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Boersema HJ, Hoekstra T, van Ooijen R, van Zon SKR, Abma FI, Brouwer S. Inability to Work Fulltime and the Association with Paid Employment One Year After the Work Disability Assessment: A Longitudinal Register-Based Cohort Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10212-z. [PMID: 38819462 DOI: 10.1007/s10926-024-10212-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES Disability benefit applicants with residual work capacity are often not able to work fulltime. In Dutch work disability benefit assessments, the inability to work fulltime is an important outcome, indicating the number of hours the applicant can sustain working activities per day. This study aims to gain insight into the association between inability to work fulltime and having paid employment 1 year after the assessment. METHODS The study is a longitudinal register-based cohort study of work disability applicants who were granted a partial disability benefit (n = 8300). Multivariable logistic regression analyses were conducted to study the association between inability to work fulltime and having paid employment 1 year after the assessment, separately for working and non-working applicants. RESULTS For disability benefit applicants, whether working (31.9%) or not working (68.1%) at the time of the disability assessment, there was generally no association between inability to work fulltime and having paid employment 1 year later. However, for working applicants diagnosed with a musculoskeletal disease or cancer, inability to work fulltime was positively and negatively associated with having paid employment, respectively. For non-working applicants with a respiratory disease or with multimorbidity, inability to work fulltime was negatively associated with paid employment. CONCLUSIONS Inability to work fulltime has limited association with paid employment 1 year after the disability benefit assessment, regardless of the working status at the time of assessment. However, within certain disease groups, inability to work fulltime can either increase or decrease the odds of having paid employment after the assessment.
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Affiliation(s)
- Henk-Jan Boersema
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, PO-box 30001, Groningen, The Netherlands.
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands.
- The Institute for Employee Benefit Schemes (UWV), Dutch Social Security Institute, Amsterdam, The Netherlands.
| | - Tialda Hoekstra
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, PO-box 30001, Groningen, The Netherlands
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands
| | - Raun van Ooijen
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, PO-box 30001, Groningen, The Netherlands
| | - Sander K R van Zon
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, PO-box 30001, Groningen, The Netherlands
| | - Femke I Abma
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, PO-box 30001, Groningen, The Netherlands
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, PO-box 30001, Groningen, The Netherlands
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands
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2
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Sears JM, Rundell SD, Fulton-Kehoe D, Hogg-Johnson S, Franklin GM. Using the Functional Comorbidity Index with administrative workers' compensation data: Utility, validity, and caveats. Am J Ind Med 2024; 67:99-109. [PMID: 37982343 PMCID: PMC10824282 DOI: 10.1002/ajim.23550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Chronic health conditions impact worker outcomes but are challenging to measure using administrative workers' compensation (WC) data. The Functional Comorbidity Index (FCI) was developed to predict functional outcomes in community-based adult populations, but has not been validated for WC settings. We assessed a WC-based FCI (additive index of 18 conditions) for identifying chronic conditions and predicting work outcomes. METHODS WC data were linked to a prospective survey in Ohio (N = 512) and Washington (N = 2,839). Workers were interviewed 6 weeks and 6 months after work-related injury. Observed prevalence and concordance were calculated; survey data provided the reference standard for WC data. Predictive validity and utility for control of confounding were assessed using 6-month work-related outcomes. RESULTS The WC-based FCI had high specificity but low sensitivity and was weakly associated with work-related outcomes. The survey-based FCI suggested more comorbidity in the Ohio sample (Ohio mean = 1.38; Washington mean = 1.14), whereas the WC-based FCI suggested more comorbidity in the Washington sample (Ohio mean = 0.10; Washington mean = 0.33). In the confounding assessment, adding the survey-based FCI to the base model moved the state effect estimates slightly toward null (<1% change). However, substituting the WC-based FCI moved the estimate away from null (8.95% change). CONCLUSIONS The WC-based FCI may be useful for identifying specific subsets of workers with chronic conditions, but less useful for chronic condition prevalence. Using the WC-based FCI cross-state appeared to introduce substantial confounding. We strongly advise caution-including state-specific analyses with a reliable reference standard-before using a WC-based FCI in studies involving multiple states.
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Affiliation(s)
- Jeanne M. Sears
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Sean D. Rundell
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- The Clinical Learning, Evidence And Research (CLEAR) Center for Musculoskeletal Disorders; University of Washington, Seattle, WA, USA
| | - Deborah Fulton-Kehoe
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Sheilah Hogg-Johnson
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Gary M. Franklin
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
- Washington State Department of Labor and Industries, Tumwater, WA, USA
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Voss MW, Richards LG, Price P, Terrill A, Wadsworth L, Hung M. A Mixed-Methods Examination of Lost Occupational Choice in Retirement. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492231221964. [PMID: 38254302 DOI: 10.1177/15394492231221964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Lost work opportunity and forced retirement demonstrate negative health impacts related to occupational deprivation. Measuring occupational loss during the retirement transition can be problematic. The objective of the study is to clarify measurement of involuntary retirement in its relationship to occupational loss and deprivation. Using an explanatory sequential mixed-methods design, survey data on unemployment, forced retirement, and earlier-than-planned retirement from 195 screened retirees yielded 102 reporting at least one lost work opportunity event, with 18 interviewed about occupational loss within the analytic timeframe. Planned retirement age was similar for full-employment and lost work opportunity groups. Actual retirement age was earlier in the lost work opportunity sample (age 57.5 compared with 61.2). Interviews identified a 22% discrepancy between forced retirement reported in survey versus interview data. Themes emerging from the interviews indicated financial and identity challenges from lost work opportunity, a dialectical trade-off between lost opportunity and daily freedom, and overall resilience.
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Affiliation(s)
| | | | | | | | | | - Man Hung
- Roseman University of Health Sciences, Salt Lake City, UT, USA
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4
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Popa AE, Bejenaru A, Mitrea EC, Morândău F, Pogan L. Return to work after chronic disease: A theoretical framework for understanding the worker-employer dynamic. Chronic Illn 2023; 19:704-718. [PMID: 35912437 DOI: 10.1177/17423953221117852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Return to work after chronic disease is important for workers, employers and society. The process, however, is challenging. This article provides an analytical and theoretical framework for explaining this process informed by the person-environment fit theory. METHODS This article uses a narrative method to (1) review the key concepts, benefits and influencing factors in the literature on return to work after chronic diseases, (2) analyse and critique the most important theoretical models used for explaining return to work after chronic diseases, and (3) review the person-environment fit theory and how it has been used so far. RESULTS The existing models highlight different aspects, but they overlook the relationship between the worker and the employer. An analytical and theoretical framework is proposed to comprehensively explain the worker-employer dynamic. The framework also considers the role of broader factors (policy, labour market) and other stakeholders (health professionals, civil society actors) emphasising the idea that return to work is a phased and cyclical process. DISCUSSION The framework can be used to guide future qualitative and quantitative studies, or as a map for identifying problematic areas related to the worker or the work environment. The model should be empirically tested in future studies.
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Affiliation(s)
- Adela Elena Popa
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Anca Bejenaru
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Elena Cristina Mitrea
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Felicia Morândău
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Livia Pogan
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, Sibiu, Romania
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Ronaldson A, Arias de la Torre J, Bendayan R, Yadegarfar ME, Rhead R, Douiri A, Armstrong D, Hatch S, Hotopf M, Dregan A. Physical multimorbidity, depressive symptoms, and social participation in adults over 50 years of age: findings from the English Longitudinal Study of Ageing. Aging Ment Health 2023; 27:43-53. [PMID: 35037790 DOI: 10.1080/13607863.2021.2017847] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim of the current study was to identify specific patterns of physical multimorbidity and examine how these patterns associated with changes in social participation over time. METHODS We used latent class analysis to identify clusters of physical multimorbidity in 11,391 older adults. Mixed effects regression models were used to assess associations between physical multimorbidity clusters and changes in social participation over 15 years. RESULTS Four clusters of physical multimorbidity were identified. All physical multimorbidity clusters were associated with a reduction in cultural engagement (e.g. visits to theatre, cinema, museums) over time, with the strongest association seen in the complex/multisystem cluster (β = -0.26, 95% CI = -0.38 to -0.15). Similar results emerged for leisure activities. Adjusting for depressive symptoms fully attenuated some associations. All physical multimorbidity clusters were associated with an increase in civic participation over time. CONCLUSIONS Physical multimorbidity reduced some aspects of social participation over time, with specific combinations of conditions having increased risk of reductions. UNLABELLED Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2017847.
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Affiliation(s)
- Amy Ronaldson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Jorge Arias de la Torre
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Institute of Biomedicine (IBIOMED), University of Leon, Leon, Spain
| | - Rebecca Bendayan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,NIHR Biomedical Research Centre at South London and Maudsley, NHS Foundation Trust and King's College London, UK
| | | | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Abdel Douiri
- School of Life Course & Population Sciences, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,National Institute for Health Research Applied Research Collaboration South London, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - David Armstrong
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Stephani Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Alex Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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6
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Chen H, Zhou Y, Huang L, Xu X, Yuan C. Multimorbidity burden and developmental trajectory in relation to later‐life dementia: A prospective study. Alzheimers Dement 2022; 19:2024-2033. [PMID: 36427050 DOI: 10.1002/alz.12840] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/09/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study assessed the associations of multimorbidity burden and its developmental trajectory with later-life dementia. METHODS Among 5923 Health and Retirement Study participants, major chronic conditions including hypertension, diabetes mellitus, cancer, lung diseases, heart disease, stroke, psychological disorders, and arthritis were self- or proxy-reported in 1994-2008. Dementia diagnosis was self- or proxy-reported in 2008-2018. We used Cox regression to assess the associations of multimorbidity with incident dementia. RESULTS During follow-up (median = 8 years), 701 participants developed dementia. Each additional chronic condition in 2008 was related to 15% (confidence interval: 9% to 22%) higher hazard of dementia. Multimorbidity trajectories in 1994-2008 were classified as "rapid growth", "steady growth", "slow growth", and "no new condition" by the group-based trajectory modelling methods. Compared to "no new condition", the "rapid growth" trajectory was related to 32% (3% to 69%) higher dementia risk. CONCLUSIONS Both multimorbidity burden and its developmental trajectory were prospectively associated with risk of dementia.
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Affiliation(s)
- Hui Chen
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
| | - Yaguan Zhou
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
| | - Liyan Huang
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
| | - Xiaolin Xu
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
- School of Public Health Faculty of Medicine The University of Queensland Brisbane Australia
| | - Changzheng Yuan
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
- Department of Nutrition Harvard T.H. Chan School of Public Health Boston Massachusetts USA
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7
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Larkin J, Walsh B, Moriarty F, Clyne B, Harrington P, Smith SM. What is the impact of multimorbidity on out-of-pocket healthcare expenditure among community-dwelling older adults in Ireland? A cross-sectional study. BMJ Open 2022; 12:e060502. [PMID: 36581975 PMCID: PMC9438209 DOI: 10.1136/bmjopen-2021-060502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Individuals with multimorbidity use more health services and take more medicines. This can lead to high out-of-pocket (OOP) healthcare expenditure. This study, therefore, aimed to assess the association between multimorbidity (two or more chronic conditions) and OOP healthcare expenditure in a nationally representative sample of adults aged 50 years or over. DESIGN Cross-sectional analysis of data collected in 2016 from wave 4 of The Irish Longitudinal Study on Ageing.SettingIreland.ParticipantsCommunity-dwelling adults aged 50 years and over.MethodA generalised linear model with log-link and gamma distributed errors was fitted to assess the association between multimorbidity and OOP healthcare expenditure (including general practitioner, emergency department, outpatients, specialist consultations, hospital admissions, home care and prescription drugs). RESULTS Overall, 3453 (58.5%) participants had multimorbidity. Among those with any OOP healthcare expenditure, individuals with multimorbidity spent more on average per annum (€806.8 for two conditions, €885.8 for three or more conditions), than individuals with no conditions (€580.3). Pharmacy-dispensed medicine expenditure was the largest component of expenditure. People with multimorbidity on average spent more of their equivalised household income on healthcare (7.1% for two conditions, 9.7% for three or more conditions), than people with no conditions (5.0%). A strong positive association was found between number of conditions and OOP healthcare expenditure (p<0.001) and between having private health insurance and OOP healthcare expenditure (p<0.001). A strong negative association was found between eligibility for free primary/hospital care and heavily subsidised medicines and OOP healthcare expenditure (p<0.001). CONCLUSIONS This study suggests that having multimorbidity in Ireland increases OOP healthcare expenditure, which is problematic for those with more conditions who have lower incomes. This highlights the need for this financial burden to be considered when designing healthcare/funding systems to address multimorbidity, so that access to essential healthcare can be maximised for those with greatest need.
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Affiliation(s)
- James Larkin
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Brendan Walsh
- Social Research Division, The Economic and Social Research Institute, Dublin, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Patricia Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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8
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van Zon SKR, Ots P, Robroek SJW, Burdorf A, Oude Hengel KM, Brouwer S. Do chronic diseases moderate the association between psychosocial working conditions and work exit? Longitudinal results from 55 950 Dutch workers. J Epidemiol Community Health 2022; 76:jech-2021-218432. [PMID: 35798538 DOI: 10.1136/jech-2021-218432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/30/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aims to examine whether the presence of chronic diseases or multimorbidity moderates the associations between psychosocial working conditions and work exit through unemployment, work disability or early retirement. METHODS Data from Lifelines (n=55 950), a prospective population-based cohort study, were enriched with monthly information on employment status from Statistics Netherlands. Working conditions were measured with the Copenhagen Psychosocial Questionnaire. Work exit was defined as unemployment, work disability and early retirement. Participants were classified as having no chronic disease, one chronic disease or multimorbidity. Cause-specific Cox proportional hazard regression models, adjusted for age, gender, education and partnership status, were used to analyse associations between working conditions and work exit. Interaction terms were used to examine moderation by chronic disease status. RESULTS Higher social support decreased the risk for unemployment, work disability and early retirement. Higher meaning of work decreased the risk of unemployment, and more possibilities for development decreased the risk for work disability. Chronic disease status did generally not moderate associations between working conditions and work exit. Only among workers without a chronic disease, more possibilities for development was associated with a lower risk for unemployment (HR: 0.89; 95% CI: 0.85 to 0.94). CONCLUSION While efforts to retain workers with chronic diseases in the labour market should continue, favourable psychosocial working conditions are important for all workers.
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Affiliation(s)
- Sander K R van Zon
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Patricia Ots
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Suzan J W Robroek
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karen M Oude Hengel
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Work, Health & Technology, Netherlands Organization for Applied Scientific Research, TNO, Leiden, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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9
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Ots P, Oude Hengel KM, Burdorf A, Robroek SJW, Nieboer D, Schram JLD, van Zon SKR, Brouwer S. Development and validation of a prediction model for unemployment and work disability among 55 950 Dutch workers. Eur J Public Health 2022; 32:578-585. [PMID: 35613006 PMCID: PMC9341844 DOI: 10.1093/eurpub/ckac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background This study developed prediction models for involuntary exit from paid employment through unemployment and disability benefits and examined if predictors and discriminative ability of these models differ between five common chronic diseases. Methods Data from workers in the Lifelines Cohort Study (n = 55 950) were enriched with monthly information on employment status from Statistics Netherlands. Potential predictors included sociodemographic factors, chronic diseases, unhealthy behaviours and working conditions. Data were analyzed using cause-specific Cox regression analyses. Models were evaluated with the C-index and the positive and negative predictive values (PPV and NPV, respectively). The developed models were externally validated using data from the Study on Transitions in Employment, Ability and Motivation. Results Being female, low education, depression, smoking, obesity, low development possibilities and low social support were predictors of unemployment and disability. Low meaning of work and low physical activity increased the risk for unemployment, while all chronic diseases increased the risk of disability benefits. The discriminative ability of the models of the development and validation cohort were low for unemployment (c = 0.62; c = 0.60) and disability benefits (c = 0.68; c = 0.75). After stratification for specific chronic diseases, the discriminative ability of models predicting disability benefits improved for cardiovascular disease (c = 0.81), chronic obstructive pulmonary disease (c = 0.74) and diabetes mellitus type 2 (c = 0.74). The PPV was low while the NPV was high for all models. Conclusion Taking workers’ particular disease into account may contribute to an improved prediction of disability benefits, yet risk factors are better examined at the population level rather than at the individual level.
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Affiliation(s)
- Patricia Ots
- Department of Health Sciences, Community & Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karen M Oude Hengel
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Work Health Technology, Netherlands Organization for Applied Scientific Research, TNO, Leiden, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Suzan J W Robroek
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jolinda L D Schram
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sander K R van Zon
- Department of Health Sciences, Community & Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community & Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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10
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The Interplay between Multimorbidity, Physical Work Demands and Work Ability: Cross-Sectional Study among 12,879 Senior Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095023. [PMID: 35564418 PMCID: PMC9103436 DOI: 10.3390/ijerph19095023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/24/2022]
Abstract
Background: Aging increases the risk of chronic diseases, which can challenge the ability to work and thereby push senior workers out of the labour market. This study investigates the association between non-communicable diseases (NCDs) and work ability among workers ≥50 years (senior workers) with physically demanding and sedentary work, respectively. Methods: In the SeniorWorkingLife study, 12,879 senior workers replied to a questionnaire survey on work and health in 2018. Associations between the type and number of NCD and work ability (scale 0−10) were modelled using a general linear model adjusting for potential confounders and combined with model-assisted weights from national registers. Results: A higher number of NCD (multimorbidity) was progressively associated with a lower work ability (trend test, p-value < 0.001). Physical work influenced the association between the number of NCDs and work ability. For specific diseases, mental disorders, including burn-out syndrome (least square mean difference (LSMD): −1.46, 95% CI: −1.61 to −1.32) and stress ( LSMD: −1.18, 95% CI: −1.29 to −1.07), demonstrated a stronger association with a lower work ability compared with somatic diseases, such as back diseases (LSMD: −0.72, 95% CI: −0.80 to −0.64). Conclusions: Multimorbidity was progressively associated with a lower work ability in senior workers, especially among those with physical work.
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11
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Gurgel do Amaral GS, Ots P, Brouwer S, van Zon SKR. Multimorbidity and exit from paid employment: the effect of specific combinations of chronic health conditions. Eur J Public Health 2022; 32:392-397. [PMID: 35253841 PMCID: PMC9159305 DOI: 10.1093/eurpub/ckac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to assess the association between multimorbidity and exit from paid employment, and which combinations of chronic health conditions (CHCs) have the strongest association with exit from paid employment. Methods Data from 111 208 workers aged 18–64 years from Lifelines were enriched with monthly employment data from Statistics Netherlands. Exit from paid employment during follow-up was defined as a change from paid employment to unemployment, disability benefits, economic inactivity or early retirement. CHCs included cardiovascular diseases (CVD), chronic obstructive pulmonary disease (COPD), rheumatoid arthritis (RA), type 2 diabetes (T2DM) and depression. Cox-proportional hazards models were used to examine the impact of multimorbidity and combinations of CHCs on exit from paid employment. Results Multimorbidity increased the risk of exiting paid employment compared with workers without CHCs (hazard ratio (HR): 1.52; 95% confidence interval (CI): 1.35–1.71) or one CHC (HR: 1.14; 95% CI: 1.01–1.28). The risk for exit from paid employment increased among workers with COPD if they additionally had CVD (HR: 1.39; 95% CI: 1.03–1.88), depression (HR: 1.46; 95% CI: 1.10–1.93) or RA (HR: 1.44; 95% CI: 1.08–1.91), for workers with T2DM if they additionally had CVD (HR: 1.43; 95% CI: 1.07–1.91) or depression (HR: 2.09; 95% CI: 1.51–2.91) and for workers with depression who also had T2DM (HR: 1.68; 95% CI: 1.21–2.32). Conclusion This study showed that workers with multimorbidity, especially having a combination of COPD and depression or T2DM and depression, have a higher risk for early exit from paid employment and, therefore, may need tailored support at the workplace.
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Affiliation(s)
- Gabriel S Gurgel do Amaral
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Patricia Ots
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sander K R van Zon
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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12
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Multimorbidity and obesity in older adults from six low- and middle-income countries. Prev Med 2021; 153:106816. [PMID: 34599928 DOI: 10.1016/j.ypmed.2021.106816] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 12/15/2022]
Abstract
Prevalence of multimorbidity (i.e., ≥2 chronic conditions), chronic diseases, and obesity is increasing in low- and middle-income countries (LMICs), posing a potential threat to the health of older adults living in these areas. This study hence investigates the unexplored association between obesity and multimorbidity among older adults from LMICs. Cross-sectional, community-based data from the WHO Study on global Ageing and adult health (SAGE) were analysed. The sample consisted of 20,198 individuals aged ≥60 years [Mean age (SD) = 69.3 (13.1) years; 54.1% female] from China, India, Ghana, Mexico, Russia, South Africa. Twelve chronic conditions were assessed. Multivariable logistic regression was conducted to assess the association between BMI ≥ 30 kg/m2, high waist circumference (WC, cut-points > 102 cm for males and > 88 cm for females) and multimorbidity. After adjusting for potential confounders, overall, BMI ≥ 30 kg/m2 was associated with 1.43 (95%CI = 1.21-1.69) times higher odds for multimorbidity, while this estimate for high WC was 1.50 (95%CI = 1.21-1.86). Significant associations emerged between obesity measures and five out of twelve chronic conditions. Results from this study underline the need to reduce obesity among older adults in areas where its prevalence is increasing, as it is associated with increased odds for multimorbidity. Future longitudinal research in this setting is required to assess the impact of obesity reduction on multimorbidity incidence.
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13
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Boersema HJ, Hoekstra T, Abma F, Brouwer S. Inability to Work Fulltime, Prevalence and Associated Factors Among Applicants for Work Disability Benefit. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:796-806. [PMID: 33710457 PMCID: PMC8558289 DOI: 10.1007/s10926-021-09966-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 06/02/2023]
Abstract
Purpose Inability to work fulltime is an important outcome in the assessment of workers applying for a disability benefit. However, limited knowledge is available about the prevalence and degree of the inability to work fulltime, the associations between disease-related and socio-demographic factors with inability to work fulltime and whether the prevalence and the associations differ across disease groups. Methods Anonymized register data on assessments of workers with residual work capacity (n = 30,177, age 48.8 ± 11.0, 53.9% female) applying for a work disability benefit in 2016 were used. Inability to work fulltime was defined as being able to work less than 8 h per day. Results The prevalence of inability to work fulltime was 39.4%, of these 62.5% could work up to 4 h per day. Higher age (OR 1.01, 95% CI 1.01-1.01), female gender (OR 1.45, 95% CI 1.37-1.52), higher education (OR 1.44, 95% CI 1.33-1.55) and multimorbidity (OR 1.06, 95% CI 1.01-1.11) showed higher odds for inability to work fulltime. Highest odds for inability to work fulltime were found for diseases of the blood, neoplasms and diseases of the respiratory system. Within specific disease groups, different associations were identified between disease-related and socio-demographic factors. Conclusion The prevalence and degree of inability to work fulltime in work disability benefit assessments is high. Specific chronic diseases are found to have higher odds for inability to work fulltime, and associated factors differ per disease group.
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Affiliation(s)
- Henk-Jan Boersema
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands.
- Research Center for Insurance Medicine, Amsterdam, The Netherlands.
- The Dutch Social Security Institute: the Institute for Employee Benefits Schemes (UWV), Amsterdam, The Netherlands.
| | - Tialda Hoekstra
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands
- Research Center for Insurance Medicine, Amsterdam, The Netherlands
| | - Femke Abma
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands
- Research Center for Insurance Medicine, Amsterdam, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands
- Research Center for Insurance Medicine, Amsterdam, The Netherlands
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14
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Dambha-Miller H, Simpson G, Akyea RK, Hounkpatin H, Morrison L, Gibson J, Stokes J, Islam N, Chapman A, Stuart B, Zaccardi F, Zlatev Z, Jones K, Roderick P, Boniface M, Santer M, Farmer A. The development and validation of population clusters for integrating health and social care: A protocol for a mixed-methods study in Multiple Long-Term Conditions (Cluster-AIM) (Preprint). JMIR Res Protoc 2021; 11:e34405. [PMID: 35708751 PMCID: PMC9247810 DOI: 10.2196/34405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/18/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Multiple long-term health conditions (multimorbidity) (MLTC-M) are increasingly prevalent and associated with high rates of morbidity, mortality, and health care expenditure. Strategies to address this have primarily focused on the biological aspects of disease, but MLTC-M also result from and are associated with additional psychosocial, economic, and environmental barriers. A shift toward more personalized, holistic, and integrated care could be effective. This could be made more efficient by identifying groups of populations based on their health and social needs. In turn, these will contribute to evidence-based solutions supporting delivery of interventions tailored to address the needs pertinent to each cluster. Evidence is needed on how to generate clusters based on health and social needs and quantify the impact of clusters on long-term health and costs. Objective We intend to develop and validate population clusters that consider determinants of health and social care needs for people with MLTC-M using data-driven machine learning (ML) methods compared to expert-driven approaches within primary care national databases, followed by evaluation of cluster trajectories and their association with health outcomes and costs. Methods The mixed methods program of work with parallel work streams include the following: (1) qualitative semistructured interview studies exploring patient, caregiver, and professional views on clinical and socioeconomic factors influencing experiences of living with or seeking care in MLTC-M; (2) modified Delphi with relevant stakeholders to generate variables on health and social (wider) determinants and to examine the feasibility of including these variables within existing primary care databases; and (3) cohort study with expert-driven segmentation, alongside data-driven algorithms. Outputs will be compared, clusters characterized, and trajectories over time examined to quantify associations with mortality, additional long-term conditions, worsening frailty, disease severity, and 10-year health and social care costs. Results The study will commence in October 2021 and is expected to be completed by October 2023. Conclusions By studying MLTC-M clusters, we will assess how more personalized care can be developed, how accurate costs can be provided, and how to better understand the personal and medical profiles and environment of individuals within each cluster. Integrated care that considers “whole persons” and their environment is essential in addressing the complex, diverse, and individual needs of people living with MLTC-M. International Registered Report Identifier (IRRID) PRR1-10.2196/34405
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Affiliation(s)
| | - Glenn Simpson
- Primary Care Research Centre, Southampton, United Kingdom
| | - Ralph K Akyea
- University of Nottingham, Nottingham, United Kingdom
| | | | | | - Jon Gibson
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Jonathan Stokes
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | | | - Adriane Chapman
- Electronic and Computer Science Centre for Health Technologies, University of Southampton, Southampton, United Kingdom
| | - Beth Stuart
- Primary Care Research Centre, Southampton, United Kingdom
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Zlatko Zlatev
- Electronic and Computer Science Centre for Health Technologies, University of Southampton, Southampton, United Kingdom
| | - Karen Jones
- Centre for the Study of Health, Science and Environment, University of Kent, Kent, United Kingdom
| | - Paul Roderick
- Public Health, University of Southampton, Southampton, United Kingdom
| | - Michael Boniface
- Electronic and Computer Science Centre for Health Technologies, University of Southampton, Southampton, United Kingdom
| | - Miriam Santer
- Primary Care Research Centre, Southampton, United Kingdom
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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15
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Wister AV, Li L, Mitchell BA. A Study of Social Isolation, Multimorbidity and Multiple Role Demands Among Middle-Age Adults Based on the Canadian Longitudinal Study on Aging. Int J Aging Hum Dev 2021; 94:312-343. [PMID: 34636660 PMCID: PMC8866749 DOI: 10.1177/00914150211040451] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Given the increasing complexity and fluidity of parenting, caregiving, and paid work patterns, in tandem with an increased risk of multimorbidity in mid-life, this study examines the relationship between these three concurrent roles and social isolation among middle-aged persons across multimorbidity statuses. Drawing upon life course theory, we applied linear mixed models to analyze 29,847 middle-aged participants from two waves of the Canadian Longitudinal Study on Aging. Findings reveal that participants experience greater social isolation over time, albeit the difference is extremely small. Among participants without multimorbidity, holding multiple roles is associated with lower social isolation. For those with multimorbidity, being employed full-time and providing intensive care are associated with social isolation. The occurrence of multiple roles demonstrates unique associations with social isolation among those with and without multimorbidity over time. Future research should study multimorbidity as a salient contextual variable. Moreover, enhanced support is needed for multimorbid middle-aged individuals with different role demands.
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Affiliation(s)
- Andrew V Wister
- Department of Gerontology, Gerontology Research Centre, Simon Fraser University, Vancouver, Canada
| | - Lun Li
- Gerontology Research Centre, 33507Simon Fraser University, Vancouver, BC, Canada
| | - Barbara A Mitchell
- Department of Gerontology & Department of Sociology/Anthropology, 33507Simon Fraser University, Burnaby, BC, Canada
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16
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Mutambudzi M, Flowers P, Demou E. Association of perceived job security and chronic health conditions with retirement in older UK and US workers. Eur J Public Health 2021; 32:52-58. [PMID: 34561693 PMCID: PMC8807079 DOI: 10.1093/eurpub/ckab170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The relationship between job insecurity, chronic health conditions (CHCs) and retirement among older workers are likely to differ between countries that have different labor markets and health and social safety nets. To date, there are no epidemiological studies that have prospectively assessed the role of job insecurity in retirement incidence, while accounting for CHC trajectories in two countries with different welfare systems. We investigated the strength of the association between baseline job insecurity and retirement incidence over an 11-year period while accounting for CHC trajectories, among workers 50–55 years of age at baseline in the UK and USA. Methods We performed Cox proportional hazards regression analysis, using 2006–2016 data from the Health and Retirement Study (US cohort, n = 570) and English Longitudinal Study on Aging (UK cohort n = 1052). Results Job insecurity was associated with retirement after adjusting for CHC trajectories (HR = 0.69, 95% CI = 0.50–0.95) in the UK cohort only. CHC trajectories were associated with retirement in both cohorts; however, this association was attenuated in the US cohort, but remained significant for the medium-increasing trajectory in the UK cohort (HR = 1.41, 95% CI = 1.01–1.97) after adjustment for all covariates. Full adjustment for relevant covariates attenuated the association between job insecurity and retirement indicating that CHCs, social and health factors are contributing mechanistic factors underpinning retirement incidence. Conclusions The observed differences in the two cohorts may be driven by macro-level factors operating latently, which may affect the work environment, health outcomes and retirement decisions uniquely in different settings.
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Affiliation(s)
- Miriam Mutambudzi
- Department of Public Health, Falk College, Syracuse University, Syracuse, NY, USA.,MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Flowers
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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17
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Calvo E, Azar A, Shura R, Staudinger UM. A New Path to Address Multimorbidity? Longitudinal Analyses of Retirement Sequences and Chronic Diseases in Old Age. J Appl Gerontol 2021; 41:952-961. [PMID: 34271835 DOI: 10.1177/07334648211031038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic disease and multimorbidity are growing health challenges for aging populations, often coinciding with retirement. We examine late-life predictors of multimorbidity, focusing on the association between retirement sequences and number of chronic diseases. We modeled the number of chronic diseases as a function of six types of previously identified 10-year retirement sequences using Health and Retirement Study (HRS) data for 7,880 Americans observed between ages 60 to 61 and 70 to 71. Our results show that at baseline, the adjusted prevalence of multimorbidity was lowest in sequences characterized by late retirement from full-time work and highest in sequences characterized by early labor-force disengagement. Age increases in multimorbidity varied across retirement sequences, though overall differences in prevalence persisted at age 70 to 71. Earlier life disadvantages did not moderate these associations. Findings suggest further investigation of policies that target health limitations affecting work, promote continued beneficial employment opportunities, and ultimately leverage retirement sequences as a novel path to influence multimorbidity in old age.
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Affiliation(s)
- Esteban Calvo
- Columbia University, New York, NY, USA.,Universidad Mayor, Santiago, Chile
| | - Ariel Azar
- Universidad Mayor, Santiago, Chile.,University of Chicago, IL, USA
| | - Robin Shura
- Kent State University at Stark, North Canton, OH, USA
| | - Ursula M Staudinger
- Columbia University, New York, NY, USA.,Technical University of Dresden, Germany
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18
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Sears JM, Fulton‐Kehoe D, Hogg‐Johnson S. Initial return to work and long-term employment patterns: Associations with work-related permanent impairment and with participation in workers' compensation-based return-to-work programs. Am J Ind Med 2021; 64:323-337. [PMID: 33616241 DOI: 10.1002/ajim.23233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/31/2020] [Accepted: 01/29/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Roughly 10% of injured workers experience work injuries that result in permanent impairment and a permanent partial disability (PPD) award. This study aimed to characterize and quantify long-term employment outcomes for injured workers, by the degree of whole body impairment (WBI) and by participation in several workers' compensation (WC)-based return-to-work (RTW) programs. METHODS A retrospective cohort of 43,968 Washington State workers were followed for up to 10 years after WC claim closure (2009-2017). Degree of impairment was classified as: (1) no PPD award, (2) PPD award with WBI < 10%, or (3) PPD award with WBI ≥ 10%. State wage files were used to construct employment outcomes for regression, modeling: (1) time to first RTW, (2) time to first RTW interruption, (3) RTW volatility, and (4) employment gaps. RESULTS Wage patterns and employment outcomes differed significantly by the degree of impairment. Compared to other workers, workers with WBI ≥ 10% had delayed RTW, shorter average times to first RTW interruption, and higher rates of both RTW interruptions and quarters without wages. Time to first RTW averaged over a year, increasing with the degree of impairment. About 9% overall-and 27% of workers with ≥10% WBI-had no observed wages after claim closure. In adjusted models, workers with WBI ≥ 10% had significantly poorer employment outcomes, compared to workers with no PPD award (p < 0.001). CONCLUSIONS State wage files provide an efficient approach to identifying RTW patterns. Workers with permanent impairment were at substantially higher risk of poor employment outcomes. WC-based RTW programs may promote better employment outcomes.
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Affiliation(s)
- Jeanne M. Sears
- Department of Health Services University of Washington Seattle Washington USA
- Department of Environmental and Occupational Health Sciences University of Washington Seattle Washington USA
- Harborview Injury Prevention and Research Center Seattle Washington USA
- Institute for Work and Health Toronto Ontario Canada
| | - Deborah Fulton‐Kehoe
- Department of Environmental and Occupational Health Sciences University of Washington Seattle Washington USA
| | - Sheilah Hogg‐Johnson
- Institute for Work and Health Toronto Ontario Canada
- Canadian Memorial Chiropractic College Toronto Ontario Canada
- Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
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19
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Pan T, Mercer SW, Zhao Y, McPake B, Desloge A, Atun R, Hulse ESG, Lee JT. The association between mental-physical multimorbidity and disability, work productivity, and social participation in China: a panel data analysis. BMC Public Health 2021; 21:376. [PMID: 33602174 PMCID: PMC7890601 DOI: 10.1186/s12889-021-10414-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 02/09/2021] [Indexed: 12/14/2022] Open
Abstract
Background The co-occurrence of mental and physical chronic conditions (mental-physical multimorbidity) is a growing and largely unaddressed challenge for health systems and wider economies in low-and middle-income countries. This study investigated the independent and combined (additive or synergistic) effects of mental and physical chronic conditions on disability, work productivity, and social participation in China. Methods Panel data study design utilised two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 5616 participants aged ≥45 years, 12 physical chronic conditions and depression. We used a panel data approach of random-effects regression models to assess the relationships between mental-physical multimorbidity and outcomes. Results After adjusting for socio-economic and demographic factors, an increased number of physical chronic conditions was independently associated with a higher likelihood of disability (Adjusted odds ratio (AOR) = 1.39; 95% CI: 1.33, 1.45), early retirement (AOR = 1.37 [1.26, 1.49]) and increased sick leave days (1.25 days [1.16, 1.35]). Depression was independently associated with disability (AOR = 3.78 [3.30, 4.34]), increased sick leave days (2.18 days [1.72, 2.77]) and a lower likelihood of social participation (AOR = 0.57 [0.47, 0.70]), but not with early retirement (AOR = 1.24 [0.97, 1.58]). There were small and statistically insignificant interactions between physical chronic conditions and mental health on disability, work productivity and social participation, suggesting an additive effect of mental-physical multimorbidity on productivity loss. Conclusion Mental-physical multimorbidity poses substantial negative health and economic effects on individuals, health systems, and societies. More research that addresses the challenges of mental-physical multimorbidity is needed to inform the development of interventions that can be applied to the workplace and the wider community in China. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10414-7.
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Affiliation(s)
- Tianxin Pan
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia.
| | - Stewart W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Yang Zhao
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China.,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Victoria, Australia
| | - Barbara McPake
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia
| | - Allissa Desloge
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia
| | - Rifat Atun
- Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, USA
| | - Emily Susannah Grace Hulse
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia
| | - John Tayu Lee
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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20
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Oude Hengel KM, Riumallo-Herl C, Schram JL, Nieboer D, van der Beek AJ, Burdorf A. Effects of changes in early retirement policies on labor force participation: the differential effects for vulnerable groups. Scand J Work Environ Health 2021; 47:224-232. [PMID: 33399213 PMCID: PMC8126444 DOI: 10.5271/sjweh.3946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: This study investigated the effects of a national early retirement reform, which was implemented in 2006 and penalized early retirement, on paid employment and different exit pathways and examined whether these effects differ by gender, income level and health status. Methods: This study included all Dutch individuals in paid employment born six months before (control group) and six months after (intervention group) the cut-off date of the reform (1 January 1950) that fiscally penalized early retirement. A regression discontinuity design combined with restricted mean survival time analysis was applied to evaluate the effect of penalizing early retirement on labor force participation from age 60 until workers reached the retirement age of 65 years, while accounting for secular trends around the threshold. Results: The intervention group postponed early retirement by 7.41 months [95% confidence interval (CI) 6.11–8.72], and partly replaced this by remaining 4.87 months (95% CI 3.60–6.24) longer in paid employment. Workers born after the threshold, annually earning €25 000–40 000, spent 1.24 months (95% CI 0.31–2.18) more in economic inactivity than those born before. The working months lost to unemployment increased by 1.50 months (95% CI 0.30–2.71) for female workers and 1.99 months (95% CI 0.06–3.92) for workers reporting multiple chronic diseases. Conclusions: The national reform successfully prolonged working lives of older workers. However, workers with a middle income, female workers, and workers with chronic diseases were more vulnerable to premature exit from the labor market through unemployment or being without any income or benefit.
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Affiliation(s)
- Karen M Oude Hengel
- Erasmus University Medical Center, Department of Public Health, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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21
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Larkin J, Foley L, Smith SM, Harrington P, Clyne B. The experience of financial burden for people with multimorbidity: A systematic review of qualitative research. Health Expect 2020; 24:282-295. [PMID: 33264478 PMCID: PMC8077119 DOI: 10.1111/hex.13166] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/08/2020] [Indexed: 12/27/2022] Open
Abstract
Background Multimorbidity prevalence is increasing globally. People with multimorbidity have higher health care costs, which can create a financial burden. Objective To synthesize qualitative research exploring experience of financial burden for people with multimorbidity. Search strategy Six databases were searched in May 2019. A grey literature search and backward and forward citation checking were also conducted. Inclusion criteria Studies were included if they used a qualitative design, conducted primary data collection, included references to financial burden and had at least one community‐dwelling adult participant with two or more chronic conditions. Data extraction and synthesis Screening and critical appraisal were conducted by two reviewers independently. One reviewer extracted data from the results section; this was checked by a second reviewer. GRADE‐CERQual was used to summarize the certainty of the evidence. Data were analysed using thematic synthesis. Main results Forty‐six studies from six continents were included. Four themes were generated: the high costs people with multimorbidity experience, the coping strategies they use to manage these costs, and the negative effect of both these on their well‐being. Health insurance and government supports determine the manageability and level of costs experienced. Discussion Financial burden has a negative effect on people with multimorbidity. Continuity of care and an awareness of the impact of financial burden of multimorbidity amongst policymakers and health care providers may partially address the issue. Patient or public contribution Results were presented to a panel of people with multimorbidity to check whether the language and themes ‘resonated’ with their experiences.
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Affiliation(s)
- James Larkin
- HRB Centre for Primary Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Barbara Clyne
- HRB Centre for Primary Care, Royal College of Surgeons in Ireland, Dublin, Ireland.,Health Information and Quality Authority, Dublin, Ireland
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22
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Ots P, van Zon SKR, Schram JLD, Burdorf A, Robroek SJW, Oude Hengel KM, Brouwer S. The influence of unhealthy behaviours on early exit from paid employment among workers with a chronic disease: A prospective study using the Lifelines cohort. Prev Med 2020; 139:106228. [PMID: 32758508 DOI: 10.1016/j.ypmed.2020.106228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study examined the risk of unhealthy behaviours and the additive effects of multiple unhealthy behaviours on exit from paid employment among workers with a chronic disease and investigated effect modification by gender and educational level. METHODS Data from the Lifelines cohort, collected between 2006 and 2013, were enriched with registry data from Statistics Netherlands with up to 11 years follow-up. Workers with a chronic disease were selected (n = 11,467). The influence of unhealthy behaviours (physical inactivity, smoking, unhealthy diet, high alcohol intake, and obesity) on exit from paid employment (unemployment, disability benefits, early retirement, and economic inactivity) was examined using competing risk models. To examine effect modification by gender and educational level, interaction terms were added. RESULTS Smoking and low fruit intake increased the risk to exit paid employment through unemployment and disability benefits. Low vegetable intake increased the risk of unemployment, obesity the risk of receiving disability benefits, and high alcohol intake the risk of early retirement. Physical inactivity was not associated with any exit from paid employment. Having multiple unhealthy behaviours increased the risk of both unemployment and of receiving disability. No consistent effect modification for gender or educational level was found. CONCLUSIONS Unhealthy behaviours increased the risk to exit paid employment through unemployment and disability benefits among workers with a chronic disease, and this risk increased when having multiple unhealthy behaviours. Health promotion to support workers with chronic diseases to make healthier choices may help to extend their working life.
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Affiliation(s)
- Patricia Ots
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, Groningen, the Netherlands.
| | - Sander K R van Zon
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, Groningen, the Netherlands.
| | - Jolinda L D Schram
- Erasmus Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands.
| | - Alex Burdorf
- Erasmus Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands.
| | - Suzan J W Robroek
- Erasmus Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands.
| | - Karen M Oude Hengel
- Erasmus Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Work, Health & Technology, Netherlands Organization for Applied Scientific Research, TNO, Leiden, the Netherlands.
| | - Sandra Brouwer
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, Groningen, the Netherlands.
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23
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Harber-Aschan L, Chen WH, McAllister A, Koitzsch Jensen N, Thielen K, Andersen I, Diderichsen F, Barr B, Burström B. The impact of longstanding illness and common mental disorder on competing employment exits routes in older working age: A longitudinal data-linkage study in Sweden. PLoS One 2020; 15:e0229221. [PMID: 32097437 PMCID: PMC7041791 DOI: 10.1371/journal.pone.0229221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/31/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives Comorbidity is prevalent in older working ages and might affect employment exits. This study aimed to 1) assess the associations between comorbidity and different employment exit routes, and 2) examine such associations by gender. Methods We used data from employed adults aged 50–62 in the Stockholm Public Health Survey 2002 and 2006, linked to longitudinal administrative income records (N = 10,416). The morbidity measure combined Limiting Longstanding Illness and Common Mental Disorder—captured by the General Health Questionnaire-12 (≥4)—into a categorical variable: 1) No Limiting Longstanding Illness, no Common Mental Disorder, 2) Limiting Longstanding Illness only, 3) Common Mental Disorder only, and 4) comorbid Limiting Longstanding Illness+Common Mental Disorder. Employment status was followed up until 2010, treating early retirement, disability pension and unemployment as employment exits. Competing risk regression analysed the associations between morbidity and employment exit routes, stratifying by gender. Results Compared to No Limiting Longstanding Illness, no Common Mental Disorder, comorbid Limiting Longstanding Illness+Common Mental Disorder was associated with early retirement in men (subdistribution hazard ratio = 1.73, 95% confidence intervals: 1.08–2.76), but not in women. For men and women, strong associations for disability pension were observed with Limiting Longstanding Illness only (subdistribution hazard ratio = 11.43, 95% confidence intervals: 9.40–13.89) and Limiting Longstanding Illness+Common Mental Disorder (subdistribution hazard ratio = 14.25, 95% confidence intervals: 10.91–18.61), and to a lesser extent Common Mental Disorder only (subdistribution hazard ratio = 2.00, 95% confidence intervals: 1.31–3.05). Women were more likely to exit through disability pension than men (subdistribution hazard ratio = 1.96, 95% confidence intervals: 1.60–2.39). Common Mental Disorder only was the only morbidity category associated with unemployment (subdistribution hazard ratio = 1.70, 95% confidence intervals: 1.36–2.15). Conclusions Strong associations were observed between specific morbidity categories with different employment exit routes, which differed by gender. Initiatives to extend working lives should consider older workers’ varied health needs to prevent inequalities in older age.
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Affiliation(s)
- Lisa Harber-Aschan
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Wen-Hao Chen
- Social Analysis and Modelling Division, Statistics Canada, Ottawa, Canada
| | - Ashley McAllister
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
- Melbourne School of Global and Population Health, Disability and Health Unit, The University of Melbourne, Melbourne, Australia
| | | | - Karsten Thielen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ingelise Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Finn Diderichsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ben Barr
- Department of Public Health and Policy, University of Liverpool, Liverpool, England, United Kingdom
| | - Bo Burström
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
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Nie J, Wang J, Aune D, Huang W, Xiao D, Wang Y, Chen X. Association between employment status and risk of all-cause and cause-specific mortality: a population-based prospective cohort study. J Epidemiol Community Health 2020; 74:428-436. [DOI: 10.1136/jech-2019-213179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/08/2020] [Accepted: 02/03/2020] [Indexed: 12/25/2022]
Abstract
BackgroundUnemployment has been reported to be associated with an increased risk of mortality. While most available studies focused on the effects of temporary unemployment on mortality, it remains unclear whether similar trends can be found in subjects who were never employed or are retirement. Therefore, this study examined the associations between temporary unemployment, never employed and retirement, integrating the risk of all-cause and cause-specific mortality in US adults.MethodsData from the National Health Interview Survey from 2001 to 2013 Linked Mortality files through 31 December 2015 were used. A total of 282 364 participants aged 18 to 65 years were included. Their employment status was categorised into four groups: employed, never employed, temporary unemployed and retired.ResultsDuring the mean follow-up time of 8.2 years, 12 645 subjects died from a variety of causes. Compared with employed participants, temporary unemployed, never employed or retired participants faced an increased risk of mortality for all-cause (temporary unemployed HR 1.76, 95% CI 1.67 to 1.86; never employed HR 1.63, 95% CI 1.47 to 1.81; retired HR 1.27, 95% CI 1.17 to 1.37). Cause-specific mortality analysis showed that compared with employed participants, temporary unemployed or never employed participants faced a significantly increased risk of mortality from cancer, cardiovascular disease, chronic lower respiratory disease, diabetes and kidney disease.ConclusionThis study showed that retired, temporary unemployed and never employed participants aged 18 to 65 years were strongly associated with higher mortality, indicating that both temporary and long-term unemployment are associated with a higher risk of mortality and adversely affect longevity.
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Oude Hengel K, Robroek SJW, Eekhout I, van der Beek AJ, Burdorf A. Educational inequalities in the impact of chronic diseases on exit from paid employment among older workers: a 7-year prospective study in the Netherlands. Occup Environ Med 2019; 76:718-725. [PMID: 31409626 PMCID: PMC6817992 DOI: 10.1136/oemed-2019-105788] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The study aimed to investigate the relative and absolute risks of early exit from paid employment among older workers with a chronic disease, and to assess whether these risks differ across educational groups. METHODS Data on chronic diseases and demographics from 9160 Dutch workers aged 45-64 years were enriched with monthly information on employment status from Statistics Netherlands. Subdistribution hazard ratios (SHR) and 7-year probabilities among workers with a chronic disease of exit from paid employment through disability benefits, unemployment benefits, early retirement benefits or economic inactivity were estimated using competing risks regression analyses based on Fine and Gray's models. RESULTS Workers with one chronic disease had a higher risk to exit paid employment through disability benefits (SHR 4.48 (95%CI 3.22 to 6.25)) compared with workers without chronic disease, and this risk further increased for multiple chronic diseases (SHR 8.91 (95%CI 6.33 to 12.55)). As occurrence of chronic diseases was highest among low educated workers, the 7-year probabilities to exit paid employment through disability benefits were highest among this group. Cardiovascular, musculoskeletal, psychological and respiratory diseases were associated with disability benefits (SHRs ranging from 2.11 (95%CI 1.45 to 3.07) to 3.26 (95%CI 2.08 to 5.12)), whereas psychological diseases were also related to unemployment (SHR 1.78 (95%CI 1.33 to 2.38)). CONCLUSIONS Older workers with a chronic disease have a higher risk to exit paid employment through disability benefits. As multimorbidity has an additive effect, addressing multimorbidity as a risk factor for sustainable employment is needed.
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Affiliation(s)
- Karen Oude Hengel
- Erasmus MC Department of Public Health, Rotterdam, The Netherlands .,Work, Health & Technology, Netherlands Organisation of Applied Scientific Research TNO, Leiden, The Netherlands
| | | | - Iris Eekhout
- Work, Health & Technology, Netherlands Organisation of Applied Scientific Research TNO, Leiden, The Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Alex Burdorf
- Erasmus MC Department of Public Health, Rotterdam, The Netherlands
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