Work participation and working life expectancy after a disabling shoulder lesion

The working life expectancy of American adults experiencing depression

OBJECTIVES

To estimate the working life expectancies (WLE) of men and women with depression, examining depression by symptom trajectories from the late 20s to early 50s, and to estimate WLE by race/ethnicity and educational attainment.

METHODS

Data from 9206 participants collected from 1979 to 2018 in the US National Longitudinal Survey of Youth 1979 cohort were used. Depression was measured using the Center for Epidemiologic Studies Depression Scale Short Form at four time points (age 28-35, age 30-37, age 40, and age 50). Labor force status was measured monthly starting at age 30 until age 58-62. Depressive symptom trajectories were estimated using growth mixture modeling and multistate modeling estimated WLE from age 30-60 for each gender and depressive symptom trajectory.

RESULTS

Five latent symptom trajectories were established: a persistent low symptom trajectory (n = 6838), an episodic trajectory with high symptoms occurring before age 40 (n = 995), an episodic trajectory with high symptoms occurring around age 40 (n = 526), a trajectory with high symptoms occurring around age 50 (n = 570), and a persistent high symptom trajectory (n = 277). The WLE for men at age 30 was 30.3 years for the persistent low symptom trajectory, 22.8 years for the episodic before 40 trajectory, 19.6 years for the episodic around age 40 trajectory, 18.6 years for the episodic around age 50 trajectory, and 13.2 years for the persistent high symptom trajectory. Results were similar for women. WLE disparities between depression trajectories grew when stratified by race/ethnicity and education level.

CONCLUSIONS

Roughly a quarter of individuals experienced episodic depressive symptoms. However, despite periods of low depressive symptoms, individuals were expected to be employed ~5-17 years less at age 30 compared to those with low symptoms. Accessible employment and mental health disability support policies and programs across the working life course may be effective in maintaining work attachment and improving WLE among those who experience depression.

The development of working life expectancy without musculoskeletal diseases against the backdrop of extended working lives

Musculoskeletal diseases (MSDs) are a major predictor of early retirement. Against the backdrop of the extension of working life, we investigated time trends and educational inequalities in years spent in the labour market free of MSD. Based on German statutory health insurance data (N = 3,405,673), total life years free of MSD (Healthy Life Expectancy, HLE) and years spent in the labour force free of MSD (Healthy Working Life Expectancy, HWLE) were estimated for three periods (2006-2008, 2011-2013, 2016-2018) using multistate analyses. Educational inequalities (8 to 11 vs. 12 or more years of schooling) are reported for 2011-2013. HLE decreased slightly over time in all genders. HWLE in women increased, while it remained rather constant in men. Over time, the share of years in the labour force spent free of MSD declined continuously. People with lower education had lower HLE and HWLE than individuals with higher education. With respect to musculoskeletal diseases, the increase in disease-free working life years cannot keep pace with the extension of working life, resulting in an increasing proportion of years spent in impaired musculoskeletal health in the labour market. Effective prevention strategies are needed, focusing especially on individuals with lower educational attainment.

The adequacy of workplace accommodation and the incidence of permanent employment separations after a disabling work injury or illness

OBJECTIVE

This study aimed to estimate the influence of the adequacy of employer accommodations of health impairments in predicting permanent separation from the employment relationship in a cohort of workers disabled by a work-related injury or illness.

METHODS

The study used data from a retrospective, observational cohort of 1793 Ontario workers who participated in an interviewer-administered survey 18 months following a disabling injury or illness. The relative risks (RR) of a permanent employment separation associated with inadequate employer accommodations were estimated using inverse probability of treatment weights to reduce confounding.

RESULTS

Over the 18-month follow-up, the incidence of permanent separation was 30.1/100, with 49.2% of separations related to health status. Approximately 51% of participants experiencing a separation were exposed to inadequate workplace accommodations, compared to 27% of participants in continuing employment. The propensity score adjusted RR of a health-related separation associated with inadequate accommodation was substantial [RR 2.72; 95% confidence interval (CI) 2.20-3.73], greater than the RR of separations not related to health (RR 1.68; 95% CI 1.38-2.21).

CONCLUSIONS

Incidence of permanent separation in this cohort of Ontario labor force participants was approximately two times more frequent than would be expected. The adequacy of employer accommodation was a strong determinant of the risk of permanent separation. These findings emphasize the potential for strengthened workplace accommodation practices in this setting.

Shoulder replacement surgery's rising demand, inequality of provision, and variation in outcomes: cohort study using Hospital Episode Statistics for England

BACKGROUND

The aim of this study was to forecast future patient demand for shoulder replacement surgery in England and investigate any geographic and socioeconomic inequalities in service provision and patient outcomes.

METHODS

For this cohort study, all elective shoulder replacements carried out by NHS hospitals and NHS-funded care in England from 1999 to 2020 were identified using Hospital Episode Statistics data. Eligible patients were aged 18 years and older. Shoulder replacements for malignancy or acute trauma were excluded. Population estimates and projections were obtained from the Office for National Statistics. Standardised incidence rates and the risks of serious adverse events (SAEs) and revision surgery were calculated and stratified by geographical region, socioeconomic deprivation, sex, and age band. Hospital costs for each admission were calculated using Healthcare Resource Group codes and NHS Reference Costs based on the National Reimbursement System. Projected rates and hospital costs were predicted until the year 2050 for two scenarios of future growth.

RESULTS

A total of 77,613 elective primary and 5847 revision shoulder replacements were available for analysis. Between 1999 and 2020, the standardised incidence of primary shoulder replacements in England quadrupled from 2.6 to 10.4 per 100,000 population, increasing predominantly in patients aged over 65 years. As many as 1 in 6 patients needed to travel to a different region for their surgery indicating inequality of service provision. A temporal increase in SAEs was observed: the 30-day risk increased from 1.3 to 4.8% and the 90-day risk increased from 2.4 to 6.0%. Patients from the more deprived socioeconomic groups appeared to have a higher risk of SAEs and revision surgery. Shoulder replacements are forecast to increase by up to 234% by 2050 in England, reaching 20,912 procedures per year with an associated annual cost to hospitals of £235 million.

CONCLUSIONS

This study reports a rising incidence of shoulder replacements, regional disparities in service provision, and an overall increasing risk of SAEs, especially in more deprived socioeconomic groups. These findings highlight the need for better healthcare planning to match local population demand, while more research is needed to understand and prevent the increase observed in SAEs.

Health and inclusive labour force participation

The future of work is rapidly changing, with higher flexibility of the labour market and increasing informal employment in many countries worldwide. There is also an increased pressure to extend working careers until older age. We introduce the concept of working life expectancy as a useful metric, capturing the expected numer of years in paid employment across the working age individuals, in particular among different groups. We describe factors that determine working life expectancy. Macro-level factors focus on the socioeconomic and political context that influences labour force participation, primarily policies and legislation in specific countries. At the meso level, employment contracts and working conditions are important. The micro level shows that individual characteristics, such as education, gender, and age, influence working careers. There are three important groups with a disadvantaged position in the labour market-workers with chronic diseases, workers with impairing disabilities, and workers aged 50 years or more. Within each of these disadvantaged groups, macro-level, meso-level, and micro-level factors that influence entering and exiting paid employment are discussed. To assure that paid employment is available for everyone of working age and that work contributes to better health, specific challenges need to be addressed at the macro, meso, and micro levels. To reach inclusive labour force participation, national policies, company practices, and workplace improvements need to be aligned to ensure safe and healthy workplaces that contribute to the health and wellbeing of workers and their communities.

Physical work demands and expected labor market affiliation (ELMA): Prospective cohort with register-follow-up among 46 169 employees

OBJECTIVE

This study aimed to estimate the impact of high physical work demands on expected labor market affiliation (ELMA) among men and women of different ages in the general working population.

METHODS

After participating in the Danish Work Environment and Health study (2012, 2014, and/or 2016), 46 169 employees were followed for two years in national registers. Using multi-state modeling, taking all day-to-day transition probabilities of labor market affiliation into account (work, unemployment, sickness absence, temporary out, and permanently out), and performing multilevel adjustment, we estimated the prospective association between physical work demands (ergonomic index including 7 factors) and ELMA.

RESULTS

During 104 896 person-years of follow-up, we identified of 439 045 transitions. Using low physical work demands as reference, higher physical work demands were associated with fewer days of active work (2-35 days) during 730 days of follow-up, and more days of sickness absence (4-26 days) and unemployment (ranging 1-9 days) among men and women of aged 40-49 and 50-64 years. Among men and women aged 18-39 years, high physical work demands only had minor and inconsistent impact on ELMA.

CONCLUSIONS

Analyzing multiple and highly detailed patterns of transition probabilities concerning labor market affiliation we showed that reducing physical work demands is likely to increase the active working time and prevent high societal cost of sickness absence and unemployment, especially among middle-aged and older workers.

Factors associated with limitations in daily life and at work in a population with shoulder pain

Background

Shoulder pain, which is a widespread condition, can lead to participation restrictions in daily and professional life. However, there are few studies focusing on the differences between daily life limitations and work limitations. This study aims at identifying the factors associated with limitations in personal and professional life in a population of working age suffering from shoulder pain.

Methods

A sample of working age job seekers and workers with shoulder pain was drawn from the last general population cross-sectional French study on disability. Limitations were categorized depending on whether they related to daily life and/or work. The variables assessed were age, sex, state of health, activity restrictions, need for accommodation, and aggravating living conditions or aggravating working conditions. Separate Quasi-Poisson regressions were performed for each type of limitation.

Results

The sample consisted of 795 individuals of which 33.7% had no limitation, 21.7% were limited in daily life, 6.0% at work, and 38.6% in both. Factors significantly associated with daily life limitations and work limitations and their computed Prevalence Ratios (PR) were the need for accommodation (PR = 2.16), activity restrictions (PR = 2.28), perceived poor health (PR = 2.42) and low income (PR = 1.64). Aggravating living conditions and aggravating working conditions were associated with daily life limitations (PR of 1.69 and 0.63 respectively).

Conclusions

The present study identifies factors associated with disability in a population with shoulder pain. Further research should be carried out in order to study health-related periods of cessation of work.

Has the share of the working life expectancy that is spent receiving a partial or full disability pension changed in Finland over the period 2005-2018? A longitudinal register-based study

OBJECTIVES

The share of the overall working careers that is spent receiving disability benefits is unclear. We examined trends in full-time equivalent working life expectancy (FTE-WLE) among those with and without receiving a permanent full or partial disability pension in Finland, where certain amounts of work are allowed while receiving these pensions.

DESIGN

Longitudinal register-based study.

SETTING

Finnish population.

PARTICIPANTS

Nationally representative 70% samples of the working-age population.

OUTCOME

Using the Sullivan method, we examined annual FTE-WLE at age 45, truncated at age 63, in 2005-2018 by disability pension status. Full-time equivalent work participation was based on combined information on annual employment days and work income.

RESULTS

Compared with those with no disability pension, disability pensioners had a larger relative (full and partial pensioners of both genders) and absolute (male partial pensioners) increase in the FTE-WLE between 2005 and 2018. In 2018, the FTE-WLE of both male and female full disability pensioners was around 3.5 months, being 6 months at its highest in musculoskeletal diseases. The FTE-WLE of partial disability pensioners was around 6.5 and 8 years among men and women, respectively, being around half of the corresponding expectancies of non-pensioners. The FTE-WLE of partial disability pensioners was considerable in musculoskeletal diseases and mental disorders and even higher in other diseases. Full disability pensioners spent a disproportionately large time in manual work, increasingly in the private sector, and partial pensioners in the public sector with lower non-manual and manual work, increasingly with the former. At the population level, the share of the FTE-WLE that is spent receiving a disability pension remained relatively small.

CONCLUSIONS

Increased work participation while receiving a disability pension is likely to have had important implications for prolonging individual working careers but only minor contribution to the length of working lives at the population level.

Asynchronous and Tailored Digital Rehabilitation of Chronic Shoulder Pain: A Prospective Longitudinal Cohort Study

Background

Chronic shoulder pain (SP) is responsible for significant morbidity, decreased quality of life and impaired work ability, resulting in high socioeconomic burden. Successful SP management is dependent on adherence and compliance with effective evidence-based interventions. Digital solutions may improve accessibility to such treatments, increasing convenience, while reducing healthcare-related costs.

Purpose

Present the results of a fully remote digital care program (DCP) for chronic SP.

Patients and Methods

Interventional, single-arm, cohort study of individuals with chronic SP applying for a digital care program. Primary outcome was the mean change between baseline and 12 weeks on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were change in pain (NPRS), analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement.

Results

From 296 patients at program start, 234 (79.1%) completed the intervention. Changes in QuickDASH between baseline and end-of-program were both statistically (p < 0.001) and clinically significant, with a mean reduction of 51.6% (mean −13.45 points, 95% CI: 11.99; 14.92). Marked reductions were also observed in all secondary outcomes: 54.8% in NPRS, 44.1% ceased analgesics consumption, 55.5% in surgery intent, 37.7% in FABQ-PA, 50.3% in anxiety, 63.6% in depression and 66.5% in WPAI overall. Higher engagement was associated with higher improvements in disability. Mean patient satisfaction score was 8.7/10.0 (SD 1.6).

Conclusion

This is the first real-world cohort study reporting the results of a multimodal remote digital approach for chronic SP rehabilitation. High completion and engagement rates were observed, which were associated with clinically significant improvement in all health-related outcomes, as well as marked productivity recovery. These promising results support the potential of digital modalities to address the global burden of chronic musculoskeletal pain.

Predictive factors for the duration until return to work after surgery for work-related rotator cuff syndrome: A prospective study of 92 workers

BACKGROUND

Return to work (RTW) after surgery for a work-related rotator cuff disorder (WRRCD) is often difficult. The study's purpose was to identify preoperative factors predicting RTW.

METHODS

Ninety-two workers with a WRRCD were identified by four surgeons. Before surgery, the workers completed a series of standardized questionnaires related to working conditions, health, and health beliefs. They were followed up prospectively for 20 months. Statistical analysis was based on single and multiple-factor Cox models of the duration of absence from the time of surgery until RTW.

RESULTS

The median age at inclusion was 49 years (27-62), with 52 women included (57%). Sixty-one subjects (66%) were employed in highly physically demanding jobs. Forty-two (46%) stayed at work until their surgery, whereas preoperative sick leave exceeded 100 days in 20 subjects (21%). Twenty months after surgery, 14 were still not back at work. For the other participants, the mean duration until RTW was 225 days (SD 156). In the fully adjusted model, variables that were significantly predictive of the duration until RTW were: work physical demand levels, preoperative sick leave, the number of body parts causing pain or discomfort in the last 12 months, self-assessed 2-year workability, and the Readiness for RTW (RRTW) Scale.

CONCLUSIONS

Several physical, psychological, and work-related factors, easily recorded, can be identified preoperatively. They may be predictive of delayed return, loss of employment, or employability as a result of shoulder surgery.

Effects of 9/11-related injury on retirement patterns among World Trade Center Health Registry enrollees

BACKGROUND

Many survivors of the 9/11/2001 terrorist attacks in New York City sustained injuries. The aim of this study was to understand how 9/11-related injuries affected retirement patterns of World Trade Center Health Registry enrollees.

METHODS

The study included enrollees who participated in the 2017 Health & Quality of Life Survey, focused on 9/11-related injuries and quality of life, and the 2017-2018 Health & Employment Survey, focused on retirement and employment (N = 3535). Using Cox proportional hazards and logistic regression modeling, we calculated the risk of retiring at earlier ages and the odds of retirees working again, controlling for relevant covariates.

RESULTS

Results showed that 9/11-related injuries did affect retirement patterns. Injured enrollees were at greater risk of retiring at younger age compared to non-injured enrollees. Compared to more severely injured retirees, non-injured and less severely injured retirees were significantly more likely to work again postretirement. Our results suggested that being injured on 9/11 was associated with retirement, meaning that if the injury had not occurred, the individual may have continued working longer.

CONCLUSIONS

The need to retire earlier than planned could be addressed with employer and societal changes. Employers should consider making accommodations for those impacted by 9/11 a priority, as it is imperative for those who were injured on 9/11 to have the ability to work to support their physical, mental, and financial well-being.

Indicators and determinants of the years of working life lost: a narrative review

Objective:

This narrative review summarizes the available indicators for working life expectancy and years of working life lost (YWLL) and their determinants.

Methods:

We searched PubMed and Embase databases from their inception until August 2020 and screened all studies proposing an indicator for working life expectancy or YWLL. We also reviewed studies focusing on sociodemographic, lifestyle and work-related determinants of working life expectancy and YWLL. The results were synthesized narratively.

Results:

We identified 13 different indicators for the length of working life or YWLL. The most frequently used indicators were ‘working life expectancy’, ‘healthy working life expectancy’, and YWLL. Working life expectancy and healthy working life expectancy are longer for men than women. Working life expectancy at the age of 50 has been increasing since the mid-90s, and the increase has been larger for women, reducing the sex difference. Working life is shorter for people with a low level of education, in lower occupational classes, for people exposed to high physical work demands, those living in the most socioeconomically deprived areas, people with overweight or obesity, smokers, people who are inactive during leisure time and in people with a chronic health problem.

Conclusions:

Despite increasing interest in understanding the determinants of YWLL, only a few studies have simultaneously considered multiple exit routes from the labour market. We propose a new measure for total YWLL considering all relevant exit routes from employment. This comprehensive measure can be used to assess the effect of given policy changes on prolonging working life.

High physical work demands and working life expectancy in Denmark

Objective

In most European countries, political reforms gradually increase the statutory retirement age to counter the economic costs of a growing elderly population. However, working to a high age may be difficult for people with hard physical labour. We aim to study the impact of high physical work demands on working life expectancy (WLE).

Methods

We combined physical work demands assessed by job exposure matrix (JEM) and longitudinal high-quality national registers (outcome) in 1.6 million Danish workers to estimate WLE and years of sickness absence, unemployment and disability pension. The JEM value for physical work demand is a summarised score of eight ergonomic exposures for 317 occupations groups, sex and age. The WLE was estimated using a multistate proportional hazards model in a 4-year follow-up period.

Results

Individuals with high physical work demands had a significantly lower WLE, than those with low physical work demands, with largest differences seen among women. At age 30 years, women with high physical work demands can expect 3.1 years less working, 11 months more of sickness absence and 16 months more of unemployment than low-exposed women. For 30-year-old men, the corresponding results were 2.0 years, 12 months and 8 months, respectively.

Conclusion

Our findings show that high physical work demands are a marked risk factor for a shortened working life and increased years of sickness absence and unemployment. The results are important when selecting high-risk occupations, and expand the knowledge base for informed political decision making concerning statutory retirement age.

Occupational differences in disability retirement due to a shoulder lesion: do work-related factors matter?

Objective

To identify occupations with a high risk of disability retirement due to a shoulder lesion and to examine the effect of physical and psychosocial work-related factors on occupational differences in disability retirement.

Methods

We followed Finnish wage earners aged 30–59 years (n = 1,135,654) from 2005 to 2014 for full disability retirement due to a shoulder lesion. The work-related exposures were assessed with job exposure matrices. We calculated age-adjusted incidence rates and hazard ratios to test for the association between occupation and disability retirement due to a shoulder lesion. We also examined the contribution of work-related exposures to the excess risk of disability retirement.

Results

As compared to professionals, the age-adjusted risk of disability retirement was increased among men in all occupational groups except managers and customer service clerks and among women in several occupational groups. Adjustment for education attenuated the occupational differences considerably, particularly among women. The physical work-related factors fully explained the excess risk of disability retirement due to a shoulder lesion among male finance and sales associate professionals and administrative secretaries as well as among agricultural and fishery workers. In women, the physical work-related factors fully explained the excess risk among construction workers, electricians and plumbers. For both genders, the contribution of psychosocial factors to excess risk of disability retirement was modest and seen for monotonous work only.

Conclusions

A reduction of the level of physical work load factors as well as monotonousness of work has a potential to prevent work disability due to a shoulder lesion.

Electronic supplementary material

The online version of this article (10.1007/s00420-020-01549-y) contains supplementary material, which is available to authorized users.

Impact of depressive symptoms on worklife expectancy: a longitudinal study on Danish employees

Objective

Depressive symptoms are associated with sickness absence, work disability and unemployment, but little is known about worklife expectancy (WLE). This study investigates the impact of depressive symptoms on the WLE of a large sample of Danish employees.

Methods

We used occupational health survey data of 11 967 Danish employees from 2010 and linked them with register data on salary and transfer payments from 2010 to 2015. Depressive symptoms were self-reported using the Major Depression Inventory. We used multistate data and a life table approach with Cox proportional hazard modelling to estimate the WLE of employees, expressed by time in work, unemployment and sickness absence. Separate analyses were conducted for sex and employees with a voluntary early retirement pension scheme. Using age as time axis, we used inverse probability weights to account for differences in educational level, sector, body mass index, smoking habits and loss of employment during sickness absence.

Results

The WLE of employees reporting depressive symptoms was shorter compared with those not reporting depressive symptoms; that is, the expected time in unemployment and sickness absence was longer, while the expected time in work was shorter. The shorter WLE was most pronounced in women; for example, a 40-year-old woman with depressive symptoms can expect 3.3 years less in work, 0.8 years more in unemployment and 0.7 years more in sickness absence. Employees with a voluntary early retirement pension scheme showed an even lower WLE.

Conclusions

Our study showed a meaningful impact of depressive symptoms on the WLE of Danish employees using a multistate framework.

Physical and psychosocial work exposures as risk factors for disability retirement due to a shoulder lesion

Objective

To assess the longitudinal associations of physical and psychosocial exposures with disability retirement due to a shoulder lesion.

Methods

In a nationwide register-based study, we followed 1 135 654 wage earners aged 30–59 years for the occurrence of disability retirement due to a shoulder lesion. The occupational exposures were assessed with job exposure matrices. We used a competing risk regression model to estimate HRs and their 95% CIs and to test for the association between the exposures and the outcome. We also calculated the attributable fraction of disability retirement due to occupational exposures.

Results

A total of 2472 persons had full disability retirement due to a shoulder lesion during the follow-up. Physically heavy work showed the strongest association with the outcome in both genders, in men with an HR of 2.90 (95% CI 2.37 to 3.55) and in women with an HR of 3.21 (95% CI 2.80 to 3.90). Of the specific physical exposures, working with hands above shoulder level was statistically significantly associated with disability retirement in men. When all physical exposures were taken into consideration, 46% and 41% of disability retirement due to a shoulder lesion were attributed to physical work load factors in men and women, respectively. In addition, 49% (men) and 35% (women) of disability retirement were attributed to psychosocial work-related factors.

Conclusions

Our findings suggest that a considerable proportion of disability retirement due to a shoulder lesion could be prevented by reducing physical and psychosocial exposures at work to a low level.