental demands, and to employees in the education sector, who showed the highest risk of emotional exhaustion.

Spatial Aspects of Health-Developing a Conceptual Framework

Numerous studies and models address the determinants of health. However, in existing models, the spatial aspects of the determinants are not or only marginally taken into account and a theoretical discussion of the association between space and the determinants of health is missing. The aim of this paper is to generate a framework that can be used to place the determinants of health in a spatial context. A screening of the current first serves to identify the relevant determinants and describes the current state of knowledge. In addition, spatial scales that are important for the spatial consideration of health were developed and discussed. Based on these two steps, the conceptual framework on the spatial determinants of health was derived and subsequently discussed. The results show a variety of determinants that are associated with health from a spatial point of view. The overarching categories are global driving forces, policy and governance, living and physical environment, socio-demographic and economic conditions, healthcare services and cultural and working conditions. Three spatial scales (macro, meso and micro) are further subdivided into six levels, such as global (e.g., continents), regional (e.g., council areas) or neighbourhood (e.g., communities). The combination of the determinants and spatial scales are presented within a conceptual framework as a result of this work. Operating mechanisms and pathways between the spatial levels were added schematically. This is the first conceptual framework that links the determinants of health with the spatial perspective. It can form the working basis for future analyses in which spatial aspects of health are taken into account.

Do working conditions contribute differently to gender gaps in self-rated health within different occupational classes? Evidence from the Swedish Level of Living Survey

Socioeconomic inequality in health among women is often referred to as smaller than health inequality among men. However, we know less about differences in health between men and women within the same socioeconomic groups. In this article the lack of attention to potential socioeconomic variation in gender health inequality is argued as unfortunate, as it can obscure how mechanisms, such as e.g. working conditions, affect gendered health within specific groups. Drawing on the nationally representative Swedish Level of Living survey (LNU), class/gender interactions as well as class-separate linear probability models are estimated to explore relationships between working conditions and health among men and women with the same occupational class positions. Results show that, although class is not a large explanatory factor for general gender differences in health, there are varying within-class differences between men and women in working conditions, that can contribute to the understanding of within-class gender differences in health. This highlights that, when targeting causes of gender health inequality, it is important to consider not only what class means for women as well as for men, but also what gender means within specific classes.

From long-term sickness absence to disability retirement: diagnostic and occupational class differences within the working-age Finnish population

Background

It is well documented that sickness absence is strongly associated with disability retirement. A long-term sickness absence (LTSA) in particular increases the risk of disability retirement, but little is known about the variation of this risk across diagnostic causes. Further, as occupational classes differ in their diagnostic profiles, it is likely that the role of diagnosis in the pathway from LTSA to disability retirement varies between occupational classes. We examined how LTSA of different diagnostic causes predicts all-cause disability retirement and disability retirement due to the same diagnostic group or due to some other diagnostic group than that which caused the LTSA spell in different occupational classes.

Methods

Cox proportional hazards models were used to analyse a 70% random sample of all employed Finns aged 25–62 Finns in 2006 (N = 1,458,288). Disability retirement was followed from 2007 to 2014. The risk of disability retirement was compared between occupational classes with at least one LTSA spell due to musculoskeletal diseases, mental disorders, respiratory diseases, or circulatory diseases and those who had no LTSA spells due to these diagnostic groups during 2005.

Results

Those who had LTSA due to musculoskeletal diseases or mental disorders transferred more often to disability retirement due to same diagnostic group, whereas those who had LTSA due to respiratory or circulatory diseases transferred more often to disability retirement due to some other diagnostic group. The largest occupational class differences in all-cause disability retirement were found among those with LTSA due to mental disorders. For men, the hazard ratios (HR) varied from HR 5.70 (95% confidence interval (CI) 5.00–6.52) in upper non-manual employees to 2.70 (95% CI 2.50–2.92) in manual workers. For women, the corresponding HRs were 3.74 (95% CI 3.37–4.14) in upper non-manual employees and 2.32 (95% 2.17–2.50) in manual workers.

Conclusions

The association between LTSA and disability retirement varies between diagnostic groups, and the strength of this association further depends on the person’s occupational class and gender.

Estimates of the Prevalence, Intensity and the Number of Workers Exposed to Cigarette Smoking across Occupations and Industries in Korea

BACKGROUND

Tobacco smoking affects the incidence of various illnesses such as lung cancer, respiratory diseases, and cardiovascular diseases. In an effort to prevent smoking-related cancers, we aimed to estimate the smoking prevalence, intensity, and number of workers exposed to smoking, which would be specific to the occupational and industrial circumstances in Korea.

METHODS

We used the Korean Working Condition Survey (KWCS) and Korea's Census data. Smoking prevalence and intensity were estimated using the KWCS data. The number of smokers was estimated by multiplying smoking prevalence with the number of workers in the occupation or industry. Smoking prevalence, intensity, and number of smokers were estimated for major, sub-major, and minor groups of occupation and industry.

RESULTS

Of the total labor force in 2010, 52.66% of men and 5.24% of women workers were estimated to be current smokers. Men workers smoked 15.42 cigarettes/day, and women workers 11.29 cigarettes/day. In terms of occupation, "craft and related trades workers" demonstrated the highest smoking prevalence (52.24%). "Managers" smoked the highest number of cigarettes (16.63 cigarettes/day) and "equipment, machine operating, and assembling workers" comprised the largest number of estimated smokers (1,368,726 workers). In terms of industry, "mining and quarrying" had the highest smoking prevalence (69.27%). Those in "construction" smoked the highest number of cigarettes (17.16 cigarettes/day) and those in "manufacturing" comprised the largest number of estimated smokers (1,629,893 workers).

CONCLUSION

Our results may help in setting priorities for smoking prevention-related activities. In addition, these results can be used for epidemiological studies controlling for the effect of smoking by occupation or industry.

Job requirement level, work demands, and health: a prospective study among older workers

Purpose

Persons in lower occupational positions experience higher rates of morbidity compared to workers in higher advantaged positions. Working conditions may explain this occupational health gradient. Most studies consider either psychosocial or physical work demands at one point in time. In our study, we examine both physical and psychosocial work demands and their association with health status differentiated by job requirement level. We further distinguish between constant and changing work demands.

Methods

Using data from the first two waves of the German cohort study on work, age and health, we analyse a sample of 3644 older workers born in 1959 and 1965. We test direct and mediating effects of high physical and psychosocial work demands on functional physical and mental health. For this, we estimate a prospective path model using multiple linear regression models.

Results

Our results show that (1) constant high physical and psychosocial work demands affect physical and mental health negatively and (2) high physical workload partly mediates the relationship between job requirement level and physical health. Moreover, at least for men, a reduction of physical and psychosocial workload improves mental health status.

Conclusions

Research and prevention measures currently focus particularly on psychosocial work demands. Our study shows that high physical workload is still present among older workers. Its negative health effect refers to occupational safety and health measures that take into account both the physical and psychosocial work environment as well as workers’ occupational positions.

Study protocol: a pragmatic, stepped-wedge trial of tailored support for implementing social determinants of health documentation/action in community health centers, with realist evaluation

BACKGROUND

National leaders recommend documenting social determinants of health and actions taken to address social determinants of health in electronic health records, and a growing body of evidence suggests the health benefits of doing so. However, little evidence exists to guide implementation of social determinants of health documentation/action.

METHODS

This paper describes a 5-year, mixed-methods, stepped-wedge trial with realist evaluation, designed to test the impact of providing 30 community health centers with step-by-step guidance on implementing electronic health record-based social determinants of health documentation. This guidance will entail 6 months of tailored support from an interdisciplinary team, including training and technical assistance. We will report on tailored support provided at each of five implementation steps; impact of tailored implementation support; a method for tracking such tailoring; and context-specific pathways through which these tailored strategies effect change. We will track the competencies and resources needed to support the study clinics' implementation efforts.

DISCUSSION

Results will inform how to tailor implementation strategies to meet local needs in real-world practice settings. Secondary analyses will assess impacts of social determinants of health documentation and referral-making on diabetes outcomes. By learning whether and how scalable, tailored implementation strategies help community health centers adopt social determinants of health documentation and action, this study will yield timely guidance to primary care providers. We are not aware of previous studies exploring implementation strategies that support adoption of social determinants of action using electronic health and interventions, despite the pressing need for such guidance.

TRIAL REGISTRATION

clinicaltrials.gov, NCT03607617 , registration date: 7/31/2018-retrospectively registered.

Adoption of Social Determinants of Health EHR Tools by Community Health Centers

PURPOSE

This pilot study assessed the feasibility of implementing electronic health record (EHR) tools for collecting, reviewing, and acting on patient-reported social determinants of health (SDH) data in community health centers (CHCs). We believe it is the first such US study.

METHODS

We implemented a suite of SDH data tools in 3 Pacific Northwest CHCs in June 2016, and used mixed methods to assess their adoption through July 2017. We modified the tools at clinic request; for example, we added questions that ask if the patient wanted assistance with SDH needs.

RESULTS

Social determinants of health data were collected on 1,130 patients during the study period; 97% to 99% of screened patients (n = 1,098) had ≥1 SDH need documented in the EHR, of whom 211 (19%) had an EHR-documented SDH referral. Only 15% to 21% of patients with a documented SDH need indicated wanting help. Examples of lessons learned on adoption of EHR SDH tools indicate that clinics should: consider how to best integrate tools into existing workflow processes; ensure that staff tasked with SDH efforts receive adequate tool training and access; and consider that timing of data entry impacts how and when SDH data can be used.

CONCLUSIONS

Our results indicate that adoption of systematic EHR-based SDH documentation may be feasible, but substantial barriers to adoption exist. Lessons from this study may inform primary care providers seeking to implement SDH-related efforts, and related health policies. Far more research is needed to address implementation barriers related to SDH documentation in EHRs.

Sickness absence as a predictor of disability retirement in different occupational classes: a register-based study of a working-age cohort in Finland in 2007-2014

OBJECTIVES

The objective of the study was to examine diagnosis-specific sickness absences of different lengths as predictors of disability retirement in different occupational classes.

DESIGN

Register-based prospective cohort study up to 8 years of follow-up.

PARTICIPANTS

A 70% random sample of the non-retired Finnish population aged 25-62 at the end of 2006 was included (n=1 727 644) and linked to data on sickness absences in 2005 and data on disability retirement in 2007-2014.

MAIN OUTCOME MEASURES

Cox proportional hazards regression was utilised to analyse the association of sickness absence with the risk of all-cause disability retirement during an 8-year follow-up.

RESULTS

The risk of disability retirement increased with increasing lengths of sickness absence in all occupational classes. A long sickness absence was a particularly strong predictor of disability retirement in upper non-manual employees as among those with over 180 sickness absence days the HR was 9.19 (95% CI 7.40 to 11.40), but in manual employees the HR was 3.51 (95% CI 3.23 to 3.81) in men. Among women, the corresponding HRs were 7.26 (95% CI 6.16 to 8.57) and 3.94 (95% CI 3.60 to 4.30), respectively. Adjusting for the diagnosis of sickness absence partly attenuated the association between the length of sickness absence and the risk of disability retirement in all employed groups.

CONCLUSIONS

A long sickness absence is a strong predictor of disability retirement in all occupational classes. Preventing the accumulation of sickness absence days and designing more efficient policies for different occupational classes may be crucial to reduce the number of transitions to early retirement due to disability.

Developing Electronic Health Record (EHR) Strategies Related to Health Center Patients' Social Determinants of Health

BACKGROUND

"Social determinants of heath" (SDHs) are nonclinical factors that profoundly affect health. Helping community health centers (CHCs) document patients' SDH data in electronic health records (EHRs) could yield substantial health benefits, but little has been reported about CHCs' development of EHR-based tools for SDH data collection and presentation.

METHODS

We worked with 27 diverse CHC stakeholders to develop strategies for optimizing SDH data collection and presentation in their EHR, and approaches for integrating SDH data collection and the use of those data (eg, through referrals to community resources) into CHC workflows.

RESULTS

We iteratively developed a set of EHR-based SDH data collection, summary, and referral tools for CHCs. We describe considerations that arose while developing the tools and present some preliminary lessons learned.

CONCLUSION

Standardizing SDH data collection and presentation in EHRs could lead to improved patient and population health outcomes in CHCs and other care settings. We know of no previous reports of processes used to develop similar tools. This article provides an example of 1 such process. Lessons from our process may be useful to health care organizations interested in using EHRs to collect and act on SDH data. Research is needed to empirically test the generalizability of these lessons.

Long-Lasting Obesity Predicts Poor Work Ability at Midlife: A 15-Year Follow-Up of the Northern Finland 1966 Birth Cohort Study

OBJECTIVE

To investigate the effect of adulthood obesity on work ability in early midlife during a 15-year follow-up.

METHODS

The study population included men and women (n = 5470), born in northern Finland in 1966. Participants evaluated their current perceived work ability compared with their lifetime best at the age of 46. Participants' weight and height were measured at 31 years and self-reported at 46 years, and body mass indexes were calculated.

RESULTS

Obesity at both ages, and developing obesity between the ages of 31 and 46 increased the relative risk of poor work ability at 46 years among sexes, and among those in both low and high physically strenuous work.

CONCLUSIONS

Long-term obesity and developing obesity in mid-adulthood increase the risk of poor work ability. Thus, the promotion of healthy behaviors by policies, healthcare services, and at workplaces is important.

Influência da organização do trabalho sobre a prevalência de transtornos mentais comuns dos agentes comunitários de saúde de Belo Horizonte

Resumo Introdução: à medida que se reconhece o papel dos agentes comunitários de saúde (ACS) para os objetivos do sistema de saúde, é evidente a preocupação com a prevalência de sintomas psíquicos entre esses trabalhadores, conclamando a identificação de indicadores passíveis de serem modificados em favor da saúde mental dos ACS. Objetivo: examinar associações entre a prevalência de transtornos mentais comuns (TMC) e condições de trabalho entre ACS inseridos nos serviços de atenção básica de Belo Horizonte, MG. Método: a amostra aleatória e representativa incluiu 196 sujeitos. Utilizou-se o Self-Reporting Questionnaire (SRQ-20) e questionário autopreenchível que continha blocos relacionados às questões sociodemográficas, ocupacionais e hábitos de vida. A análise multivariável adotou entrada hierárquica das variáveis e regressão de Poisson com estimativa da variância robusta. Resultados: a prevalência de TMC de 26,5% foi associada à alta demanda psicológica, relato de agressões contra o trabalhador e insatisfação com as relações pessoais. Conclusão: a significância da associação no tocante à demanda psicológica no trabalho é preocupante, pois seria possível projetar o trabalho dos ACS sem ultrapassar os seus próprios limites. Adequações do modelo organizacional e redesenho das tarefas podem contribuir favoravelmente para a saúde mental dos ACS.

"Community vital signs": incorporating geocoded social determinants into electronic records to promote patient and population health

Social determinants of health significantly impact morbidity and mortality; however, physicians lack ready access to this information in patient care and population management. Just as traditional vital signs give providers a biometric assessment of any patient, "community vital signs" (Community VS) can provide an aggregated overview of the social and environmental factors impacting patient health. Knowing Community VS could inform clinical recommendations for individual patients, facilitate referrals to community services, and expand understanding of factors impacting treatment adherence and health outcomes. This information could also help care teams target disease prevention initiatives and other health improvement efforts for clinic panels and populations. Given the proliferation of big data, geospatial technologies, and democratization of data, the time has come to integrate Community VS into the electronic health record (EHR). Here, the authors describe (i) historical precedent for this concept, (ii) opportunities to expand upon these historical foundations, and (iii) a novel approach to EHR integration.

Association of active and passive smoking with occupational injury in manual workers: a cross-sectional study of the 2011 Korean working conditions survey

This study was conducted to investigate the relationship of active and passive smoking with occupational injury among manual workers. Data from the 2011 Korean Working Conditions Survey were analyzed for 12,507 manual workers aged ≥15 yr. Overall, 60.4% of men and 5.8% of women were current smokers. The prevalence of injury was higher among never smokers who were exposed to secondhand smoke (SHS) (7.7% in men and 8.1% in women) than current smokers (4.2% in men and 4.1% in women). After controlling for potential confounders, in men, compared to those who never smoked and were not exposed to SHS, people who never smoked and were exposed to SHS (adjusted odds ratio (aOR)=3.7, 2.2-6.4) and current smokers (aOR=2.5, 1.6-3.8) were more likely to experience injury. Among women, the aORs of occupational injury were 8.4 (4.2-16.7) for never smoking women with occasional exposure to SHS and 3.5 (95% CI: 1.4-8.7) for current smokers, in comparison to never smoking women who were never exposed to SHS at work (reference group). The present study suggests that exposure to SHS is a possible risk factor of occupational injury for never smoking men and women.

The contribution of lifestyle and work factors to social inequalities in self-rated health among the employed population in Switzerland

We sought to examine the joint and independent contributions of working conditions and health-related behaviours in explaining social gradients in self-rated health (SRH). Nationally representative cross-sectional data from the Swiss Health Survey of 2007 were used for this study. Bi- and multivariate statistical analyses were carried out on a sample of 6950 adult employees of working age. We examined a comprehensive set of five health behaviours and lifestyle factors as well as twelve physical and psychosocial work factors as potential mediators of the relationship between social status and SRH. Analyses were stratified by sex and performed using two measures of social status, educational level and occupational position. Strong social gradients were found for SRH, but mainly in men whereas in women the associations were either not linear (educational level) or not statistically significant (occupational position). Social gradients were also found for most lifestyle and all physical and psychosocial work factors studied. These three groups of factors equally contributed to and largely accounted for the social gradients in SRH although not all of the individual factors turned out to be independent and significant risk factors for poor SRH. Such risk factors included physical inactivity and obesity, poor posture and no or low social support at work (both sexes), heavy smoking (men) and underweight, overweight, uniform arm or hand movements at work, monotonous work and job insecurity (women). In conclusion, social inequalities (or more precisely educational and occupational status differences) in SRH were more pronounced in men and can be attributed for the most part to a sedentary lifestyle and to a physically demanding and socially unsupportive and insecure work environment. Apart from this main finding and overall pattern, sex-specific risk profiles were observed with regard to SRH and need to be taken into consideration.

All part of the job? The contribution of the psychosocial and physical work environment to health inequalities in Europe and the European health divide

This study is the first to examine the contribution of both psychosocial and physical risk factors to occupational inequalities in self-assessed health in Europe. Data from 27 countries were obtained from the 2010 European Working Conditions Survey for men and women aged 16 to 60 (n = 21,803). Multilevel logistic regression analyses (random intercept) were applied, estimating odds ratios of reporting less than good health. Analyses indicate that physical working conditions account for a substantial proportion of occupational inequalities in health in both Central/Eastern and Western Europe. Physical, rather than psychosocial, working conditions seem to have the largest effect on self-assessed health in manual classes. For example, controlling for physical working conditions reduced the inequalities in the prevalence of"less than good health" between the lowest (semi- and unskilled manual workers) and highest (higher controllers) occupational groups in Europe by almost 50 percent (Odds Ratio 1.87, 95% Confidence Interval 1.62-2.16 to 1.42, 1.23-1.65). Physical working conditions contribute substantially to health inequalities across "post-industrial" Europe, with women in manual occupations being particularly vulnerable, especially those living in Central/Eastern Europe. An increased political and academic focus on physical working conditions is needed to explain and potentially reduce occupational inequalities in health.

Work organization, job insecurity, and occupational health disparities

BACKGROUND

Changes in employment conditions in the global economy over the past 30 years have led to increased job insecurity and other work organization hazards. These hazards may play a role in creating and sustaining occupational health disparities by socioeconomic position, gender, race, ethnicity, and immigration status.

METHODS

A conceptual model was developed to guide the review of 103 relevant articles or chapters on the role of work organization and occupational health disparities identified through a comprehensive search conducted by NIOSH. A second review was conducted of employment and workplace policies and programs designed to reduce the health and safety risks due to job insecurity and other work organization hazards.

RESULTS

There is consistent evidence that workers in lower socioeconomic or social class positions are exposed to greater job insecurity and other work organization hazards than workers in higher socioeconomic positions. Likewise, racial and ethnic minorities and immigrants are exposed to greater job insecurity. Limited research examining the effects of interventions targeting work organization hazards on disparities has been conducted; nonetheless, intervention strategies are available and evidence suggests they are effective.

CONCLUSIONS

Job insecurity and work organization hazards play a role in creating and sustaining occupational health disparities. Employment and workplace policies and programs have the potential to reduce these hazards, and to reduce disparities.

Individual and spousal education, mortality and life expectancy in Switzerland: a national cohort study

BACKGROUND

Household measures of socioeconomic position may better account for the shared nature of material resources, lifestyle, and social position of cohabiting persons, but household measures of education are rarely used. We aimed to evaluate the association of combined educational attainment of married couples on mortality and life expectancy in Switzerland.

METHODS

The study included 3,496,163 ever-married persons aged ≥30 years. The 2000 census was linked to mortality records through 2008. Mortality by combined educational attainment was assessed by gender-age-specific HRs, with 95% CIs from adjusted models, life expectancy was derived using abridged life tables.

RESULTS

Having a less educated partner was associated with increased mortality. For example, the HR comparing men aged 50-64 years with tertiary education married to women with tertiary education to men with compulsory education married to women with compulsory education was 2.05 (1.92-2.18). The estimated remaining life expectancy in tertiary educated men aged 30 years married to women with tertiary education was 4.6 years longer than in men with compulsory education married to women with compulsory education. The gradient based on individual education was less steep: the HR comparing men aged 50-64 years with tertiary education with men with compulsory education was 1.74 (1.67-1.81).

CONCLUSIONS

Using individual educational attainment of married persons is common in epidemiological research, but may underestimate the combined effect of education on mortality and life expectancy. These findings are relevant to epidemiologic studies examining socio-demographic characteristics or aiming to adjust results for these characteristics.

The social gradient in work and health: a cross-sectional study exploring the relationship between working conditions and health inequalities

Background

Social inequalities in health are widely examined. But the reasons behind this phenomenon still remain unclear in parts. It is undisputed that the work environment plays a crucial role in this regard. However, the contribution of psychosocial factors at work is unclear and inconsistent, and most studies are limited with regard to work factors and health outcomes. This study, therefore, aimed to explore the role and contribution of various physical and psychosocial working conditions to explaining social inequalities in different self-reported health outcomes.

Methods

Data from a postal survey among the workforces of four medium-sized and large companies from diverse industries of the secondary sector in Switzerland were used and analysed. The study sample covered 1,846 employees aged 20 and 64 and included significant proportions of unskilled manual workers and highly qualified non-manual workers. Cross tabulations and logistic regression analyses were performed to study multiple associations between social status, work factors and health outcomes. Combinations of educational level and occupational position wee used as a measure of social status or class.

Results

Clear social gradients were observed for almost all adverse working conditions and poor health outcomes studied, but in different directions. While physical workloads and other typical blue-collar job characteristics not suprisingly, were found to be much more common among the lower classes, most psychosocial work demands and job resources were more prevalent in the higher classes. Furthermore, workers in lower classes, i.e. with lower educational and occupational status, were more likely to report poor self-rated health, limited physical functioning and long sickness absence, but at the same time were less likely to experience increased stress feelings and burnout symptoms showing a reversed health gradient. Finally, blue-collar job characteristics contributed substantially to the social gradient found in general and physical health outcomes. In contrast, white-collar job characteristics made no contribution to explaining the gradient in these health outcomes, but instead largely explained the reversed social gradient observed for the mental health outcomes.

Conclusion

The findings suggest a more differentiated pattern of the commonly found social gradient in health and the differential role of work in this respect.

Actual cardiovascular disease risk and related factors: a cross-sectional study of Korean blue collar workers employed by small businesses

Actual cardiovascular disease (CVD) risk and related factors among blue collar workers employed by small businesses were investigated. This cross-sectional study of 238 Korean blue collar workers used surveys, anthropometric and blood pressure measurements, and blood sampling for lipid and glucose levels to answer the research questions. Multiple regression techniques were used to analyze study data. The prevalence of actual CVD risk among blue collar workers was 32 cases per 100 workers. A multiple regression model showed that a combination of individual, psychosocial, and work-related factors explained 34% of the variance in actual CVD risk. The significant predictors of actual CVD risk included knowledge of CVD risk, risk perception, job stress, and waist-to-hip ratio. It is important for clinicians to consider all of these significant predictors of actual CVD risk when designing an intervention program to reduce CVD among Korean blue collar workers.

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.

[Labor market status and the use of healthcare services in Brazil]

This study compares the use of health services among economically active men according to labor market status in the years 1998, 2003, 2008 and investigates whether both are associated after adjustment for socio-demographic characteristics and health indicators. All males aged 15 to 64, participating in the National Household Survey 1998, 2003 and 2008 were included. The association between labor market status and use of services in 2008 was estimated by Poisson regression. 33,726 males were surveyed and the prevalence of medical and dental care use was found to be higher among workers with social protection. The frequency of health care use increased over the period, but remained significantly higher among formally employed workers. Unemployment and work without social protection were negatively associated with medical and dental care visits. The socio-economic structure that establishes different social groups with unequal health conditions also affects the use of health services. Further investigation into the social and physical barriers to health care use by the unemployed and informal workers is required in order to reduce perceived health inequities.

Population trends and late-life disability in Hispanics from the Midwest

OBJECTIVES

To describe the growth of the Hispanic population in the Midwest states of the United States, to present disability levels in older Mexican and non-Mexican-origin Midwest Hispanics by place of birth and poverty status, and compare disability levels among older Midwest Hispanics with those among Southwest Hispanics as well as non-Hispanics Whites and African Americans in each region.

METHOD

Population data come from decennial U.S. Census Bureau surveys. Disability data for adults ≥ 50 years old come from the 2008 American Community Survey.

RESULTS

The Hispanic population in the Midwest has tripled since 1980 and now constitutes 6.6% of the entire Midwest population. Older Midwest Hispanics are somewhat younger, have a higher male-female ratio, and are more likely to be born outside the continental United States than Southwest Hispanics. In the Midwest, foreign-born Mexican American men report the lowest disability levels. Foreign-born Hispanic women of non-Mexican origin report the highest disability levels. Overall, older Hispanics have intermediate disability levels relative to non-Hispanic Whites and African Americans. Midwest Hispanics report less disability than Southwest Hispanics.

DISCUSSION

There is substantial heterogeneity in late-life disability among Midwest Hispanics, which may be related to place of birth and of origin. Future research is needed to examine age at immigration and health selection as potential reasons for low disability levels among foreign-born Mexican American men.

Which health conditions impact on productivity in working Australians?

OBJECTIVE

To identify health conditions associated with productivity loss in working Australians, adjusting for comorbidity, demographics, and work-related characteristics.

METHODS

The Australian Work Outcomes Research Cost-benefit study cross-sectional screening data set was used to identify health-related productivity losses in a sample of approximately 78,000 working Australians. Data collected with the World Health Organisation Health and Productivity Questionnaire were analyzed using negative binomial logistic regression and multinomial logistic regression models for absenteeism and presenteeism, respectively.

RESULTS

Health conditions impacted on both presenteeism and absenteeism. Drug and alcohol problems and psychological distress had a greater impact on absenteeism and presenteeism than other investigated health conditions. Demographic characteristics, health status (comorbidity), and work-related characteristics all impacted significantly on both absenteeism and presenteeism.

CONCLUSION

Mental health conditions contributed more strongly to productivity loss than other investigated health conditions.

Social class differences in health behaviours among employees from Britain, Finland and Japan: the influence of psychosocial factors

This study aims to examine social class differences in smoking, heavy drinking, unhealthy food habits, physical inactivity and obesity, and work-related psychosocial factors as explanations for these differences. This is done by comparing employee cohorts from Britain, Finland and Japan. Social class differences in health behaviours are found in the two western European countries, but not in Japan. The studied psychosocial factors related to work, work-family interface and social relationships did not explain the found class differences in health behaviours.