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Perhoniemi R, Blomgren J, Laaksonen M. Unemployed and disabled for work: identifying 3-year labour market pathways from the beginning of a sickness absence using sequence and cluster analyses in a register-based longitudinal study in Finland. BMJ Open 2023; 13:e076435. [PMID: 38151282 PMCID: PMC10753752 DOI: 10.1136/bmjopen-2023-076435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES This study followed the labour market pathways of unemployed persons who started a sickness absence (SA) spell. We aimed to unravel subgroups based on altering labour market states and to identify covariates of these subgroups. DESIGN Register-based longitudinal study, with nine labour market states and 36-month units. SETTING AND PARTICIPANTS All Finnish persons aged 18-59 years with an SA in 2016 who were unemployed at the start of the SA spell (N=12 639). OUTCOME MEASURES Sequence analysis was used to study transitions between nine labour market states based on monthly register data on permanent and temporary (full and partial) disability pensions (DP), rehabilitation, all-cause SA, unemployment and employment. Individuals were grouped into clusters based on cluster analysis and intersequence distances. Multinomial regression analysis was used to examine covariates of cluster memberships. RESULTS Six clusters with the following pathway identities were found: (1) recurring unemployment (44%); (2) employment after a short SA (18%); (3) rehabilitation, recurring SA and unemployment (12%); (4) unknown sources of income (11%); (5) permanent DP after a prolonged SA (9%) and (6) temporary DP after a prolonged SA (7%).Compared with the reference cluster 2, all other clusters were associated with less employment days and having a chronic illness before the SA spell, SA based on a mental disorder and a rejected DP application during the follow-up. In addition, the clusters had some unique covariates. CONCLUSIONS Unemployed persons starting an SA are a heterogeneous group, with different labour market pathways. For many, the combination of unemployment and work disability means low chances for employment or regained work ability during the following years. Unemployed persons with poorer health, long history outside employment, older age, low educational level, a rejected DP application and a mental disorder could benefit from targeted support.
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Affiliation(s)
| | - Jenni Blomgren
- Social Insurance Institution of Finland, Helsinki, Finland
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Moreira AAO, Martins JT, Haddad MDCFL, Galdino MJQ, Ribeiro RP, Barreto MFC. Factors associated with work activity of technical-administrative staff from state universities retired due to disability. Rev Gaucha Enferm 2023; 44:e20220252. [PMID: 37851834 DOI: 10.1590/1983-1447.2023.20220252.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/01/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE To verify the factors associated with the type of work activity performed by university technical-administrative staff retired due to disability. METHOD Cross-sectional research with 68 workers, conducted using an electronic questionnaire between November 2019 and September 2020. Data were collected on sociodemographic, occupational characterization and causes of disability. Data were analyzed descriptively and by multiple logistic regressions. RESULTS Health professionals were more likely to have mental and behavioral disorders, associated with females and regardless of age. The chances of the nervous system diseases were higher in workers who performed administrative work, being associated with higher education. Operational employees were more likely to have musculoskeletal diseases associated with primary and secondary education and were male, regardless of age. CONCLUSION There was an association between work activity performed before retirement and the diseases responsible for disability, with differences between gender, age, and educational levels.
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Affiliation(s)
- Aline Aparecida Oliveira Moreira
- Universidade Estadual de Londrina (UEL). Departamento de Enfermagem. Programa de Pós-Graduação em Enfermagem. Londrina, Paraná, Brasil
| | - Júlia Trevisan Martins
- Universidade Estadual de Londrina (UEL). Departamento de Enfermagem. Programa de Pós-Graduação em Enfermagem. Londrina, Paraná, Brasil
| | | | - Maria José Quina Galdino
- Universidade Estadual do Norte do Paraná (UENP). Departamento de Enfermagem. Bandeirantes, Paraná, Brasil
| | - Renata Perfeito Ribeiro
- Universidade Estadual de Londrina (UEL). Departamento de Enfermagem. Programa de Pós-Graduação em Enfermagem. Londrina, Paraná, Brasil
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Thern E, Falkstedt D, Almroth M, Kjellberg K, Landberg J, Bodin T, Melin B, Hemmingsson T. Educational qualification differences and early labor market exit among men: the contribution of labor market marginalization measured across the working life. BMC Public Health 2022; 22:1015. [PMID: 35590290 PMCID: PMC9121573 DOI: 10.1186/s12889-022-13397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study aims to investigate the association between educational qualification and early labor market exit among men and to examine the contribution of labor market marginalization measured across the working life on this association. METHOD A register-linked cohort study was conducted including men who completed military service in 1969/70 (born between 1949 and 1951) and were alive at age 55 and not disability pension beneficiaries (n = 40 761). Information on the highest level of educational qualification and the outcome of early exit (disability pension, sickness absence, unemployment, and early old-age pension) was obtained from Swedish nationwide registers between the ages of 55 and 64 years. Labor market marginalization was defined as periods of long-term unemployment and sickness absence over the working life and up to follow-up. Cox regression analyses were used to obtain hazard ratios (HR) with 95% confidence intervals (CI). RESULTS Low-educated men were more likely to leave the labor force early due to disability pension or sickness absence (HR: 2.48), unemployment (HR: 2.09), and early old-age pension with- (HR:1.25) and without -income (HR: 1.58). Labor market marginalization across the working life explained a large part of the association for the more involuntary early exit routes (disability pensions, sickness absence, unemployment) and explained very little with regards to the more voluntary early exit routes (early old-age pension with and without income). CONCLUSION Exposure to labor market marginalization across the working life was important in explaining educational differences in early labor market exit due to disability pension or sickness absence and unemployment. This study underscores the importance of identifying and implementing preventive measures in the workplace (e.g. adaptions) to prevent new spells of sickness absence and unemployment, especially among low educated individuals.
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Affiliation(s)
- Emelie Thern
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden. .,Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Daniel Falkstedt
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Melody Almroth
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Katarina Kjellberg
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jonas Landberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Theo Bodin
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Bo Melin
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Tomas Hemmingsson
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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Junna L, Moustgaard H, Martikainen P. Health-related selection into employment among the unemployed. BMC Public Health 2022; 22:657. [PMID: 35382786 PMCID: PMC8985275 DOI: 10.1186/s12889-022-13023-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Successful transitions from unemployment to employment are an important concern, yet little is known about health-related selection into employment. We assessed the association of various physical and psychiatric conditions with finding employment, and employment stability. METHODS Using total population register data, we followed Finnish residents aged 30-60 with an unemployment spell during 2009-2018 (n = 814,085) for two years from the onset of unemployment. We predicted any, stable, and unstable employment by health status using Cox proportional hazards models. The data on specialized health care and prescription reimbursement were used to identify any alcohol-related conditions and poisonings, psychiatric conditions and self-harm, injuries, and physical conditions. We further separated physical conditions into cancer, diabetes, heart disease, and neurological conditions, and psychiatric conditions into depression, anxiety disorders and substance use disorders. RESULTS The likelihood of any employment was lower among those who had any of the assessed health conditions. It was lowest among those with alcohol-related or psychiatric conditions with an age-adjusted hazard ratio of 0.45 (95% confidence interval 0.44, 0.46) among men and 0.39 (0.38, 0.41) among women for alcohol-related and 0.64 (0.63, 0.65) and 0.66 (0.65, 0.67) for psychiatric conditions, respectively. These results were not driven by differences in socioeconomic characteristics or comorbidities. All the included conditions were detrimental to both stable and unstable employment, however alcohol-related and psychiatric conditions were more harmful for stable than for unstable employment. CONCLUSIONS The prospects of the unemployed finding employment are reduced by poor health, particularly alcohol-related and psychiatric conditions. These two conditions may also lead to unstable career trajectories. The selection process contributes to the health differentials between employed and unemployed people. Unemployed people with health problems may therefore need additional support to improve their chances of employment.
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Affiliation(s)
- Liina Junna
- Population Research Unit, University of Helsinki, Unioninkatu 35 (P.O. Box 18), 00014, Helsinki, Finland. .,Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, 18057, Rostock, Germany.
| | - Heta Moustgaard
- Helsinki Institute for Social Sciences and Humanities, University of Helsinki, Vuorikatu 3, 00014, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, University of Helsinki, Unioninkatu 35 (P.O. Box 18), 00014, Helsinki, Finland.,Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, 18057, Rostock, Germany.,Centre for Health Equity Studies, University of Stockholm and Karolinska Institute, Stockholm University, SE-106 91, Stockholm, Sweden
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Blomgren J, Laaksonen M, Perhoniemi R. Changes in Unemployment Affect Sickness Absence and Disability Retirement Rates: A Municipality-Level Panel Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126359. [PMID: 34208260 PMCID: PMC8296176 DOI: 10.3390/ijerph18126359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022]
Abstract
To enhance understanding of the interplay between unemployment and sickness absence and disability retirement, the aim of this study was to examine how changes in area-level unemployment rates are associated with changes in sickness absence and disability retirement rates in a longitudinal setting. Municipality-level time-series data were collected on unemployment, sickness absence, disability retirement and covariates from databases for Finnish municipalities for years 2003–2017 (n = 4425 municipality–year observations). Fixed effects panel regression models were used to analyse how changes in unemployment rates predict changes in sickness absence and disability retirement rates when comparing consecutive years. The results showed that when examining yearly cross-sections, a higher level of unemployment in the municipality was associated with higher sickness absence and disability retirement rates. However, longitudinal assessment of consecutive years with panel regression models showed that a one percentage point increase in the municipality-level unemployment rate was associated with a decrease both in the sickness absence rate (−1.3%, p < 0.001) and in the disability retirement rate (−2.1%, p = 0.011), adjusted for simultaneous changes in demographic and socio-economic covariates, morbidity and economic situation of the municipality. The results indicate that unemployment and disability benefits partly act as substitutes for each other. Unemployment and disability rates should be assessed together to reach a more complete understanding of the level of non-employment overall and in different areas.
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Affiliation(s)
- Jenni Blomgren
- The Social Insurance Institution of Finland, Nordenskiöldinkatu 12, 00250 Helsinki, Finland;
- Correspondence:
| | - Mikko Laaksonen
- Finnish Centre for Pensions, Tukkutorinkuja 5, 00580 Helsinki, Finland;
| | - Riku Perhoniemi
- The Social Insurance Institution of Finland, Nordenskiöldinkatu 12, 00250 Helsinki, Finland;
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Polvinen A, Laaksonen M. Determinants of transition from partial to full disability pension: A register study from Finland. Scand J Public Health 2021; 50:622-628. [PMID: 34058908 DOI: 10.1177/14034948211020172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: This study explored the rate of transition from partial to full disability pension (DP) and aimed to determine whether age, sex, education, employment status, employment sector, pension type and medical cause of disability were associated with transition to full DP during a four-year follow-up. Methods: We used register data, including a 70% random sample of partial disability pensioners aged 20-58 at the time that their partial DP started in 2010 or 2011 (N=5277). Competing risk analysis was used to estimate sub-hazard ratios (SHR) and their 95% confidence intervals (CI) for full DP. Results: One third of partial disability pensioners transitioned to full DP during the four-year follow-up. More than half (52%) continued on partial DP, and 15% were in some other state. Men, older people, those with low education levels, those whose pension was granted until further notice and those whose pension was due to mental disorders (MD) proceeded to full DP more often than others. The SHR for full DP was 1.62 (95% CI 1.43-1.83) among partial disability pensioners with MD and 1.15 (95% CI 1.02-1.28) among partial disability pensioners with other diseases compared to those whose pension was granted due to musculoskeletal diseases. Conclusions: Partial DP is a relatively stable state, and moving to full DP is relatively rare. However, male sex, older age, low education level, a pension granted until further notice and partial DP due to MD are important risk factors for full DP. The risk factors for ending up on full DP varies by diagnosis and pension type.
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Affiliation(s)
- Anu Polvinen
- Finnish Centre for Pensions (ETK), Eläketurvakeskus, Finland
| | - Mikko Laaksonen
- Finnish Centre for Pensions (ETK), Eläketurvakeskus, Finland
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Incidence and Length of Sickness Absence among Hierarchical Occupational Classes and Non-Wage-Earners: A Register Study of 1.6 Million Finns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020501. [PMID: 33435424 PMCID: PMC7827837 DOI: 10.3390/ijerph18020501] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 11/22/2022]
Abstract
Socioeconomic differences in sickness absence are well known, but previous studies have tended to focus on wage earners only. This study examined incidence and length of sickness absence comparing the employee groups of upper and lower non-manual employees and manual workers, but also entrepreneurs, the unemployed and other non-wage-earners. The study utilized register data on a nationally representative 70% sample of Finns aged 25–62 at the end of year 2012 (N = 1,615,352). Sickness absence spells compensated by sickness allowance and initiated during 2013 were retrieved from the register of the Social Insurance Institution of Finland (SIIF) and followed until the end of each episode and linked to socio-demographic covariates collected from the registers of the SIIF and of Statistics Finland. Zero-inflated negative binomial regression was used in multivariate models. After adjusting for age, marital status, region and income, there were clear differences in the occurrence and length of sickness absence across socioeconomic groups. Compared to upper non-manual employees, lower non-manual employees and especially manual workers had higher cumulative annual incidence of sickness absence among both men and women, but the entrepreneurs, the unemployed and other non-wage-earners had a clearly higher expected number of sickness absence days. Results varied by diagnostic group. The results highlight the importance of different types of preventive measures for reducing the occurrence of sickness absence and for preventing prolongations of sickness absence spells in different socioeconomic groups.
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