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

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).

Job demands and job control and their associations with disability pension-a register-based cohort study of middle-aged and older Swedish workers

OBJECTIVES

Job demands and control at work and their combination, job strain, have been studied in relation to risk of disability pension (DP) previously. In the present study, based on registry data, we aimed to deepen the knowledge by analyzing major disease groups among the DPs, dose-response shape of the associations, and potential confounding effects of physical workload.

METHODS

Approximately 1.8 million workers aged 44 or older and living in Sweden in 2005 were followed up for 16 years, up to a maximum of 65 years of age. We linked mean values of job demands and job control, estimated in a job-exposure matrice (JEM) by gender, to individuals through their occupational titles in 2005. These values were categorized by rank order, and, for the construction of job-strain quadrants, we used a median cut-off. Associations with DP were estimated in Cox proportional-hazards models.

RESULTS

In models accounting for covariates including physical workload, low levels of job control were associated with higher risk of DP among both men and women. This association was most clear for DP with a psychiatric diagnosis, although a dose-response shape was found only among the men. High levels of job demands were associated with decreased risk of DP across diagnoses among men, but the same association varied from weak to non-existing among women. The high- and passive job-strain quadrants both showed increased risk of DP with a psychiatric diagnosis.

CONCLUSION

The results suggest that, at the occupational level, low job control, but not high job demands, contributes to an increased incidence of DP, particularly regarding DP with a psychiatric diagnosis.

Pain, Physical Demands at Work, and Future Work Expectations Among Older Adults in the United States

Background and Objectives

In the United States, pain is becoming increasingly prevalent among older adults at the same time as policies are incentivizing work longer. Given that pain and physically demanding jobs are both linked to early retirement and they often go hand-in-hand, it is important to assess how the unique effects of pain and physical work demands may interact in predicting future work expectations.

Research Design and Methods

Using Health and Retirement Study data (1998, 2004, 2010, and 2016 waves), we assess how pain and physical job demands influence future work expectations of 10,358 adults at midlife (ages 51-56), after accounting for sociodemographic, job, health, and financial characteristics.

Results

Compared to men with no pain, activity-interfering pain was associated with low expectations of full-time work past 62 regardless of job demands, while noninterfering pain was associated with 62% higher odds (odds ratio [OR] = 1.62, 95% confidence interval [CI]: 1.35-1.93) of expecting not to work full-time past age 62 only among those with physically demanding jobs. Having both interfering pain and a physically demanding job was associated with increased odds of expecting not to work full-time past age 65 for men (OR = 1.25, 95% CI: 1.06-1.47) and past age 62 for women (OR = 1.18, 95% CI: 1.00-1.39).

Discussion and Implications

The co-occurrence of physically demanding work with pain-particularly activity-interfering pain-is associated with low expectations of full-time work past ages 62 and 65 for adults at midlife. Working longer may be feasible for older adults whose pain does not interfere with work, but unrealistic for individuals facing both pain and physically demanding work.

Differences between men and women in their risk of work injury and disability: A systematic review

Background

Health responses associated with occupational exposures can vary between men and women.

Aims

This study reviewed the work injury and disability risks associated with similar types of occupational exposures for men and women within and across occupations.

Materials & Methods

A systematic review was undertaken of observational studies published between 2009 and 2019. Studies were required to empirically compare men and women for associations between occupational exposures and work injury or disability outcomes. Included studies were appraised for methodological quality and medium to high rated studies were compared for risk differences between men and women.

Results

Of 14,006 records identified, 440 articles were assessed for methodological quality, and 33 medium to high rated studies were included and reviewed. Among all occupations, the association between physical exposures, job demands, noise, and repetitive tasks, and injury risk were stronger among men. The relationship between repetitive tasks and sickness absence was stronger among women. Most studies examining psychological exposures found no risk differences for men and women across occupations. Men were at higher injury risk in certain occupations in primary and secondary industry sectors involving physical exposures and some chemical/biological exposures. Women were at higher injury risk for the physical demands and repetitive tasks of health care and aluminum production occupations.

Conclusion

This review found that men and women can have different work injury and disability risks, both across and within the same occupations, for some physical exposures and to a lesser extent for some chemical and biological exposures. These differences might be a result of occupation‐specific task differences.

Disability pensions related to heavy physical workload: a cohort study of middle-aged and older workers in Sweden

OBJECTIVES

The aim of the study was to examine the associations between heavy physical workload among middle-aged and older workers and disability pension due to any diagnosis, as well as musculoskeletal, psychiatric, cardiovascular or respiratory diagnoses. The population-based design made it possible to examine dose-response and potential gender differences in the associations.

METHODS

About 1.8 million men and women aged 44-63 years and registered as living in Sweden in 2005 were followed regarding disability pension during 2006-2016, until ages 55-65 years. Mean values of physical workload and job control, estimated through gender-specific job-exposure matrices (JEMs), were assigned to individuals through their occupational titles in 2005. Exposure values were ranked separately for women and men and divided into quintiles. Associations were analyzed with Cox proportional-hazards regression.

RESULTS

The analyses showed robust, dose-response associations between physical workload and disability pension with a musculoskeletal diagnosis in both genders: the adjusted hazard ratio and 95% confidence interval for those with the heaviest exposure was 2.58 (2.37-2.81) in women and 3.34 (2.83-3.94) in men. Dose-response associations were also seen in relation to disability pension with a cardiovascular or a respiratory diagnosis, though the hazard ratios were smaller. Physical workload was not associated with disability pension with a psychiatric diagnosis after adjustment for job control.

CONCLUSION

This study of the entire Swedish population of middle-aged and older workers suggests that higher degrees of physical workload may increase the risk of disability pension overall, and specifically with musculoskeletal, cardiovascular or respiratory diagnosis, in both women and men.

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

Objective

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

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.

Work despite poor health? A 14-year follow-up of how individual work accommodations are extending the time to retirement for workers with poor health conditions

Given many OECD countries' efforts to extend their citizens' working years, research underscores the importance of work accommodations to maintain older workers and enable them to work despite poor health or declines in physical functions. Nevertheless, few studies have investigated the associations between poor health conditions and opportunities to accommodate work in accordance with individual needs and preferences. In this study, we differentiate between three types of poor health conditions (disease, illness, or sickness). We examine the separate effects of these health conditions as well as of possibilities for work accommodations (working hours, pace, planning), on time to retirement. Additionally, we examine the potentially joint effect of poor health and low opportunities for work accommodations. The analyses are based on a representative sample of 1143 Swedish workers from Panel Survey of Ageing and the Elderly (PSAE) with a baseline (2002/2003) age of 55–64 years. Using complementary register data on income, we followed the labor market activity of these individuals until the end of 2015. We employed Cox proportional hazard regression to estimate the time to retirement and adjusted for demographical, socio-economic, and work-related covariates. In comparison to those with good health, having disease, illness, and sickness is associated with a higher risk of earlier exit from the labor market, and the joint effect of poor health and low opportunities for work accommodations increases this risk. High influence to accommodate work while having a disease or sickness supports work participation, while these patterns of associations were not equally consistent for individuals with illness. This study highlights the importance of increasing older individuals’ opportunities to make their own work accommodations, particularly in the presence of disease and sickness, and thereby combat the negative effects of poor health on time to retirement.

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Government efforts to extend working life face challenges concerning older workers health conditions and physical function.

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Poor health is known as an important predictor for early retirement.

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Work accommodations are advocated as critical to maintaining older workers ability to work despite poor health conditions.

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Longitudinal studies capturing individual's health and working conditions with retirement are needed.

Physical work environment factors affecting risk for disability pension due to mental or musculoskeletal diagnoses among nursing professionals, care assistants and other occupations: a prospective, population-based cohort study

OBJECTIVE

To study the influence of physical work factors on the risks of future disability pension (DP) due to mental or musculoskeletal diagnoses among nursing professionals, care assistants and all other occupations in the general working population in Sweden.

METHODS

The prospective population study was based on representative samples of working individuals (n=79 004) aged 16-64, interviewed in the Swedish Work Environment Survey between 1993 and 2013. Information on diagnosed DP in 1994-2014 was gathered from the Social Insurance Agency's database. The focus was on nursing professionals (registered nurses and midwives) and care assistants, for example, assistant nurses and hospital ward assistants. The outcome was DP, classified into two diagnostic groups. Associations between physical work factors and risk of DP were calculated using Cox regression with HR and 95% CI.

RESULTS

Physical work factors were associated with future DP after adjusting for sociodemographic conditions and psychosocial work factors among care assistants (n=10 175) and among all other occupations (n=66 253), but not among nursing professionals (n=2576). The increased risk among care assistants (n=197) exposed to heavy physical work was 66% (HR 1.66, 95% CI 1.39 to 1.97), and for those exposed to strenuous work postures (n=420) it was 56% (HR 1.56, 95% CI 1.35 to 1.80). Physical work indicators were mainly associated with musculoskeletal DP diagnoses among care assistants, but two indicators were significant also for mental diagnoses. An increased risk of DP was found among nursing professionals (n=102) exposed to detergents or disinfectants (HR 1.48, 95% CI 1.06 to 2.05), but not among care assistants.

CONCLUSIONS

Heavy physical work and strenuous postures are predictors of future DP, particularly among care assistants and in the general working population. In order to reduce early exit from the workforce, efforts should be made to improve physical and ergonomic working conditions.

Body mass index and the risk of disability retirement: a systematic review and meta-analysis

The aim of this study was to determine the associations of body mass index (BMI) with all-cause and cause-specific disability retirement. Literature searches were conducted in PubMed, Embase and Web of Science from their inception to May 2019. A total of 27 (25 prospective cohort and 2 nested case-control) studies consisting of 2 199 632 individuals qualified for a meta-analysis. Two reviewers independently assessed the methodological quality of the included studies. We used a random effects meta-analysis, assessed heterogeneity and publication bias, and performed sensitivity analyses. There were a large number of participants and the majority of studies were rated at low or moderate risk of bias. There was a J-shaped relationship between BMI and disability retirement. Underweight (hazard ratio (HR)/risk ratio (RR)=1.20, 95% CI 1.02 to 1.41), overweight (HR/RR=1.13, 95% CI 1.07 to 1.19) and obese individuals (HR/RR=1.52, 95% CI 1.36 to 1.71) were more commonly granted all-cause disability retirement than normal-weight individuals. Moreover, overweight increased the risk of disability retirement due to musculoskeletal disorders (HR/RR=1.26, 95% CI 1.15 to 1.39) and cardiovascular diseases (HR=1.73, 95% CI 1.24 to 2.41), and obesity increased the risk of disability retirement due to musculoskeletal disorders (HR/RR=1.66, 95% CI 1.42 to 1.94), mental disorders (HR=1.29, 95% CI 1.04 to 1.61) and cardiovascular diseases (HR=2.80, 95% CI 1.85 to 4.24). The association between excess body mass and all-cause disability retirement did not differ between men and women and was independent of selection bias, performance bias, confounding and adjustment for publication bias. Obesity markedly increases the risk of disability retirement due to musculoskeletal disorders, cardiovascular diseases and mental disorders. Since the prevalence of obesity is increasing globally, disease burden associated with excess body mass and disability retirement consequently are projected to increase. Reviewregistrationnumber: CRD42018103110.

Does dispositional optimism moderate the relationship between role conflict and risk of disability retirement?

This study determines whether dispositional optimism moderates the relationship between role conflict and the risk of disability retirement. The study was based on a combination of self-report survey questionnaire data on role conflict and dispositional optimism with official register data on disability benefits from the Norwegian Labour and Welfare Administration. The sample comprised 14,501 Norwegian employees from various occupations and industries. Role conflict was significantly related to higher risk (HR 1.35, 95% CI 1.19-1.53), whereas optimism was associated with decreased risk (HR 0.75, 95% CI 0.64-0.88), of disability retirement. Optimism did not modify the effect on role conflict on disability retirement. Having an optimistic life orientation decreases the risk of disability retirement in general, but does not protect against the detrimental effects of role conflict at the workplace. As optimism is a malleable personality characteristic, organizations may benefit from interventions that help employees experience daily events more positively.