Cigarette smoking and alcohol use as predictors of disability retirement: A population-based cohort study

The effect of heavy smoking on retirement risk: A mendelian randomisation analysis

BACKGROUND AND AIMS

The extent to which heavy smoking and retirement risk are causally related remains to be determined. To overcome the endogeneity of heavy smoking behaviour, we employed a novel approach by exploiting the genetic predisposition to heavy smoking, as measured with a polygenic risk score (PGS), in a Mendelian Randomisation approach.

METHODS

8164 participants (mean age 68.86 years) from the English Longitudinal Study of Ageing had complete data on smoking behaviour, employment and a heavy smoking PGS. Heavy smoking was indexed as smoking at least 20 cigarettes a day. A time-to-event Mendelian Randomization (MR) analysis, using a complementary log-log (cloglog) link function, was employed to model the retirement risk.

RESULTS

Our results show that being a heavy smoker significantly increases the risk of retirement (β = 1.324, standard error = 0.622, p < 0.05). Results were robust to a battery of checks and a placebo analysis considering the never-smokers.

CONCLUSIONS

Overall, our findings support a causal pathway from heavy smoking to earlier retirement.

Estimating the Effect of Engagement in Community-Based Going-Out Program on Incidence Disability in Older Adults

OBJECTIVES

Although going out has been reported to be associated with the incidence of disability, few studies have investigated the effect of community-based programs to promote going out on the incidence of disability. This study aimed to estimate the effects of a program fostering going-out on the incidence of disability in community-dwelling older adults.

DESIGN

Longitudinal, observational study.

SETTING AND PARTICIPANTS

Nonengaged (n = 1086) and engaged older adults (n = 1086) enrolled in the National Center for Geriatrics and Gerontology Study of Geriatric Syndrome by using a one-to-one nearest neighbor propensity score-matching scheme.

METHODS

After the baseline assessments, participants in the community-based going-out program received a specialized physical activity tracker, monitored their daily physical activity, and received personalized feedback on going out to community facilities with a system for reading the device for 12 months. Disability onset was defined as a new case of long-term care under the public insurance certification in Japan within 48 months of program completion. The absolute risk reduction and the number needed to treat for the incidence of disability were calculated for the nonengaged and engaged groups. Cox proportional hazard regression analysis, using inverse probability weighting was used to obtain the hazard ratio.

RESULTS

Disabilities occurred in 112 individuals in the matched nonengaged group and 51 individuals in the engaged group. The absolute risk reduction was 5.67% (95% CI 3.46%-7.88%). The number needed to treat was 18 (95% CI 13-29). The hazard ratio, with the nonengaged group as the reference, was 0.49 (95% CI 0.36-0.67).

CONCLUSIONS AND IMPLICATIONS

This longitudinal observational study suggested that a community-based program could prevent 1 disability in every 18 participants. This program does not require a professional instructor, only the distribution of devices and system installation, and it could be beneficial as a population-based approach to preventing disabilities.

Can a Healthy Lifestyle Prevent Disability Pension among Female Healthcare Workers with Good and Poor Self-Rated Health? Prospective Cohort Study with 11-Year Register Follow-Up

BACKGROUND

Our purpose was to investigate whether healthy lifestyle habits prevent disability pension among female healthcare workers.

METHODS

We conducted a prospective cohort study with an 11-year register follow-up in which 8159 female healthcare workers from Denmark completed a questionnaire concerning self-rated health, work environment, leisure-time physical activity (LTPA), smoking, and body mass index (BMI). Data on disability benefit payments were obtained from the Danish Register for Evaluation of Marginalization during an 11-year follow-up. Potential confounders included age, occupational education, psychosocial work factors, and physical exertion during work.

RESULTS

Among workers in good health at baseline, smoking, obesity, and low levels of LTPA were risk factors for disability pension during 11-year follow-up. Among workers with poor health, only low levels of physical activity were a risk factor for disability pension.

CONCLUSIONS

This underscores the importance of a healthy lifestyle, specially being physically active, for preventing premature exit from the labor market in female healthcare workers.

US trends in binge drinking by gender, occupation, prestige, and work structure among adults in the midlife, 2006-2018

BACKGROUND

Rates of binge drinking have nearly doubled among US women ages 30-49 since 2006. Employment influences alcohol use and varies by the prestige and structure (e.g., authority, autonomy, expertise) of one's occupation.

METHODS

We examined trends in binge drinking among adults ages 30-49 in the labor force in 2006-2018 National Health Interview Surveys (N = 108,981) by occupation, work prestige (General Social Survey's occupational prestige score), work structure (occupational authority, autonomy, automation, expertise), and gender. We estimated odds of binge drinking by year with survey-weighted logistic regression controlled for sociodemographics, smoking, and disability.

RESULTS

In 2018, 30% of women and 43% of men reported binge drinking; drinking increased annually from 2006-2018 (OR for women = 1.08, OR for men = 1.03). Work status, prestige, and work structure modified the association. Women in high- (OR = 1.10, 95% CI: 1.09-1.12) versus low-prestige (OR = 1.05, 95% CI: 1.04-1.06) jobs had higher increases, as did men in high-prestige jobs (OR = 1.04, 95% CI: 1.03-1.05). Respondents in higher relative to lower authority, autonomy, and expertise jobs increased binge drinking.

CONCLUSIONS

Though all strata of workforce adults increased binge drinking, increases were concentrated among women in higher-status careers, implicating gendered shifts in labor as one determinant of recent national alcohol trends.

P, Neupane S. Process of Work Disability: From Determinants of Sickness Absence Trajectories to Disability Retirement in A Long-Term Follow-Up of Municipal Employees

Work disability may originate early during work history and involve sickness absences (SA) and eventually permanent disability. We studied this process over 15 years. Questionnaire data collected in 1981 on health, working conditions, and lifestyle of Finnish municipal employees aged 44-58 years (n = 6257) were linked with registers on SA (≥10 workdays), disability pension, and death from the period 1986-1995. Trajectory analysis was used to assess development in SA (days/year) over 5 years (1981-1985). We analyzed determinants of the trajectories with multinomial regression, while trajectory membership was used as a predictor of disability pension (DP) during the subsequent 10 years in survival analysis. Three SA trajectories emerged: increasing (women: 6.8%; men: 10.2%), moderate (21.2%; 22.7%), and low. In a mutually adjusted model, the increasing trajectory in women was associated with baseline musculoskeletal (MSD), mental and respiratory disorders, injuries, obesity, sleep problems, and low exercise (effect sizes OR > 2), and in men with MSD, sleep problems, smoking, low exercise, and non-satisfaction with management. The moderate trajectory associated with MSD, 'other somatic disorders', sleep problems, and awkward work postures in both genders; in women, also overweight, cardiovascular and respiratory morbidity, and (inversely) knowledge-intensive work, and in men, smoking and mental disorders were thus associated. Ten-year risks of DP contrasting increasing vs. low SA were more than 10-fold in both genders and contrasting moderate vs. low SA 3-fold in women and 2-fold in men. These findings emphasize the need for early identification of workers with short-term problems of work ability and interventions regarding lifestyle, health, and working conditions, to help prevent permanent disability.

Predictors of working days lost due to sickness absence and disability pension

Objective

To identify social and health-related predictors of the number of days lost due to sickness absence (SA) and disability pension (DP) among initially 55-year-old public-sector workers.

Methods

The data from the Finnish Helsinki Health Study included participants aged 55 years at the baseline (in 2000–2002, N = 1630, 81% women), and were enriched with register-based information on SA and DP. The cumulative number of calendar days lost due to SA ≥ 1 day or DP between ages 55 and 65 was calculated. Negative binomial regression model was used to identify the predictors of days lost.

Results

The average calendar days lost was 316 days (about 220 working days) during a 10-year follow-up, and 44% were due to SA and 56% due to DP. Smoking [incidence rate ratio (IRR) = 1.19, 95% CI 1.01–1.40 for past and IRR = 1.30, CI 1.07–1.58 for current], binge drinking (IRR = 1.22, CI 1.02–1.46), lifting or pulling/pushing heavy loads (IRR = 1.35, CI 1.10–1.65), awkward working positions (IRR = 1.24, CI 1.01–1.53), long-standing illness limiting work or daily activities (IRR = 2.32, CI 1.93–2.79), common mental disorder (IRR = 1.52, CI 1.30–1.79), and multisite pain (IRR = 1.50, CI 1.23–1.84) increased the number of days lost, while high level of education (IRR = 0.66, CI 0.52–0.82) and moderate level of leisure-time physical activity (IRR = 0.80, CI 0.67–0.94) reduced the number of days lost.

Conclusions

Modifiable lifestyle risk factors, workload factors, common mental disorder, and multisite pain substantially increase the number of days lost. However, the findings of this study could be generalized to female workers in the public sector. Future research should also consider shorter SA spells in estimating working years lost and working life expectancy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-020-01630-6.

Smoking and disability pension: a systematic review and meta-analysis

OBJECTIVES

Smoking has negative consequences on occupational health. The current meta-analysis was conducted with the aim to pool the studies about smoking and increased disability pension.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

Articles were found in the scientific literature using keywords, and searching was limited to prospective cohort studies that had been published before August 2018. Based on the inclusion and exclusion criteria, 23 prospective cohort studies were selected. The analyses were carried out on the basis of the random-effects method. Subgroup analysis was also carried out. Finally, the bias of publication was examined using Begg's test, the Egger test, the trim-and-fill method, and the funnel plot.

RESULTS

Twenty-three studies were included. The results showed a positive association between smoking and disability pension, with a risk ratio (RR) of 1.41 and 95% confidence interval (95% CI) of 1.30-1.53 (P < 0.001). In men, the RR was equal to 1.48 and 95% CI was equal to 1.30-1.68 (P < 0.001). In women, the RR was equal to 1.23 and 95% CI was equal to 1.09-1.37 (P = 0.001). In current smokers, the RR was equal to 1.41 and 95% CI was equal to 1.26-1.57 (P < 0.001). In former smokers, the RR was equal to 1.16 and 95% CI was equal to 1.05-1.29 (P = 0.003). Qualitative evaluation showed that the studies had a low level of selection bias, data collection bias, and withdrawal and dropout bias.

CONCLUSIONS

Smoking is a risk factor for increasing disability pension, and men are at higher risk of disability pension. In addition, both current and former smokers are in high risk of disability pension. Overall, it can be concluded that smoking is a risk factor for occupational health.

Childhood adversities, parental education and disability retirement among Finnish municipal employees

Background

There is increasing evidence that childhood socioeconomic position and childhood adversities influence adult health. However, the potential contribution of these factors to disability retirement is poorly understood. This study aimed to examine the associations between childhood adversities, parental education and disability retirement.

Methods

Data on parental education and childhood adversities were derived from the Helsinki Health Study baseline survey, conducted in 2000–02 among 40- to 60-year old employees of the City of Helsinki, Finland. Data on disability retirement and their diagnoses were obtained from the Finnish Centre of Pensions and followed until the end of 2016. The analyses included 5992 employees. The associations of parental education and childhood adversities with disability retirement due to any cause, musculoskeletal diseases and mental disorders were analysed using Cox regression analysis.

Results

Low parental education was associated with an increased risk of disability retirement due to any cause (maternal education: HR 1.74, 95% CI 1.16–2.62; paternal education: 1.86, 1.38–2.51) and due to musculoskeletal diseases (maternal education: 4.44, 1.66–11.92; paternal education: 3.81, 2.02–7.17). However, adjustment for own education mainly abolished the associations. Economic difficulties in the childhood family, parental alcohol problems and having been bullied at school or by peers increased the risk of disability retirement due to all studied diagnostic groups, whereas parental death or divorce had no effect. Childhood illness (1.53, 1.20–1.95) and parental mental illness (1.68, 1.28–2.20) were associated with disability retirement due to any cause and due to mental disorders (1.65, 1.05–2.59; 3.60, 2.46–5.26). The associations between childhood adversities and disability retirement remained after adjustment for own education, whereas working conditions, and weight and health behaviours somewhat attenuated the associations.

Conclusions

Parental education and childhood adversities contributed to disability retirement even in midlife. Policy actions investing in children’s well-being might promote work ability in midlife.

Smoking and early retirement due to chronic disability

This paper considers the long-term effects of smoking on disability retirement in Sweden. Smoking is known to have damaging effects on health, but there is limited evidence on how the effects of smoking translate into worse labour market outcomes, such as the inability to work. In contrast to the few previous studies on smoking and disability retirement, we use a large population sample with registry information on smoking, which is recorded for all women who give birth in Sweden. Thanks to these comprehensive data, we are able to account for a much broader range of potential confounders. In particular, by the use of sibling and twin fixed effects, we account for unobserved heterogeneity in childhood environment and family characteristics. Given that smoking is often initiated in adolescence, one would suspect such factors to play important roles. Among individuals aged 50-64 in 2011, a simple model suggested smokers to have a 5 percentage point higher probability of receiving (full) disability pension, making them more than twice as likely as non-smokers to receive this. However, in a model with sibling fixed effects, the size of the effect was reduced by more than a third. The results point to the importance of confounders, such as childhood circumstances or behaviours, which were not accounted for by previous studies. We also consider effects on disability due to different health conditions. In relative terms, effects are the largest for circulatory conditions and tumours. Results are largely driven by health problems severe enough to merit hospitalization, and there is no evidence of a role played by financial incentives.

If you drink, don't smoke: Joint associations between risky health behaviors and labor market outcomes

This paper examines the links between risky health behaviors and labor market success. We provide new evidence on the joint relationships between the most prominent forms of risky health behavior - alcohol consumption, smoking and physical inactivity - and long-term labor market outcomes. We use twin data for Finnish men and women linked to register-based individual information on earnings and labor market attachment. The twin data allow us to account for shared family and environmental factors and to measure risky health behaviors in 1975 and 1981. The long-term labor market outcomes were measured in adulthood as an average over the period 1990-2009. The sample sizes are 2156 and 2498 twins, for men and women, respectively. We find that being both a smoker and a heavy drinker in early adulthood is negatively related to long-term earnings and employment later in life, especially for men. We conclude that how and why risky health behaviors cluster and how that affects individual level outcomes call for more attention.

Predictors and estimation of risk for early exit from working life by poor health among middle and older aged workers in Korea

The aims of this study were to investigate the predictors and estimate the risk for early exit from work owing to poor personal health status of the retirees. This study analysed the longitudinal data of 2,708 workers aged more than 45 years old from the Korean Longitudinal Study of Ageing. Multivariate Cox regression analyses were conducted to identify the predictors and to build a prediction model for early exit from work due to poor health. Internal validation was performed using random split, and external validation using the English Longitudinal Study of Ageing. Over the 8-year follow-up, 124 workers exited work early because of poor health. Significant predictors for early exit from work due to poor health included hypertension (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.01-2.28), abnormal body mass index (HR, 1.60; 95% CI, 1.10-2.35), decreased grasping power index, and perceived health status. The prediction model designed to estimate the risk of unwanted early exit from work because of poor health status showed fair performance in both the internal and external validations. The current study revealed the specific determinants and the possibility of prediction of shortened working life due to poor health status.

Unfit for work: Health and labour-market prospects

AIM

The aim of this study was to examine whether health status (number of chronic diseases, health shock and use of tranquilizers/sleeping pills) is related to labour-market outcomes later in life.

METHODS

Twin data for Finnish men and women who were at least 33 years old in 1990 were linked to comprehensive register-based information on unemployment and the incidence of disability pension. We used the within-twin dimension of the data to account for shared family and genetic factors. Self-reported information on the number of diagnosed chronic diseases, health shock and drug use were obtained from the 1975 and 1981 twin surveys, when the twins were at least 18 years old. Unemployment months and the incidence of disability pension were measured during prime working age over the 1990-2004/2009 period.

RESULTS

Poor health status is significantly positively related to unemployment and the incidence of disability pension. The results are robust to controlling for shared family and genetic factors and the key measures of risky health behaviours (alcohol use, lifetime smoking and body mass index).

CONCLUSIONS

Health status is a fundamental determinant of long-term labour-market outcomes.

Health, lifestyle and employment beyond state-pension age

Background

The factors influencing one’s choice to retire vary, with financial and health considerations being some of the main factors impacting or associated with people’s timing of retirement. The aim of the study is to investigate the differences in current health and health-related behaviours, such as smoking, drinking and exercising, between people who kept on working beyond state-pension age and those who retired before or at state-pension age.

Methods

Data from six waves (2003, 2008–2012) of the Scottish Health Survey (SHeS) are used. Descriptive analyses were used to characterise the population. Multivariate logistic regression was undertaken to analyse the relationship between retirement groups and gender, age, deprivation, marital status, housing tenure, general health, longstanding illness, cigarette smoking status, amount of exercise and mental health, using Stata.

Results

Reporting poor self-rated health or having a long-standing illness was associated with increased odds of retiring before state pension age (SPA) in groups with a medium deprivation profile in almost all the survey years. For the least deprived there was little evidence of an association between poor health and extended-working-life, while significant associations were observed for the most deprived. An increasing trend was observed for both genders in the number of people extending their working life. Similar associations between reporting poorer self-rated health and extended working lives were observed for men and women. Distinct gender differences were observed for the associations with reporting poor mental health and no exercise. In the adjusted models, both were significantly associated with retiring at or before SPA in almost every year for women, whereas no significant associations were observed (except in 1 year) for men.

Conclusions

This study shows an increasing trend in the number of people extending their working lives and demonstrates significant associations between health and lifestyle behaviours and employment status past SPA. The results suggest that good health – both physically and mentally – along with either a need or a want to stay in employment could be important reasons for continuing to work beyond SPA.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4957-5) contains supplementary material, which is available to authorized users.

Development and validation of a risk prediction model for work disability: multicohort study

Work disability affects quality of life, earnings, and opportunities to contribute to society. Work characteristics, lifestyle and sociodemographic factors have been associated with the risk of work disability, but few multifactorial algorithms exist to identify individuals at risk of future work disability. We developed and validated a parsimonious multifactorial score for the prediction of work disability using individual-level data from 65,775 public-sector employees (development cohort) and 13,527 employed adults from a general population sample (validation cohort), both linked to records of work disability. Candidate predictors for work disability included sociodemographic (3 items), health status and lifestyle (38 items), and work-related (43 items) variables. A parsimonious model, explaining > 99% of the variance of the full model, comprised 8 predictors: age, self-rated health, number of sickness absences in previous year, socioeconomic position, chronic illnesses, sleep problems, body mass index, and smoking. Discriminative ability of a score including these predictors was high: C-index 0.84 in the development and 0.83 in the validation cohort. The corresponding C-indices for a score constructed from work-related predictors (age, sex, socioeconomic position, job strain) were 0.79 and 0.78, respectively. It is possible to identify reliably individuals at high risk of work disability by using a rapidly-administered prediction score.

Trajectories of risky drinking around the time of statutory retirement: a longitudinal latent class analysis

BACKGROUND AND AIMS

Life transitions such as retirement may influence alcohol consumption, but only a few studies have described this using longitudinal data. We identified patterns and predictors of risky drinking around the time of retirement.

DESIGN

A cohort study assessing trajectories and predictors of risky drinking among employees entering statutory retirement between 2000 and 2011.

SETTING AND PARTICIPANTS

A total of 5805 men and women from the Finnish Public Sector study who responded to questions on alcohol consumption one to three times prior to (w_-3 , w_-2 , w_-1 ), and one to three times after (w₊₁ , w₊₂ , w₊₃ ) retirement.

MEASUREMENTS

We assessed trajectories of risky drinking (> 24 units per week among men, > 16 units among women, or an extreme drinking occasion during past year) from pre- to post-retirement, as well as predictors of each alcohol consumption trajectory.

FINDINGS

Three trajectories were identified: sustained healthy drinking (81% of participants), temporary increase in risky drinking around retirement (12%) and slowly declining risky drinking after retirement (7%). The strongest pre-retirement predictors for belonging to the group of temporary increase in risky drinking were current smoking [odds ratio (OR) = 3.90, 95% confidence interval (CI) = 2.70-5.64], male sex (OR = 2.77, 95% CI = 2.16-3.55), depression (OR = 1.44, 95% CI = 1.05-1.99) and work-place in the metropolitan area (OR = 1.29, 95% CI = 1.00-1.66). Compared with the slowly declining risky drinking group, the temporary increase in risky drinking group was characterized by lower occupational status and education, and work-place outside the metropolitan area.

CONCLUSIONS

In Finland, approximately 12% of people who reach retirement age experience a temporary increase in alcohol consumption to risky levels, while approximately 7% experience a slow decline in risky levels of alcohol consumption. Male gender, smoking, being depressed and working in a metropolitan area are associated with increased likelihood of increased alcohol consumption.

Effects of increased alcohol availability during adolescence on the risk of all-cause and cause-specific disability pension: a natural experiment

AIM

To test if being exposed to increased alcohol availability during adolescence is associated with an increased risk of receiving disability pension due to all-cause, alcohol use disorders and mental disorders.

DESIGN

Register-based population-based study using a natural experiment setting, the alcohol policy change in Sweden (1967-68), with increased access to strong beer in a narrow time window and geographical area. The individuals exposed to the policy change were compared with non-exposed individuals living in the rest of Sweden, excluding a border area.

SETTING

Sweden.

PARTICIPANTS

A total of 518 810 individuals (70 761 in the intervention group; 448 049 in the control group) born 1948-1953, aged 14-20 years during the policy change.

MEASUREMENTS

Date and diagnosis of the outcome variable of disability pension due to all-cause, alcohol use disorders and mental disorders were obtained from the Swedish National Social Insurance Agency database from 1971 to 2013. Individual and family level socio-demographic and health-related covariates, as well as a regional level covariate, were included.

FINDINGS

Compared with the control group, adolescents exposed to the alcohol policy change were at an increased risk of receiving disability pension due to all-causes [hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.07-1.11], alcohol use disorders (HR = 1.17, 95% CI = 1.05-1.30) and mental disorders (HR = 1.19, 95% CI = 1.15-1.23).

CONCLUSION

In Sweden, a natural experiment with a 43-year follow-up suggests that exposure to increased alcohol availability during adolescence is associated with an increased risk of receiving a disability pension due to all-cause, alcohol use disorder and mental disorder diagnoses.

Devil in disguise: Does drinking lead to a disability pension?

OBJECTIVES

To examine whether alcohol consumption in adulthood is related to the incidence of receiving a disability pension later in life.

METHODS

Twin data for Finnish men and women born before 1958 were matched to register-based individual information on disability pensions. Twin differences were used to eliminate both shared environmental and genetic factors. The quantity of alcohol consumption was measured as the weekly average consumption using self-reported data from three surveys (1975, 1981 and 1990). The disability pension data were evaluated from 1990-2004.

RESULTS

The models that account for shared environmental and genetic factors reveal that heavy drinkers are significantly more likely to receive a disability pension than moderate drinkers or constant abstainers. Heavy drinking that leads to passing out is also positively related to receiving a disability pension. The results were robust to the use of potential confounders that twins do not share, such as education years, the number of chronic diseases, physical activity at work and leisure, and stressful life events.

CONCLUSION

Drinking profiles in early adulthood are an important predictor of receiving a disability pension later in life.