Social determinants of disability pension: a 10-year follow-up of 62 000 people in a Norwegian county population

Metabolic syndrome and poor self-rated health as risk factors for premature employment exit: a longitudinal study among 55 016 middle-aged and older workers from the Lifelines Cohort Study and Biobank

BACKGROUND

Poor self-rated health (SRH) is a well-established risk factor for premature employment exit through unemployment, work disability, and early retirement. However, it is unclear whether the premature employment exit risk associated with underlying cardio-metabolic health conditions is fully captured by poor SRH. This study examines the metabolic syndrome (MetS), an early-stage risk factor for cardiovascular disease and type two diabetes mellitus, as a risk factor for premature employment exit while controlling for poor SRH.

METHODS

We analyzed data from N = 55 016 Dutch workers (40-64 years) from five waves of the Lifelines Cohort Study and Biobank. MetS components were based on physical measures, blood markers, and medication use. SRH and employment states were self-reported. The associations between MetS, SRH, and premature employment exit types were analyzed using competing risk regression analysis.

RESULTS

During 4.3 years of follow-up, MetS remained an independent risk factor for unemployment [adjusted subdistribution hazard ratio (SHR): 1.14, 95% CI: 1.03, 1.25] and work disability (adjusted SHR: 1.33, 95% CI: 1.11, 1.58) when adjusted for poor SRH, common chronic diseases related to labor market participation (i.e., cancer, musculoskeletal-, pulmonary-, and psychiatric diseases), and sociodemographic factors. MetS was not associated with early retirement.

CONCLUSIONS

Poor SRH did not fully capture the risk for unemployment and work disability associated with MetS. More awareness about MetS as a 'hidden' cardio-metabolic risk factor for premature employment exit is needed among workers, employers, and occupational health professionals. Regular health check-ups including MetS assessment and MetS prevention might help to prolong healthy working lives.

Post-injury long-term sickness absence and risk of disability pension: The role of socioeconomic status

INTRODUCTION

Previous research has identified low socioeconomic status (SES) as a risk factor for long-term sickness absence (LTSA) and disability pension (DP) following trauma. However, most studies lack information on medical diagnoses, limiting our understanding of the underlying factors. To address this gap, we retrieved information about diagnostic causes for receipt of welfare benefits to explore the role of SES in the transition from post-injury LTSA to permanent DP among the working population in Norway.

MATERIALS AND METHODS

We conducted a population-based cohort study of all Norwegian residents aged 25-59 years registered with a spell of LTSA due to injury commencing in the period 2000-2003. This cohort was followed through 2014 by linking information on receipt of welfare benefits with sociodemographic data from administrative registers. SES was defined as a composite measure of educational attainment and income level. We used flexible parametric survival models to estimate hazard ratios (HR) with 95 % confidence intervals (CI) for all-cause and diagnosis-specific DP according to SES, adjusting for sex, age, marital status, immigrant status and healthcare region of residence.

RESULTS

Of 53,937 adults with post-injury LTSA, 9,665 (18 %) transferred to DP during follow-up. The crude risk of DP was highest for LTSA spells due to poisoning and head injuries. Overall, individuals in the lowest SES category had twice the risk of DP compared to those in the highest SES category (HR = 2.25, 95 % CI 2.13-2.38). The difference by SES was greatest for LTSA due to poisoning and smallest for LTSA due to head injuries. A majority (75 %) of DP recipients had a non-injury diagnosis as the primary cause of DP. The socioeconomic gradient was more pronounced for non-injury causes of DP (HR = 2.47, 95 % CI 2.31-2.63) than for injury causes (HR = 1.73, 95 % CI 1.56-1.92) and was especially steep for DP due to musculoskeletal diseases and mental and behavioural disorders.

CONCLUSIONS

The relationship between SES and DP varied by both the type of injury that caused LTSA and the diagnosis used to grant DP, highlighting the importance of taking diagnostic information into account when investigating long-term consequences of injuries.

The impact of cardiorespiratory fitness and physical workload on disability pension-a cohort study of Swedish men

OBJECTIVE

Understanding the impact of physical capacity in combination with high physical workload could be beneficial for the prevention of health-related exits from work. Therefore, the aim of this study was to investigate the separate and combined effects of low cardiorespiratory fitness and high physical workload on disability pension (DP) due to any cause, musculoskeletal disorders (MSD), and cardiovascular diseases (CVD).

METHODS

A total of 279 353 men born between 1951 and 1961 were followed regarding DP between 2006 and 2020, ages 45-64. Cardiorespiratory fitness was assessed during military conscription, using an ergometer bicycle test. Physical workload was based on a job-exposure matrix (JEM) linked to occupational title in 2005. Cox regression models estimated separate and combined associations with DP.

RESULTS

Low cardiorespiratory fitness and high physical workload were associated with increased risk of DP. For all cause DP, the fully adjusted hazard ratio and 95% confidence interval for those with low cardiorespiratory fitness was 1.38 (1.32-1.46) and for those with high physical workload 1.48 (1.39-1.57). For all cause and MSD DP, but not for CVD DP, the combination of low cardiorespiratory fitness and high physical workload resulted in higher risks than when adding the effect of the single exposures.

CONCLUSION

Both low cardiorespiratory fitness in youth and later exposure to high physical workload were associated with an increased risk of DP, where workers with the combination of both low cardiorespiratory fitness and a high physical workload had the highest risks (all-cause and MSD DP).

Disability pension and sociodemographic & work-related risk factors among 2.3 million migrants and natives in Finland (2011-2019): a prospective population study

BACKGROUND

Increasing employment and immigration have been proposed as possible solutions to tackle the problem of the labour force shortage in aging societies. Ensuring sufficient health and work ability among migrants is a key factor in increasing and maintaining their employment. Many studies have found higher disability pension (DP) rates among migrants compared to natives but such studies lack in determining the risk of DP by occupational class and industrial sector. This study explores the risk of DP and the contribution of sociodemographic and work-related factors between migrants and natives in Finland.

METHODS

Full-population panel data obtained from the administrative registers of Statistics Finland were used to study 2.3 million individuals aged 25-60 years in 2010. We calculated hazard ratios (HR) and their 95% confidence intervals (CI) to estimate the risk of having a DP in 2011-2019 using Cox proportional hazard models adjusting for different sociodemographic and work-related factors.

RESULTS

Compared to natives, migrants had a lower risk of a DP (HR 0.58, 95% CI 0.53-0.63). We found great variation between countries of origin, where compared to natives, migrants from refugee-exporting countries (HR 1.37, 95% CI 1.22-1.53) and other non-European countries (HR 1.30; CI 1.18-1.43) had a higher risk of DP, but migrants from other countries did not differ or had a slightly lower risk of DP than natives. The associations between sociodemographic factors and the risk of DP were very similar between natives and migrants.

CONCLUSION

Migrants had a lower risk of a DP than natives except for migrants from outside Europe. The associations between different sociodemographic and work-related factors and the risk of DP were similar between natives and migrants and did not completely explain the differences in the risk of DP.

Changes in health-related rehabilitation trajectories following a major Norwegian welfare reform

BACKGROUND

In this study we investigated the health-related rehabilitation trajectories of young Norwegian adults between 2004-2019. The study period is interesting because it overlaps with an extensive welfare system reform that occurred in Norway between 2006-2011. In parallel with the reform there was a substantial increase in health-related welfare dependency among young people due to mental health conditions. To better understand this group, we addressed three questions: 1) what were the most typical health-related rehabilitation trajectories for young Norwegians aged 23-27 between 2004-2019, 2) did the trajectories and composition of health-related benefit recipients change overtime and 3) in parallel with the welfare reform, do we see improved labour market outcomes in our study population?

METHODS

Using high-quality Norwegian registry data, we established four cohorts of Norwegian health-related rehabilitation benefit recipients aged 23-27 in either 2004 (cohort 1), 2008 (cohort 2), 2011 (cohort 3) or 2014 (cohort 4). The follow-up period for each cohort was six years. We used sequence and cluster analyses to identify typical health-related rehabilitation trajectories. In addition, descriptive statistics and multinomial logistic regression were used to scrutinise the relationship between trajectory types, sociodemographic characteristics and cohort membership.

RESULTS

The majority follow trajectories consisting of welfare dependency, unemployment and unstable, low-income work. Both the trajectories and composition of the study population changed across cohorts. Over the observation period there was a 1) three-fold increase in the proportion following a trajectory ending in permanent disability benefits, 2) nine-fold increase in the proportion following trajectories characterised by long periods of health-related rehabilitation, 3) five-fold decrease in the share following unemployment occupational handicap trajectories 4) 6.9% increase in the proportion of early school leavers and 5) 8.9% decrease in the share with disabled parents.

CONCLUSION

Our study population is a vulnerable group with suboptimal mental health, functioning and employment outcomes. In conjunction with the welfare reform, we witnessed a significant drop in use of work-related benefits, accompanied by a substantial increase in uptake of health-related rehabilitation- and disability benefits. Thus, it appears that rather than improving employment outcomes, welfare policy changes have created a new problem by steering a greater proportion into disability benefits.

Work Disability and Return to Work After Lymphoma: A Danish Nationwide Cohort Study

Purpose

Many patients diagnosed with lymphoma are of working age. Cancer patients are known to have a higher risk of sick leave and disability pension, but this has only been delineated for certain subtypes of lymphoma. Therefore, this study aimed at investigating the overall risk of disability pension for all lymphoma subtypes and at quantifying return to work for patients with lymphoma in work before diagnosis.

Patients and Methods

Patients aged 18-60 years with lymphoma in complete remission (CR) diagnosed between 2000 and 2019 were included in the study. Using national registers, each patient was matched with five comparators from the general population with same sex, birth year, and level of Charlson Comorbidity Index. Risk of disability pension was calculated from 90 days after CR or end of treatment with competing events (death, retirement pension, early retirement pension, relapse for patients, or lymphoma diagnosis for comparators). Return to work for patients was calculated annually until 5 years after diagnosis for patients employed before diagnosis.

Results

In total, 4072 patients and 20,360 comparators were included. There was a significant increased risk of disability pension for patients with all types of lymphoma compared to the general population (5-year risk difference: 5.3 (95% confidence interval (CI): 4.4;6.2)). Patients with non-Hodgkin lymphoma were more likely to get disability pension than patients with Hodgkin lymphoma (sex- and age-adjusted 10-year risk difference: 2.9 (95% CI: 0.3;5.5)). One year after diagnosis, 24.5% of the relapse-free patients were on sick leave. Return to work was highest 2 years after diagnosis (82.1%).

Conclusion

Patients with lymphoma across all subtypes have a significantly higher risk of disability pension. Return to work peaks at 2 years after diagnosis.

Sociodemographic and morbidity characteristics of people on long-term sick leave

BACKGROUND

Certifying long-term sick leave and coordinating complex rehabilitation programs are essential activities of social insurance doctors. These doctors have a role in preventing the decreased work capacity of employees that may lead to leaving the labour market and the transition of these employees to other social insurance benefits, such as a work disability pension.

OBJECTIVES

Analysis of long-term sick leaves (over 183 days) to identify risk factors and population groups with low potential for work capacity rehabilitation.

METHOD

We conducted a cross-sectional study between September 2019 and September 2020. The information was collected from the National Institute of Medical Assessment and Work Capacity Rehabilitation Bucharest registers and the EXPMED application. The data were statistically analysed using PSPP software.

RESULTS

The highest rehabilitation percentage was achieved in cases of traumatic injuries (73.17%), followed by musculoskeletal diseases (70.06%). We noticed lower recovery in cases of nervous system diseases (50.56%) and cardiovascular diseases (44.23%). In the group that summed up the other pathologies, the recovery percentage was 58.37%. People who regained their work capacity were significantly younger (mean age 47.87 y ± 8.93) than those who turned to other forms of social benefits, such as a disability pension or an old-age pension (mean age 53.16 y ± 8.43).

CONCLUSION

Most of the subjects (72%) regained their work capacity and did not need a disability pension. We identified the sociodemographic and morbidity characteristics of people on long-term sick leave along with target groups requiring intensive intervention measures.

Gender Differences in Associations between Biomechanical and Psychosocial Work Exposures and Age of Withdrawal from Paid Employment among Older Workers

BACKGROUND

Work exposures are known predictors of withdrawal from employment, but the associations between work exposures and withdrawal may vary with gender. This study evaluated gender differences in associations between biomechanical and psychosocial work exposures and age of withdrawal from paid employment among older workers in Norway.

METHODS

77,558 men and 67,773 women (born 1949-1953) were followed from age 62 until withdrawal from paid employment or end of follow-up in 2016 (up to five years follow-up). Information about eight biomechanical and seven psychosocial exposures was obtained from a gender-specific job exposure matrix. Using Cox regression, the difference in mean estimated time until withdrawal between non-exposed and exposed was calculated for each gender and work exposure separately.

RESULTS

The largest gender difference was found for high psychological demands. Among men, the non-exposed withdrew earlier than the exposed (-3.66 months (95% CI: -4.04--3.25 months)), and contrary among women (0.71 (0.28-1.10)), resulting in a gender difference of 4.37 (3.81-4.97) months. Gender differences were also found for monotonous work (4.12 (3.51-4.69) months), hands above shoulder height (2.41 (1.76-3.10) months), and high iso-strain (2.14 (1.38-2.95) months).

CONCLUSIONS

There were observed gender differences in the associations between some biomechanical and psychosocial work exposures and mean age of withdrawal from paid employment among older workers. However, the results are likely affected by the selection of who remains in the workforce at age 62 and should be interpreted accordingly.

Predicting disability retirement among Abu Dhabi police using multiple measure of sickness absence

Background

Disability retirement has been investigated in the last two decades using predictors such as measures of sickness absence, psychological, social, and organizational work factors. The impact of various health-related and sickness measures on disability retirement across various occupational group reveal a significant relation. However, current literature lacks understanding in police personnel.

Methods

This study examines the roles of demographic and measures of sickness absence on disability retirement among police personnel in Abu Dhabi, UAE. The case–control design was used to predict disability retirement wherein controls were matched with cases according to age and gender from those who worked in the same administration as the case at baseline, to reduce the possible confounding influence of these variables. Conditional logistic regression models were used determine the odds-ratio of various measures of sickness absence in predicting disability retirement.

Results

Results indicate that increased number of spells, and number of days of sickness absence can predict disability retirements among police personnel in the UAE. Results indicate that odds ratios for disability retirement for the total exposure period increased from 1.76 (95% CI = 1.42-2.20) for spells of 4-7d to 2.47 (95%CI = 1.79-3.40) for spells of > 4 weeks. When compared with their married counterparts, non-married police employees had a statistically significant increase in odds of disability retirement of almost three fold (OR = 2.93, 95% CI = 1.55-5.56). Non-field and field police officers, on the other hand, had significantly reduced odds of disability retirement compared with admin/supportive staff (OR = 0.43 and 0.28 with 95% CI = 0.19-0.96 and 0.13-0.61 respectively). Odds ratios of disability retirement at end of the exposure period for the matching variables with those obtained after additionally adjusting for all demographic variables (model b), namely, marital status, occupation, employment grade and type, and educational level. The odds ratios of disability retirement remained significantly raised for the total number of days of sickness absence and for the number of spells of sickness absence for all spell types.

Conclusions

Recommendation to reduce the number of future disability retirements among Abu Dhabi Police include structured problem-solving process addressed through stepwise meetings between the line-managers and the employee.

Long-term sick leave for back pain, exposure to physical workload and psychosocial factors at work, and risk of disability and early-age retirement among aged Swedish workers

Purpose

To assess the risk of disability and early-age retirement associated with previous long-term sickness absence for back pain (back-pain SA), exposure to high physical workload, low job control, high demands and high strain, and to evaluate effect modification by work factors on the relationship between back-pain SA and premature retirement.

Methods

All employed Swedish residents born 1946–1955 (n = 835,956) were followed up from 2010 to 2016 for disability (DP) and early-age pension (EAP). Associations of premature retirement with exposure to work factors and back-pain SA in the 3 years before follow-up were estimated through proportional hazards models. Retirement, back-pain SA and covariates were assessed through administrative sources, and exposure to work factors through a job-exposure matrix.

Results

In both genders, back-pain SA was associated with DP (> 1 episode: HR 3.23 among men; HR 3.12 among women) and EAP (> 1 episode: HR 1.24 among men; HR 1.18 among women). Higher physical workload and lower job control were also associated with an increased DP risk in both genders, whereas higher job demands showed a decreased risk. For EAP, associations with work factors were weak and inconsistent across genders. No effect modification by work factors was found, except for a negative effect modification by job strain on DP risk among women, i.e. a reduced effect of back-pain SA with increasing exposure.

Conclusion

Back-pain SA was a significant predictor of both DP and EAP, while work factors were consistently associated only with DP. Our results indicate that the joint effect of back-pain SA and work factors on DP is additive and does not support effect modification by work factors.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-022-01862-8.

Parallel use of primary and secondary healthcare by frequent attenders in occupational health and their work disability: a longitudinal study in Finland

OBJECTIVES

To investigate occupational health frequent attenders' (FAs) use of other healthcare sector services and whether parallel use affects their likelihood to receive a disability pension.

DESIGN

Longitudinal study combining routine medical record data with register data.

SETTING

Primary care in Finland is provided through three parallel healthcare sectors, all available to the working population. Additionally, patients can be referred to secondary care. This study combines medical record data from a nationwide occupational healthcare provider, with healthcare attendance data from private care and from public primary and secondary care attendance, sociodemographic data and disability pension decisions.

PARTICIPANTS

Patients between 18 and 68 years of age who used occupational health primary care at least once during the study years 2014-2016 were included. The total study population was 59 650 patients. They were divided into three groups (occasional and persistent FAs and non-FAs) for analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was FAs parallel use of private care and public primary and secondary care. The secondary outcome was work disability pension granted to FAs who used several healthcare sectors.

RESULTS

Both FA groups were more likely to use other healthcare service sectors more than non-FAs did. Persistent FAs were likely to use public secondary care services in particular (OR 4.31 95% CI 3.46 to 5.36). FAs using all healthcare sectors were also more likely to receive a disability pension than those FAs using only occupational health services (OR 4.53 (95% CI 1.54 to 13.34). This association was strengthened by attendance in public secondary care.

CONCLUSIONS

FAs using several healthcare sectors in parallel have an increased likelihood to receive a disability pension. There is need for care coordination to ensure adequate measures for work ability support.

Disability pension dynamics in early adulthood: A two-decade longitudinal study of educational, work and welfare-state trajectories in Norway

Background

Since the 1990's, structural transformations in the Norwegian economy have decreased employment opportunities for low-skilled young people lacking formal education credentials. In parallel with these economic changes, there has been a strong increase in the proportion of young disability pensioners. Preventing labour market exit requires a thorough understanding of the disability process. We aim to 1) identify the most typical trajectories into disability pension for young Norwegian inhabitants between 1993 and 2014 and 2) investigate if the trajectories and composition of young disability pensioners changed over time.

Methods

Using high-quality Norwegian registry data, we established two population-based cohorts of Norwegian inhabitants aged 29–39 years in either 2003 (cohort 1) or 2014 (cohort 2) who were not disability pensioners during the first month of their cohort period but had been granted a disability pension by the cohort end-date. Cohort 1 was followed from the beginning of 1993 through 2003, cohort 2 from 2004 through 2014. We used sequence and cluster analyses to identify typical disability pension trajectories and investigate how they changed overtime.

Results

The majority follow trajectories characterised by little or no previous work participation. Both the trajectories and composition of young disability pensioners changed overtime. Between the two cohorts there was 1) a doubling in the probability of following 'precarious income trajectories', 2) a decrease in the probability of following ‘work and/or education trajectories’ and 3) an increase in the proportion of early school leavers.

Conclusion

Current initiatives such as the Norwegian Inclusive Workplace Agreement (IA) focus on preventing transitions from employment to disability benefits. However, such initiatives have little relevance for young disability pensioners as the majority have weak labour market attachment. Policymakers should therefore consider placing more emphasis on non-workplace interventions.

•

The majority of young Norwegian disability pensioners are early school leavers with weak labour market attachment.

•

Disability benefits may increasingly cater for young people based on social (rather than medical) needs.

•

Preventing disability pension dependency in early adulthood requires a thorough understanding of the disability process based on knowledge of typical trajectories.

•

Sequence analysis is a novel approach within the medical sciences and has been used to identify holistic life course trajectories.

Sociodemographic characteristics and disability pensions of frequent attenders in occupational health primary care - a follow-up study in Finland

BACKGROUND

Work disability is a complex issue that requires preventive efforts from healthcare systems and individuals, and that too often results in disability pensions (DP). While many studies have attempted to characterize risk factors of work disability, many showing for example a link between socioeconomic positions, working conditions and frequent attendance to OH primary care it is not known if frequent attendance is associated with DP despite the sociodemographic factors. This study aims to address this gap and examine the association between frequent attendance to OH primary care and DP, when adjusted by sociodemographic factors.

METHODS

This study combines routine medical record data of an occupational health service provider with comprehensive national registers. Medical record data were used to define groups of frequent attenders to OH primary care (FA) (1-year-FA, 2-year-FA, persistent-FA and non-FA) from 2014 to 2016. The sociodemographic factors (including i.e. educational level, occupational class, unemployment periods) were derived from Statistic Finland and DP decisions were derived from Finnish Centre for Pensions. Association of frequent attendance to OH primary care with DP decisions were analyzed and adjusted by sociodemographic factors.

RESULTS

In total, 66,381 patients were included. Basic and intermediate education along with manual and lower non-manual work predicted frequent attendance to OH primary care. Unemployment in 2013 did not predict frequent attendance to OH primary care. Frequent attendance to OH primary care was associated with DP within next two years, even when adjusted for sociodemographic factors. The association of frequent attendance to OH primary care with DP grew stronger as high service use persisted over time.

CONCLUSIONS

Frequent attendance to OH primary care is associated with DP risk in the near future despite the underlying sociodemographic differences. Patients using OH primary care services extensively should be identified and rehabilitative needs and measures necessary to continue in the work force should be explored. Sociodemographic issues that co-exist should be explored and considered when planning interventions.

Self-reported sickness absence and presenteeism as predictors of future disability pension: Cohort study with 11-year register follow-up

Many healthcare workers in eldercare are pushed out of the labor market before the official retirement age due to poor health. Identification of early warnings signs is important to avoid complete loss of work ability. The aim of this study was to investigate to what degree sickness absence and presenteeism increase future risk for disability pension among eldercare workers. A total of 8952 Danish female eldercare workers responded to a survey about work environment and health. They were followed for 11 years in the Danish Register for Evaluation of Marginalization, with time-to-event analyses estimating the hazard ratios (HRs) for disability pension from sickness absence and presenteeism at baseline. Analyses were adjusted for age, education, body mass index, leisure-time physical activity, smoking, physical exertion at work, and psychosocial factors related to the work environment. During the 11-year follow-up, 11.9% participants received disability pension. For the whole cohort, the highest risk for disability pension was observed for the category of >30 days of combined sickness absence and presenteeism at baseline in the fully adjusted model (HR = 7.93 [95%CI 5.20-12.09]). Eldercare workers aged >45 years were at a higher risk for disability pension in all included categories. Sickness absence and presenteeism increased the risk of disability pension among female eldercare workers. These results suggest that organizations would benefit from identifying early warning signs among workers in the prevention of involuntary early retirement.

Evening chronotype is associated with poor work ability and disability pensions at midlife: a Northern Finland Birth Cohort 1966 Study

OBJECTIVES

This is the first general population study to evaluate whether evening chronotypes (E) have poorer work ability (WA) and higher probability for early disability pensions (DPs) than morning types (M) in middle age.

METHODS

Among non-retired individuals (n=5831; 2672 men, 3159 women) of the Northern Finland Birth Cohort 1966, chronotype was determined at the age of 46 years with shortened Morningness-Eveningness Questionnaires in 2012. The outcomes were poor WA in 2012, indicated by scores 0-7/10 of Work Ability Score, and registered emergence of DPs in 2013-2016. Multivariate logistic and Cox regression analyses were separately adjusted for factors related to sleep, health and behaviours, sociodemographic and economic factors, or working times.

RESULTS

E-types represented 10% (n=264) of men and 12% (n=382) of women. Compared with M-types, the unadjusted ORs with 95% CIs of poor WA for E-type men and women were 2.24 (95% CI 1.62 to 3.08) and 2.33 (95% CI 1.74 to 3.10), respectively. The odds remained statistically significant and approximately twofold in all separate adjustment models tested. During 2013-2016, 8 (3.0%) E-type men and 10 (2.6%) E-type women were granted DP, which, compared with M-types, represented a higher HR that was statistically significant for men (HR 3.12, 95% CI 1.27 to 7.63) and remained significant except when multiple sleep variables or working times were adjusted for.

CONCLUSIONS

Eveningness appears a previously unrecognised risk factor for poor WA and early disability. We suggest that individual chronotype be considered in attempts to lengthen work careers.

Girls' transition to adulthood and their later life socioeconomic attainment: Findings from the English longitudinal study of ageing

Transitions to adulthood represent a sensitive period for setting young people into particular life course trajectories, and the nature of these transitions have varied more for girls, historically, than for boys. We aim to investigate the long-term significance of different transitions out of full-time education for socioeconomic attainment in later life amongst postwar young women in England. Our data are from the English Longitudinal Study of Ageing for girls born during World War II and the post-war period (1939-1952, n = 1798). Using sequence analysis, we identified six types of transition out of full-time education between ages 14 and 26: Early-Work, Mid-Work, Late-Work, Early-Domestic, Late-Domestic, and Part-time Mixed. We used linear and multinomial regression models to examine associations between transition types and socioeconomic attainment outcomes from age 50, including individual income, household income and wealth, and occupational class. Our study found that later transitions into employment (Mid-Work and Late-Work) were associated with higher socioeconomic attainment after age 50 compared with women who made early transitions from education to employment (Early-Work); much of the advantage of making later transitions to employment was due to higher educational attainment. We also found that early transitions to domestic work (Early-Domestic) set young women onto trajectories of lower socioeconomic attainment than compared with those who made early transitions to employment, suggesting the nature of the transition from full-time education is as important as the timing, perhaps uniquely for women. A pathway of cumulative advantage/disadvantage is also evident in our study; results suggest a partial mediating role for educational attainment in associations between childhood social class and later life socioeconomic attainment.

Health behaviours and psychosocial working conditions as predictors of disability pension due to different diagnoses: a population-based study

BACKGROUND

To investigate whether the clustering of different health behaviours (i.e. physical activity, tobacco use and alcohol consumption) influences the associations between psychosocial working conditions and disability pension due to different diagnoses.

METHODS

A population-based sample of 24,987 Swedish twins born before 1958 were followed from national registers for disability pension until 2013. Baseline survey data in 1998-2003 were used to assess health behaviours and psychosocial Job Exposure Matrix for job control, job demands and social support. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

During follow-up, 1252 disability pensions due to musculoskeletal disorders (5%), 601 due to mental diagnoses (2%) and 1162 due to other diagnoses (5%) occurred. In the models controlling for covariates, each one-unit increase in job demands was associated with higher (HR 1.16, 95%CI 1.01-1.33) and in job control with lower (HR 0.87, 95%CI 0.80-0.94) risk of disability pension due to musculoskeletal disorders among those with unhealthy behaviours. Among those with healthy behaviours, one-unit increase of social support was associated with a higher risk of disability pension due to mental and due to other diagnoses (HRs 1.29-1.30, 95%CI 1.04-1.63).

CONCLUSIONS

Job control and job demands were associated with the risk of disability pension due to musculoskeletal disorders only among those with unhealthy behaviours. Social support was a risk factor for disability pension due to mental or other diagnoses among those with healthy behaviours. Workplaces and occupational health care should acknowledge these simultaneous circumstances in order to prevent disability pension.

Working conditions as risk factors for early exit from work-in a cohort of 2351 employees in Germany

Objectives

We would assess the possible impact of a range of physical and psychosocial working conditions on early exit from paid employment (i.e., before retirement age) in a representative employee population in Germany.

Methods

We analysed a cohort from the German Study on Mental Health at Work (S-MGA) with a baseline of 2351 employees in 2011/12, sampled randomly from the register of integrated employment biographies (IEB) at the Institute for Employment Research (IAB). Follow-up ended mid-2015. Early Exit comprised episodes of either pensioning, long-term sickness absence or unemployment ≥ 18 months. Total follow-up years were 8.422. Working conditions were partly assessed by the Copenhagen Psychosocial Questionnaire (COPSOQ). Through Cox regressions, associations of baseline working conditions with time to event of exit were estimated—adjusting for baseline age, gender, poverty, fixed-term contract and socioeconomic position.

Results

In multiple regressions, awkward body postures (HR = 1.24; 95% CI = 1.07–1.44), heavy lifting (1.17; 1.00–1.37) and high work pace (1.41; 1.16–1.72) were associated with exit. The estimated attributable fraction of exit for being exposed to less than optimal work environment was 25%. Regarding specific exit routes, repetitive movements (1.25; 1.03–1.53) increased the risk for the long-term sickness absence; work pace (1.86; 1.22–2.86) and role clarity (0.55; 0.31–1.00) were associated to unemployment; and control over working time (0.72; 0.56–0.95) decreased the risk of the early retirement.

Conclusions

Work environment seems to be important for subsequent early exit from work. Physical and psychosocial demands seem to be associated to exit to a stronger extent than resources at work.

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

Background

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

Methods

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

Results

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

Conclusions

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

Individual- and Company-Level Predictors of Receiving Vocational Rehabilitation: A Multilevel Study of Finnish Private Sector Workplaces

Purpose The aim of this study was to examine the magnitude of company-level variation in vocational rehabilitation (VR) and to determine which individual- and company-level characteristics are associated with receiving VR due to mental disorders, musculoskeletal diseases, and other somatic diseases. Methods A 30% random sample of all Finnish private sector companies with more than 10 employees aged 25-62 years at the end of 2010 (5567 companies with 300,601 employees) was followed up for the receipt of VR over the next 6 years. Company size and industry, as well as gender, age, education, social class and sickness absence measured both at the individual- and company-level were used as explanatory variables in multilevel logit models. Results After controlling for the individual-level characteristics, 12% of the variance in VR was attributed to the company level. The proportion was largest in VR due to musculoskeletal diseases. Receiving VR was more common among women, older employees (except the oldest age group), those with low education (particularly due to musculoskeletal diseases), low social class, and previous sickness absence. Receiving VR was more common in larger companies, and in construction and in health and social work, and less common in professional, scientific and technical activities. Furthermore, receiving VR was more common in companies with low proportion of highly educated employees and with higher sickness absence rates. Conclusions Company-level variation in receiving VR was substantial. Adopting the practices of the companies with highest participation in VR could help to avoid work disability problems.

Sickness absence and disability pension in relation to first childbirth and in nulliparous women according to occupational groups: a cohort study of 492,504 women in Sweden

Background

Childbirth has been suggested to increase sickness absence (SA) and disability pension (DP). This may vary by occupation; however, knowledge in this field remains limited. We explored SA and DP in the years before and after childbirth among women in four occupational groups and those without occupation.

Methods

We studied nulliparous women aged 18–39 years, living in Sweden on December 31, 2004 (n = 492,504). Women were categorized into five skill-level based occupational groups and three childbirth groups; no childbirths within 3 years (B0), first childbirth in 2005 with no childbirth within 3 years (B1), and first childbirth in 2005 with at least one more birth within 3 years (B1+). We compared crude and standardized annual mean SA (in spells> 14 days) and DP net days in the 3 years before and 3 years after first childbirth date.

Results

Women in the highest skill level occupations and managers, had less mean SA/DP days during most study years than women in the lowest skill level occupations group. In B1 and B1+, absolute differences in mean SA/DP, particularly in SA, among occupational groups were highest during the year before childbirth. DP was most common in B0, regardless of group and year.

Conclusions

We found that women’s mean SA/DP days before and after first childbirth was higher with decreasing skill-level of the occupational group and these differences were most pronounced in the year before childbirth. DP was most common among women not giving birth, regardless of occupational group.

Mortality in persons with disability pension due to common mental disorders: A cohort study of Swedish construction workers

Aims: This study investigated mortality in disability pensions due to common mental disorder, and variation over time after first receiving disability pension. Methods: Objectives were explored in 301,863 construction workers (97.2% men) recruited through healthcare examinations from 1971-1993. By linking with the Swedish National Insurance Agency registers, disability pensions until 2014 were identified. Common mental disorder was defined as disability pension diagnosis due to anxiety, stress-related disorders or moderate depression. Mortality was calculated in all-psychiatric diagnosis and diagnostic sub-groups, and compared to persons without disability pensions, using Poisson regression. Additional analyses were stratified by age at follow-up. Results: In total 6030 subjects received disability pensions based on psychiatric diagnoses, and 2624 constituted common mental disorder. Analyses in an all-psychiatric diagnosis displayed increased mortality risks in men (relative risk 3.6; 95% confidence interval 3.3-3.9) and women (relative risk 2.1; 95% confidence interval 1.6-2.6). Common mental disorder was associated with mortality, especially in men (relative risk 2.5; 95% confidence interval 2.2-2.8). Increased relative risks in alcohol and substance abuse were also observed. Results in analyses stratified by age at follow-up displayed persistent high relative risks for mortality in older ages (75-89 years) in men in all-psychiatric disability pensions diagnosis (relative risk 2.8; 95% confidence interval 2.1-3.7) and common mental disorder diagnosis (relative risk 2.6; 95% confidence interval 1.8-3.6), compared to men without disability pensions. Similar results were found in women, but few cases lowered the precision of estimates. Conclusions: This study shows that disability pension based on common mental disorders, often regarded as a 'lighter' psychiatric diagnosis, is a risk for early mortality in construction workers, even several years after first receiving disability pension.

Company-level determinants of disability retirement: a multilevel study of Finnish private sector workplaces

BACKGROUND

We examined whether the risk for disability retirement varies between companies over and above the individual-level characteristics of their employees and which company-level characteristics are associated with the risk for any, full or partial disability retirement.

METHODS

A 30% random sample of Finnish private sector companies with at least 10 employees was used (5567 companies and 301 313 employees). The risk for disability retirement over 6 years was analyzed using multilevel logistic regression. Company size and industry, as well as gender, age, education and social class measured both at the individual- and the company-level were used as explanatory variables.

RESULTS

3.8% of the variance in the risk for disability retirement was attributed to the company level after controlling for individual-level characteristics of the employees. Company-level variance was much larger in partial (11.7%) than in full (4.2%) disability retirement. After controlling for all individual- and company-level characteristics, those working in health and social work activities had increased risk for both full and partial disability retirement. The risk for full disability retirement increased by decreasing educational level of the company. The risk for partial disability retirement increased by increasing company size and was elevated in companies with the highest proportion of women.

CONCLUSIONS

After controlling for the individual-level characteristics, variation in the risk for disability retirement between companies was modest. The more substantial variation in partial disability pension suggests that companies have a marked role in advancing working with partial disabilities.

Working in a cold environment, feeling cold at work and chronic pain: a cross-sectional analysis of the Tromsø Study

AIM

The aim of this study was to investigate if working in a cold environment and feeling cold at work are associated with chronic pain (ie, lasting ≥3 months).

METHODS

We used data from the sixth survey (2007-2008) of the Tromsø Study. Analyses included 6533 men and women aged 30-67 years who were not retired, not receiving full-time disability benefits and had no missing values. Associations between working in a cold environment, feeling cold at work and self-reported chronic pain were examined with logistic regression adjusted for age, sex, education, body mass index, insomnia, physical activity at work, leisure time physical activity and smoking.

RESULTS

779 participants reported working in a cold environment ≥25% of the time. This exposure was positively associated with pain at ≥3 sites (OR 1.57; 95% CI 1.23 to 2.01) and with neck, shoulder and leg pain, but not with pain at 1-2 sites. Feeling cold sometimes or often at work was associated with pain at ≥3 sites (OR 1.58; 95% CI 1.22 to 2.07 and OR 3.90; 95% CI 2.04 to 7.45, respectively). Feeling cold often at work was significantly and positively associated with pain at all sites except the hand, foot, stomach and head.

CONCLUSION

Working in a cold environment was significantly associated with chronic pain. The observed association was strongest for pain at musculoskeletal sites and for those who often felt cold at work.

Life satisfaction in Norwegian medical doctors: a 15-year longitudinal study of work-related predictors

BACKGROUND

Despite many recent studies on burn-out and dissatisfaction among American medical doctors, less is known about doctors in the Scandinavian public health service. The aims of this study were to analyse long-term work-related predictors of life satisfaction among established doctors in Norway and to identify predictors in a subgroup of doctors who reported a decline in life satisfaction.

METHODS

Two nationwide cohorts of doctors (n = 1052), who graduated medical school 6 years apart, were surveyed at graduation from medical school (T1, 1993/94 and 1999), and 4 (T2), 10 (T3), and 15 (T4) years later. Work-related predictors of life satisfaction (three items) obtained at T2 to T4 were analysed. Individual and lifestyle confounders were controlled for using mixed-models repeated-measures analyses, and logistic regression analyses were applied to identify predictors of the decrease in life satisfaction.

RESULTS

Ninety per cent (947/1052) responded at least once, and 42% (450/1052) responded at all four times. Work-related predictors of higher life satisfaction in the adjusted model were work-home stress (β = - 0.20, 95% confidence interval [CI] = - 0.25 to - 0.16, p < 0.001), perceived job demands (β = - 0.10, CI = - 0.15 to - 0.05, p < 0.001), and colleague support (β = 0.05, CI = 0.04 to 0.07, p < 0.001). The new adjusted individual predictors that we identified included female gender, reality weakness trait, and problematic drinking behaviour. Neuroticism trait and low colleague support predicted a decrease in life satisfaction.

CONCLUSIONS

Work-home stress, perceived job demands, and colleague support were the most important predictors of life satisfaction related to doctors' work. When personality traits were controlled for, female doctors were more satisfied with their life than male doctors. These findings suggest that improving work-related factors with targeted interventions, including a supportive work environment, may increase life satisfaction among doctors.

Inequalities in time from stopping paid work to death: findings from the ONS Longitudinal Study, 2001-2011

BACKGROUND

UK state pension eligibility ages are linked to average life expectancy, which ignores wide socioeconomic disparities in both healthy and overall life expectancy.

OBJECTIVES

Investigate whether there are occupational social class differences in the amount of time older adults live after they stop work, and how much of these differences are due to health.

METHODS

Participants were 76 485 members of the Office for National Statistics Longitudinal Study (LS), who were 50-75 years at the 2001 census and had stopped work by the 2011 census. Over 10 years of follow-up, we used censored linear regression to estimate mean differences in years between stopping work and death by occupational social class.

RESULTS

After adjustment for age, both social class and health were independent predictors of postwork duration (mean difference (95% CI): unskilled class vs professional: 2.7 years (2.4 to 3.1); not good vs good health: 2.4 years (1.9 to 2.9)), with LS members in the three manual classes experiencing ~1 additional year of postwork duration than professional workers (interaction p values all <0.001). Further adjustment for gender and educational qualifications was reduced but did not eliminate social class and postwork duration associations. We estimate the difference in postwork years between professional classes in good health and unskilled workers not in good health as 5.1 years for women (21.0 vs 26.1) and 5.5 years for men (19.5 vs 25.0).

CONCLUSIONS

Lower social class groups are negatively affected by uniform state pension ages, because they are more likely to stop work at younger ages due to health reasons.

Examining the Likelihood of Experiencing Productivity Loss and Receiving Social Security Disability Income Following the Onset of Chronic Disease

OBJECTIVE

The aim of the study was to examine the likelihood of reporting productivity loss and receiving social security disability (SSD) income following a chronic health condition diagnosis using a longitudinal panel design.

METHODS

Using the Panel Study of Income Dynamics, logistic regression analyses were conducted to estimate the likelihood of reporting productivity loss or receiving SSD following the diagnosis of arthritis, cancer, psychological problems, or heart conditions. Respondents reporting a new diagnosis of a condition were matched with five similarly aged respondents not reporting a diagnosis.

RESULTS

For all conditions except cancer, the odds of reporting productivity loss and receiving SSD increased at both the wave where the condition was first reported and 2 years after for respondents reporting a condition compared with those not reporting a condition.

CONCLUSIONS

The onset of chronic disease increases the likelihood of experiencing productivity loss and receiving SSD.

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.

Controlling for Structural Changes in the Workforce Influenced Occupational Class Differences in Disability Retirement Trends

We explored occupational class differences in disability retirement trends accounting for structural changes in the workforce induced by the recent economic crisis and the following economic stagnation. Using nationwide register data on the general Finnish population aged 30–59 years, we examined trends in disability retirement due to all causes, musculoskeletal diseases, and mental disorders in 2007, 2010, and 2013. Applying propensity score (PS) matching to control for bias induced by structural changes in the workforce over time, we obtained 885,807 matched triplets. In the original study population, all-cause and cause-specific disability retirement declined between 2007 and 2013 for most occupational classes. In the matched study population, the disability retirement among skilled and unskilled manual workers sharply increased in 2010 and then declined in 2013. PS matching considerably attenuated the decline in disability retirement, particularly between the years 2007 and 2010. In general, the differences in disability retirement between both skilled and unskilled manual workers and upper-level non-manual employees widened during the period of economic stagnation. In occupational epidemiology, structural changes in the workforce should be accounted for when analysing trends in ill-health. Controlling for these changes revealed widening occupational class differences in disability retirement during the period of economic stagnation.

Job characteristics as risk factors for early retirement due to ill health: The Korean Longitudinal Study of Aging (2006-2014)

Objectives

To investigate work‐related factors that contribute to early retirement due to ill health (ERIH) in middle‐aged and elderly people in Korea.

Methods

Data were collected from a sample from the first through the fifth phases of the Korean Longitudinal Study of Aging which was conducted biennially from 2006 to 2014. ERIH was defined as the retirement of workers due to health problems before their scheduled or regular retirement age as reported in one of the follow‐up surveys. Three broad subdomains of working conditions were examined: work arrangements, physical working conditions, and job satisfactions. Hazard ratios of ERIH were estimated by Cox regression.

Results

Females, older people, unskilled manual workers, and day laborers were more likely to experience ERIH. In adjusted Cox proportional hazard models, the risk for ERIH in male workers was significantly higher among those with the following conditions: high physical demands, awkward posture, dissatisfaction with the working environment, and no industrial compensation insurance or retirement benefits. However, no significant association was found among female participants.

Conclusions

Occupational class, physical working conditions, job satisfaction, and work arrangement were the potential risk factors for ERIH among male workers in Korea. Moreover, our results revealed gender differences in the risk for ERIH.

Work-related psychosocial risk factors and risk of disability pension among employees in health and personal care: A prospective cohort study

BACKGROUND

Researchers have suggested that psychological factors at work contribute to early retirement due to disability pension in the general working population. Disability pension is a problem that shortens working careers among nursing professionals and personal care or related workers, but few researchers have focused on these occupational groups. Also, a need for studies based on measurements of specific work exposure instead of combined measures has been identified.

OBJECTIVES

The aim was to study the potential influence of work-related psychosocial risk factors on the future risk of disability pension among nursing professionals and care assistants in Sweden. Those occupational groups are compared to all other occupations in Sweden. A specific aim was to describe differences in associations to cause-specific disability, and how the results were modified by occupation categories.

PARTICIPANTS

A representative sample of 79,004 women and men in Sweden comprising 2,576 nursing professionals, 10,175 care assistants and 66,253 workers in other occupations.

METHODS

Factors of the psychosocial work environment were obtained from questionnaire data of the Swedish Work Environment Surveys (SWES) 1993-2013. Information on cause-specific disability pension during follow-up was added from the Social Insurance Agency's database (1994-2014). We calculated Cox's proportional hazards with 95% confidence intervals.

RESULTS

During a mean follow-up time of 11.1 years, 6.6% of nursing professionals and 9.4% of care assistants, as compared to 6.1% among all other occupations, received disability pension. Among nursing professionals and care assistants, high quantitative job demands and low social support, but not job control, were associated with future disability pension also after controlling for age, year of interview, socio demographic conditions, and physical work factors. An increase in risk was also noticeable among nursing professionals and care assistants who reported an active job in combination with low social support. An increased risk for disability pension due to mental diagnosis was found among care assistants who reported high job demands. In all other occupations, low social support was associated with an increased risk for disability pension under any condition of job strain (high strain, low strain, active, and passive jobs).

CONCLUSION

Based on the results we conclude that high quantitative job demands and poor social support are predictors of future disability pension.

Long-term exposure to heavy physical work, disability pension due to musculoskeletal disorders and all-cause mortality: 20-year follow-up-introducing Helsinki Health Study job exposure matrix

PURPOSE

We developed a job exposure matrix (JEM) to study the association between long-term exposure to heavy physical effort or heavy lifting and carrying at work with disability pension due to musculoskeletal disorders and premature all-cause mortality.

METHODS

Exposure to heavy physical effort at work during 1996-2005 was estimated with JEM developed for this study population, where the exposure was based on occupational titles of the participants. We included all employees of the City of Helsinki, Finland, who had annual data of exposure for 8-10 years (1996-2005, n = 18387). The outcome variables were register-based, and the follow-up was from 2006 until 2015. The risk estimates were evaluated using competing risk survival analysis.

RESULTS

There were 530 (3%) disability pension events due to musculoskeletal disorders during the 10-year follow-up. After adjustment for sex, age, education and chronic diseases, employees in the second (SHR = 1.46, 95% CI 1.05-2.05), third (SHR = 2.73, 95% CI 2.00-2.29), and the highest exposure quartile (SHR = 2.56, 95% CI 1.88-3.50) had a higher risk of musculoskeletal disability pension than employees in the lowest quartile. A total of 110 (4%) men and 266 (2%) women died during the follow-up. Men in the third quartile (SHR = 2.29, 95% CI 1.23-4.24), and women in the highest exposure quartile (SHR = 1.54, 95% CI 0.99-2.41) had a higher risk of premature mortality than those in the lowest quartile.

CONCLUSIONS

Eight to ten years of exposure to heavy physical effort at work is strongly associated with disability pension due to musculoskeletal disorders. This exposure also increases the risk of premature mortality, particularly among men.

Socio-economic differences in retirement timing and participation in post-retirement employment in a context of a flexible pension age

Socio-economic circumstances influence later-life employment participation, which may take different forms as retirement processes are complex. We aimed to explore the diverse effects of various socio-economic sub-domains on pre- and post-retirement employment. We used Finnish register data to examine socio-economic predictors of time to retirement (i.e. receiving the statutory pension) using Cox regression analysis and on time spent in post-retirement employment using repeated negative binomial regression analysis over a follow-up between the ages of 63 and 68, i.e. the flexible pension age range. An average wage earner still employed at age 62 spent 13.5 months in pre-retirement employment (this corresponds to time to retirement) and 4.8 months in post-retirement employment. Those with tertiary education retired later, but the educational differences in the total time spent in employment were small when post-retirement employment was also considered. There was little variation in the timing of retirement by household income, but those in the highest quintile spent the longest time in post-retirement employment. Upper non-manual employees, home renters and those with high household debt retired later, and those with high household debt also spent a longer time in post-retirement employment. In a national flexible pension age system, high occupational class and household income thus appear to encourage either later retirement or participation in post-retirement employment. However, economic constraints also appear to necessitate continued employment.

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

OBJECTIVES

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

DESIGN

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

PARTICIPANTS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Factors associated with Health-Related Quality of Life in Kidney Transplant Recipients in France

Background

Health-Related Quality of Life (HRQoL) assessment after kidney transplantation has become an important tool in evaluating outcomes. This study aims to identify the associated factors with HRQoL among a representative sample size of Kidney Transplant Recipients (KTR) at the time of their inclusion in the study.

Methods

Data of this cross-sectional design is retrieved from a longitudinal study conducted in five French kidney transplant centers in 2011, and included KTR aged 18 years with a functioning graft for at least 1 year. Measures include demographic, psycho-social and clinical characteristics. To evaluate HRQoL, the Short Form-36 Health Survey (SF-36) and a HRQoL instrument for KTR (ReTransQol) were administered. Multivariate linear regression models were performed.

Results

A total of 1424 patients were included, with 61.4% males, and a mean age of 55.7 years (±13.1). Demographic and clinical characteristics were associated with low HRQoL scores for both questionnaires. New variables were found in our study: perceived poor social support and being treated by antidepressants were associated with low scores of Quality of Life (QoL), while internet access was associated with high QoL scores.

Conclusion

The originality of our study’s findings was that psycho-social variables, particularly KTR treated by antidepressants and having felt unmet needs for any social support, have a negative effect on their QoL. It may be useful to organize a psychological support specifically adapted for patients after kidney transplantation.

Assessing factors associated with long-term work disability after cancer in Belgium: a population-based cohort study using competing risks analysis with a 7-year follow-up

OBJECTIVES

The number of workers with cancer has dramatically increasing worldwide. One of the main priorities is to preserve their quality of life and the sustainability of social security systems. We have carried out this study to assess factors associated with the ability to work after cancer. Such insight should help with the planning of rehabilitation needs and tailored programmes.

PARTICIPANTS

We conducted this register-based cohort study using individual data from the Belgian Disability Insurance. Data on 15 543 socially insured Belgian people who entered into the long-term work disability between 2007 and 2011 due to cancer were used.

PRIMARY AND SECONDARY OUTCOME MEASURES

We estimated the duration of work disability using Kaplan-Meier and the cause-specific cumulative incidence of ability to work stratified by age, gender, occupational class and year of entering the work disability system for 11 cancer sites using the Fine and Gray model allowing for competing risks.

RESULTS

The overall median time of work disability was 1.59 years (95% CI 1.52 to 1.66), ranging from 0.75 to 4.98 years. By the end of follow-up, more than one-third of the disabled cancer survivors were able to work (35%). While a large proportion of the women were able to work at the end of follow-up, the men who were able to work could do so sooner. Being women, white collar, young and having haematological, male genital or breast cancers were factors with the bestlikelihood to be able to return to work.

CONCLUSION

Good prognostic factors for the ability to work were youth, woman, white collar and having breast, male genital or haematological cancers. Reviewing our results together with the cancer incidence predictions up to 2025 offers a high value for social security and rehabilitation planning and for ascertaining patients' perspectives.

Impact of changes in welfare legislation on the incidence of disability pension. A cohort study of construction workers

Aims: Study objectives were to investigate how changes in social insurance legislation influenced the incidence of disability pension. Methods: The study included 295,636 male construction workers who attended health examinations between 1971 and 1993, aged 20-60 years and without previous disability pension. Via the Swedish National Insurance Agency national register we identified 66,046 subjects who were granted disability pension up until 2010. The incidence rates were calculated and stratified according to age and diagnosis. Results: The incidence rate of disability pension was fairly stable until the 1990s when large variations occurred, followed by a strong decreasing trend from the early 2000s to 2010. Trends in incidence rates, stratified by age and diagnosis, showed a consistent decrease in cardiovascular disease for all age groups. In subjects aged 30-49 years there was a high peak around 2003 for musculoskeletal diseases and psychiatric diseases. For the age group 50-59 years, musculoskeletal diagnosis, the most common cause of disability pension, had a sharp peak around 1993 and then a decreasing trend. In the 60-64 age group, the incidence rate for psychiatric diagnosis was stable, while incidence rates for musculoskeletal diagnosis varied during the 1990s. Conclusions: There are considerable variations in the incidence rate of disability pension over time, with different patterns depending on age and diagnosis. Changes in social insurance legislation, as well as in administration processes, seem to influence the variation.

New benzodiazepine and Z-hypnotic users and disability pension: an eight-year nationwide observational follow-up study

OBJECTIVE

To compare how newly initiated treatment with benzodiazepines, Z-hypnotics or both associates with the reception of disability pension among 40,661 individuals of a working age.

DESIGN

Prescription register study.

SETTING

Norwegian nationwide prescriptions socio-economic and disability status data.

METHODS

Cox regression analyses.

SUBJECTS

New benzodiazepine or Z-hypnotic users.

MAIN OUTCOME MEASURE

Time to receive disability pension given benzodiazepine or Z-hypnotic use or both. Additional analyses focused on the benzodiazepine first redeemed.

RESULTS

Among new users 8.65% of Z-hypnotic users, 12.29% of benzodiazepines users and 13.96% of combined Z-hypnotic and benzodiazepine users became disability pensioners. Z-hypnotic users were weaker associated with becoming disability pensioners (HR = 0.78, CI: 0.73-0.84) and combined users were stronger associated (HR = 1.09, CI: 1.01-1.17), than benzodiazepine users. Women had higher risk than men for becoming disability pensioners. Higher age, lower education, previous drug use and psychiatrist as first prescriber were risk factors. Comparing first benzodiazepine redeemed; clonazepam initiators were stronger associated with becoming disability pensioners than diazepam initiators were (HR = 2.22, CI: 1.81-2.71). No differences between other benzodiazepine users were found.

CONCLUSIONS

Adjusting for known risk factors gave lower risk for Z-hypnotic users compared to benzodiazepine users for receiving disability pension. Combined use increased the risk further. Clonazepam initiators are especially at risk. These findings may be helpful in prescribing situations to identify and guide individuals at risk for becoming disability pensioners.

Potentially traumatic events as predictors of disability pension: A 10-year follow-up study in Norway

AIMS

Are potentially traumatic events associated with subsequent disability pension? Traumatic exposure and post-traumatic stress disorder (PTSD) may represent a disabling state with both personal and professional consequences for the affected individual. Despite this, there is a scarcity of research studying the effects of traumatic exposure on disability pension. This study examined the differences in risk for disability pension among unexposed, exposed to trauma and PTSD cases.

METHODS

An ambidirectional Norwegian cohort study, consisting of 1238 individuals aged 18-66 years who were at risk of disability pension, were interviewed using the Composite International Diagnostic Interview, and linked with registry data on disability pension. Registry follow-up in the Norwegian Insurance Database lasted ten years following interview in 2000-01. The risk of disability pension after traumatic exposure, divided into accidental and premeditated, was assessed by Cox proportional hazards regression analysis.

RESULTS

In 10 years, 9.5% of the cohort had been granted disability pension. Overall exposure to traumatic events did not alter the risk of disability pension. However, among women, exposure to premeditated traumas did increase the risk (HR 2.96 (95% CI 1.54-5.68)), and was an independent risk factor. Fulfilling criteria for PTSD caseness further increased the risk (HR 4.69 (95% CI 1.78-12.40)). There was no increased risk found between traumatic exposure and disability pension for men.

CONCLUSIONS

Exposure to trauma, particularly premeditated trauma, seems to be an independent risk factor for disability pension in women.

Temporal changes in health within 5 years before and after disability pension-the HUNT Study

Background

Health status has been reported to change before, during and after disability pension receipt. These associations might be subject to temporal changes according to changes in policy, incidence of disability pensions and other contextual factors. We compared the perceived health around time of disability retirement among persons receiving disability pension in the 1990 s and 2000 s in Norway.

Methods

We linked data from two consecutive cross-sectional population based Norwegian health surveys, HUNT2 (1995-97) and HUNT3 (2006-08), to national registries, identifying those who received disability pension within 5 years before or after participation in the survey (HUNT2: n = 5362, HUNT3: n = 4649). We used logistic regression to assess associations of time from receiving a disability pension with self-rated health, insomnia, depression and anxiety symptoms and subsequently estimated adjusted prevalence over time.

Results

Prevalence of poor self-rated health peaked around time of receiving disability pension in both decades. For those aged 50+, prevalence the year before disability pension was slightly lower in 2006-08 (74%, 95% CI 70-79%) than in 1995-97 (83%, 95% CI 79-87%), whereas peak prevalence was similar between surveys for those younger than 50. Depression symptoms peaked more pronouncedly in 1995-97 than in 2006-08, whereas prevalence of anxiety symptoms was similar at time of receiving disability pension between surveys.

Conclusions

We found no strong evidence of differences in health selection to disability pension in the 2000 s compared to the 1990 s. However, we found indication of less depression symptoms around time of disability pension in the 2000 s compared to the 1990 s.

Do family and neighbourhood matter in secondary school completion? A multilevel study of determinants and their interactions in a life-course perspective

BACKGROUND

Completion of secondary education is important for individuals' future health and health behaviour. The fundamental purpose of this study is to investigate the variation and clustering of school completion in families and neighbourhoods. Secondly, we aim to examine the impact of individuals' family structure and neighbourhood of residence and examine to what extent parental education level moderates these associations.

METHODS

Longitudinal register data for 30% of the entire Norwegian population aged 21-27 years in 2010 (N = 107,003) was extracted from Statistic Norway´s event database. Three-level logistic regression models, which incorporated individual, family, and neighbourhood contextual factors, were applied to estimate the family and neighbourhood general contextual effects and detect possible educational differences in the impact of family structure and urban place of residence in school completion.

RESULTS

Completion rates were significantly higher within families with higher education level (79% in tertiary educated families vs. 61% and 48% in secondary and primary educated families respectively) and were strongly correlated within families (ICC = 39.6) and neighbourhoods (ICC = 5.7). Several structural factors at the family level negatively associated with school completion (e.g., family disruption, large family size, and young maternal age) were more prevalent and displayed more negative impact among primary educated individuals. Urban residence was associated with school completion, but only among the tertiary educated.

CONCLUSIONS

Investment in the resources in the individuals' immediate surroundings, including family and neighbourhood, may address a substantial portion of the social inequalities in the completion of upper secondary education. The high intra-familial correlation in school completion suggests that public health policies and future research should acknowledge family environments in order to improve secondary education completion rates among young people within lower educated families.

The contribution from psychological, social, and organizational work factors to risk of disability retirement: a systematic review with meta-analyses

BACKGROUND

Previous studies indicate that psychological, social, and organizational factors at work contribute to health, motivation, absence from work, and functional ability. The objective of the study was to assess the current state of knowledge of the contribution of psychological, social, and organizational factors to disability retirement by a systematic review and meta-analyses.

METHODS

Data sources: A systematic literature search for studies of retirement due to disability in Medline, Embase, and PsychINFO was performed. Reference lists of relevant articles were hand-searched for additional studies.

DATA EXTRACTION

Internal validity was assessed independently by two referees with a detailed checklist for sources of bias. Conclusions were drawn based on studies with acceptable quality.

DATA SYNTHESIS

We calculated combined effect estimates by means of averaged associations (Risk ratios) across samples, weighting observed associations by the study's sample size. Thirty-nine studies of accepted quality were found, 37 of which from the Nordic countries.

RESULTS

There was moderate evidence for the role of low control (supported by weighted average RR = 1.40; 95% CI = 1.21-1.61) and moderate evidence for the combination of high demands and low control (although weighted average was RR = 1.45; 95% CI = 0.96-2.19) as predictors of disability retirement. There were no major systematic differences in findings between the highest rated and the lowest rated studies that passed the criterion for adequate quality. There was limited evidence for downsizing, organizational change, lack of employee development and supplementary training, repetitive work tasks, effort-reward imbalance to increase risk of disability pension. Very limited evidence was found for job demands, evening or night work, and low social support from ones superior.

CONCLUSIONS

Psychological and organizational factors at work contribute to disability retirement with the most robust evidence for the role of work control. We recommend the measurement of specific exposure factors in future studies.

Association between midlife health behaviours and transitions out of employment from midlife to early old age: Whitehall II cohort study

Background

It is important to determine whether unhealthy behaviours might influence transitions out of employment from midlife to old age, given the anticipated need for adults to work for longer. Our aim was to determine the association between repeated assessments of cigarette smoking, heavy/problem alcohol drinking, low physical activity and poor diet at midlife, in relation to work exit from midlife to old age.

Methods

Data from 7704 participants (5392 men) from the Whitehall II cohort study in employment at midlife were used to evaluate the association between unhealthy behaviours and a subsequent transition out of work during 22 years follow-up, using logistic regression models.

Results

Men who smoked cigarettes, consistently drank alcohol heavily, or reported problem drinking, were more likely to leave employment over follow-up. Women with a consistently poor diet were more likely to leave employment. Associations were stronger when the reason for leaving was health grounds, and stronger among those with persistently unhealthy behaviours over follow-up. The size of the effects were broadly equivalent to one advancing year of age on employment. Physical health functioning over follow-up only partly accounted for the associations with work exit, whereas physical and mental functioning accounted for most of the associations with work exit on health grounds.

Conclusions

Unhealthy behaviours in midlife are associated with transitions out of employment into old age. Promoting healthy behaviours at midlife might support current policy initiatives aimed at extending working life. Future research should consider possible mechanisms that link behaviours to transitions out of employment, and consider sex differences in larger cohorts.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3970-4) contains supplementary material, which is available to authorized users.

Anxiety and Depression Symptoms Among Farmers: The HUNT Study, Norway

Agriculture has undergone profound changes, and farmers face a wide variety of stressors. Our aim was to study the levels of anxiety and depression symptoms among Norwegian farmers compared with other occupational groups. Working participants in the HUNT3 Survey (The Nord-Trøndelag Health Study, 2006-2008), aged 19-66.9 years, were included in this cross-sectional study. We compared farmers (women, n = 317; men, n = 1,100) with HUNT3 participants working in other occupational groups (women, n = 13,429; men, n = 10,026), classified according to socioeconomic status. We used the Hospital Anxiety and Depression Scale (HADS) to measure anxiety and depression symptoms. Both male and female farmers had higher levels of depression symptoms than the general working population, but the levels of anxiety symptoms did not differ. The differences in depression symptom levels between farmers and the general working population increased with age. In an age-adjusted logistic regression analysis, the odds ratio (OR) for depression caseness (HADS-D ≥8) when compared with the general working population was 1.49 (95% confidence interval [CI]: 1.22-1.83) in men and 1.29 (95% CI: 0.85-1.95) in women. Male farmers had a higher OR of depression caseness than any other occupational group (OR = 1.94, 95% CI: 1.52-2.49, using higher-grade professionals as reference). Female farmers had an OR similar to men (2.00, 95% CI: 1.26-3.17), but lower than other manual occupations. We found that farmers had high levels of depression symptoms and average levels of anxiety symptoms compared with other occupational groups.

Psychological, social, and mechanical work exposures and disability retirement: a prospective registry study

BACKGROUND

Relations between several occupational psychological and social factors and disability retirement remain largely unexplored. Knowledge of which specific aspects of the work environment that affect risk of disability is a prerequisite for the success of organizational interventions aiming to prevent premature work force exit. The objective of the present study was to determine contributions to registered disability retirement by a broad range of psychological and social work exposures while taking into account effects of mechanical exposure.

METHODS

Written consent was obtained from 13 012 employees (96 organizations) representing a wide range of occupations, to link their survey responses to data from the Norwegian national registry of disability compensation. Median follow-up time was 5.8 years. To determine effects of self-reported work exposures on risk of disability retirement hazard ratios (HR) and 99% confidence intervals (99% CI) were calculated with Cox regression analysis. Effects of sex, age group, skill level, sickness absence in the last three years, and work exposures estimated to be confounders were accounted for. Post hoc stratification by sex was conducted to explore if identified predictors affected risk of disability retirement differently in men compared to women.

RESULTS

Contributors to higher risk of disability retirement were "role conflict" (high level HR 1.55 99% CI 1.07 to 2.24) and "physical workload" (high level HR 1.93 99% CI 1.39 to 2.68). Contributors to lower risk of disability retirement were "positive challenge" (high level HR 0.56 99% CI 0.34 to 0.93), "fair leadership" (high level HR 0.56 99% CI 0.39 to 0.81), and "control over work intensity" (high level HR 0.62, 99% CI 0.47 to 0.82). Direction of effects was not dependent on sex in any of the five identified predictors.

CONCLUSIONS

Several specific psychological and social work factors are independent contributors to risk of disability retirement. In order to prevent premature work force exit workplace interventions should consider targeting the predictors identified by the present study.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Variations in the risk of disability pension in Norway 1970 - 99

Aims: A study was undertaken to investigate whether cohort or period effects could explain the varying and generally increasing incidence of disability pension in Norway between 1970 and 1999. Methods: The study used data from a complete national register of new disability cases in Norway, including all cases of disability pension in the 16 - 60 age group categorized according to age and gender for each year from 1970 to 1999. The population at risk was defined for each year from census data and number of individuals already receiving disability pension. Data were organized in five-year age groups, five-year time periods and corresponding overlapping nine-year birth cohorts. Age- and gender-specific rates were displayed graphically for periods and cohorts. Separate Poisson regression models were fitted for age periods and age cohorts. Finally a combined age, period, and cohort model was applied. Results: The overall incidence was 7.4/1,000 non-disabled persons per year for women and 6.0/1,000 for men. For women 52.1% of the cases were in the 51 - 60 age group, whereas the corresponding figure for men was 57.6%. Statistical analysis showed an increasing trend for both genders, more pronounced for women than men. All time periods deviated significantly from the trend, either upwards or downwards. Age-cohort models showed less variation, but recent cohorts had higher than expected rates, especially for men. Conclusions: Further studies should investigate why Norwegian women were more affected by the period effects than men. An increasing incidence of disability pension among recent cohorts is a major challenge for the Norwegian welfare system.