Associations between combinations of job demands and job control among 6,16,818 people aged 55-64 in paid work with their labour market status 11 years later: a prospective cohort study

BACKGROUND

Given current discussions about extending working lives, more knowledge is needed on working conditions associated with labour market status in older age.

OBJECTIVE

To explore associations between combinations of job demands and job control among workers aged 55-64 years and their labour market status 11 years later.

METHODS

A population-based prospective cohort study using nationwide register data. The 616,818 individuals in Sweden aged 55-64 who in 2001 were in paid work were categorised using a job exposure matrix based on tertiles (reference = medium control/medium demands). Participants were followed up in 2012 regarding their main labour market status (paid work, old-age pension, no income/social assistance, sickness absence/disability pension, emigrated, dead; reference = old-age pension) using multinomial logistic regression for odds ratios (OR) and 95% confidence intervals (CI). The fully adjusted analyses included adjustment for sociodemographic factors and unemployment or sickness absence/disability pension for more than half the year in 2001.

RESULTS

Those in occupations with low job control at baseline were less likely to be in paid work at follow-up (OR low demands/low control 0.74, CI 0.71-0.78; high demands/low control 0.81, CI 0.75-0.87). Those in occupations with baseline high demands were less likely to have no income/social assistance at follow-up (OR high demands/low control 0.71, CI 0.52-0.96; high demands/high control 0.59, CI 0.47-0.75).

CONCLUSION

Job demands and control when aged 55-64 were associated with labour market status 11 years later: high control was associated with greater chance of being in paid work, and high demands were associated with lower risk of no income/social assistance.

Job demands/control among people in paid work age 55-64 and their labour market status 11 years later

Background

As discussions about extending working lives are ongoing, more knowledge is warranted on working conditions that are associated with labour market status in older age.

Aim

Among employees aged 55-64 years, associations between job demands/job control with their labour market status 11 years later were explored.

Methods

A population-based prospective cohort study using a job exposure matrix (JEM) and nationwide register data. All 616,818 individuals in Sweden who in 2001 were in paid work and aged 55-64, were assigned JEM values for job demands/control that were categorized into tertiles resulting in nine combinations of job demands/control (reference=medium control/medium demands). Follow-up was in 2012 regarding labour market status (paid work, old-age pension, low/no income, sickness absence emigrated, dead). Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multinomial logistic regression (reference category=old-age pension) with adjustment for educational level, age, birth country, family situation and type of living area.

Results

Women in occupations with high control (OR low demands/high control 1.21, CI 1.06-1.39, medium demands/high control 1.32, CI 1.20-1.46, high demands/high control 1.29, CI 1.20-1.37); and men in occupations with high demands/high control (OR 1.11, CI 1.02-1.21) were more likely to be in paid work. Those in occupations with high demands at baseline were less likely to have low/no income at follow-up (OR women high demands/medium control 0.51, CI 0.37-0.68, high demands/high control 0.68, CI 0.50-0.92; men high demands/medium control 0.55, CI 0.31-0.96, high demands/high control 0.47, CI 0.32-0.74.

Conclusions

High job control combined with any level of demands for women and high demands for men aged 55-64 in 2001 were associated with higher OR of having main income from paid work in 2012, and high job demands combined with any level of job control were associated with lower OR of low/no income.

Key messages

Combinations of job demands and job control among workers aged 55-64 years in 2001 were associated with labour market situations in 2012. Using a job exposure matrix divided into tertiles allows for greater detail in measuring high, medium, and low demands and control than methods used in previous studies.

Emotional demands at work and risk of long-term sickness absence among 1.5 million Danish employees

Background

Emotional demands concern aspects of work requiring an emotional effort of employees and have been associated with risk of depression and long-term sickness absence (LTSA) in previous studies. Associations may, however, partly be affected by reporting bias. Further, previous studies have primarily been conducted using smaller samples in selected job groups or sectors. We, therefore, examined the association between emotional demands and LTSA using a job exposure matrix (JEM) in a nationwide cohort.

Methods

We included all employed individuals in Denmark who were 30 to 59 years old in 2000. We assessed emotional demands at work with a JEM. JEM values were categorized into quartiles based on the distribution within each year and updated annually from 2000 to 2009. LTSA was register-based, defined as ≥ 6 weeks and assessed until 2015. Individuals with LTSA from 1998 to 2000 were excluded, yielding a sample of 1,521,352 individuals. Exposure in year t was related to outcome in year t + 1 until 2009. We estimated hazard ratios (HR) and 95% confidence intervals (95%CI) using Cox regression adjusted for age, sex, income and ergonomic job demands.

Results

During 15,453,980 person-years, we identified 594,858 LTSA cases. In the fully adjusted model, individuals in the highest emotional demands quartile had a HR of 1.30 (95%CI: 1.29-1.31) compared to individuals the lowest quartile Repeating the analysis separately for women and men showed similar results.

Conclusions

Emotional demands at work were prospectively associated with an increased LTSA risk in this JEM based nationwide cohort study.

Key messages

This study found that emotional demands at work predict risk of long-term sickness absence. Future studies should focus on factors that may buffer the association between emotional demands at work and long-term sickness absence.

Emotional demands at work and risk of depressive disorder: A nationwide Danish cohort study

Background

Studies suggest that high emotional demands at work are associated with increased risk of depression. However, most previous studies have measured emotional demands using self-report and estimates may be inflated due to reporting bias. Furthermore, no study has yet accounted for the potential selection of individuals with increased risk of depressive disorder into occupations with high emotional demands.

Methods

We analyzed data from two separate nationwide register-based Danish cohorts, The Danish Work Life Course Cohort (n = 955,712; person-years=6.99 mill.), and the JEMPAD study (n = 1,680,214; person-years=21.73 mill.). We measured emotional demands annually by job exposure matrices, and depressive disorder using registers on psychiatric hospital treatment. Emotional demands were categorized as quartiles. To account for selection into jobs with high emotional demands, we adjusted for numerous confounders, including health services use before workforce entry, parental socioeconomic position, and psychiatric and somatic diagnoses. The present abstract reports preliminary results based on a subset of the study population used as a development sample (n = 16,163, person-years=168,889). Final results will be available for the conference.

Results

Preliminary findings showed a tendency towards an increased risk of depressive disorder for employees in occupations with the highest level of emotional demands (hazard ratio: 1.20 (95% CI: 0.85-1.69). The association was similar with and without adjustment for confounders and was not explained by selection into occupations with high emotional demands.

Conclusions

If confirmed in analyses of the full study population, our results suggest that high emotional demands at work may be associated with increased risk of depressive disorder, and that this association is explained by neither reporting bias nor a selection of individuals vulnerable to depression into occupations with high emotional demands.

Key messages

Emotional demands may be associated with an increased risk of depressive disorder. Further research is needed to explore the potential for workplace prevention of high emotional demands.

Psychosocial working conditions and future sick leave and disability pension trajectories in Sweden

Background

Psychosocial working conditions such as job demands and job control have been found to be associated with employee health and well-being, but studies on the associations with sickness absence (SA) and disability pension (DP) are scarce. We examined 11-year SA/DP trajectories and the association between psychosocial working conditions and subsequent SA/DP trajectories in the Swedish workforce.

Methods

Using a prospective cohort study with microdata we explored SA/DP trajectories among female and male employees, respectively, aged 30-53 years in 2001 in Sweden (1,076,042 women; 1,102,721 men). Group-based trajectory analysis was used to model annual mean SA/DP net days trajectories in 2002-2012. Based on a Swedish Job Exposure Matrix (JEM), individuals were assigned an age-, sex- and occupation-specific mean score for demands and control, respectively. Mean scores were categorized into tertiles and categorised into 3x3 combinations of exposure categories. Using multinomial regression we predicted trajectory group memberships for the JEM.

Results

The highest rate of women were in occupations with low demands and control (24.8%), while the highest rate of men (22.9%) was in occupations with high demands and control. We found three SA/DP trajectories for women (low, medium, high increasing) and two for men (low, high increasing). In fully adjusted models, those in occupations with low demands and low control were at higher risk of belonging to the high increasing SA/DP trajectory compared to those in occupations with high job demands and control in both women (OR 3.86; 95% CI: 3.75-3.97) and men (OR 3.0; 2.99-3.16).

Conclusions

Low job demands and low job control were associated with more high increasing future SA/DP trajectories compared to high job demands and job control in both women and men.

Key messages

In Sweden, women are more often in occupations characterized by low job demands and low job control and men are more often in occupations with high job demands and high job control. Occupations with low job demands and low job control were associated with more adverse SA/SP trajectories compared to occupations with high job demands and high job control in both women and men.

Job control and risk of disability pension in the nationwide Danish Work Life Course Cohort

Background

A large number of studies have found job control to be consistently associated with an increased risk of disability pension. However, most previous studies have measured job control by self-report, introducing possible reporting bias inflating the risk estimates. Furthermore, previous studies have not accounted for the potential selection of individuals with pre-existing risk factors for disability pensioning into low control jobs.

Methods

We analyzed data from the nationwide register-based Danish Work Life Course Cohort (DAWCO; n = 960,562 with approx. 6 million person-years). We measured job control annually by a job exposure matrix, based on a scale of five self-reported items from The Danish Work Environment Cohort Study, and disability pension using registers on public transfer payments. To account for potential selection into occupations with lower levels of job control, we included numerous life course confounders, including parental socioeconomic position and psychiatric and somatic diagnoses.

Results

Employees in jobs with lower levels of job control had increased risk of disability pensioning. The association attenuated after adjustment for confounders but was not explained by selection into job groups with lower levels of job control (hazard ratio: 1.16 (95% CI: 1.03-1.31).

Conclusions

Our findings suggest that lower levels of job control are associated with an increased risk of disability pension, and that this association is explained by neither reporting bias nor a selection of individuals with an increased risk of disability pensioning into job groups with lower levels of job control.

Key messages

Lower levels of job control appear associated with an increased risk of disability pension independent of life course confounders. Further research is needed on preventive measures in occupations with low levels of job control.

Work stress, migration background and risk of long-term sickness absence in Denmark

Background

Work stress may increase risk of long-term sickness absence, but little is known if this association differs by migration background. In this study, we examined the prospective association between effort-reward imbalance at work and risk of long-term sickness absence in individuals with and without migration background in the Danish workforce.

Methods

We included 59,468 respondents from a nationwide survey on work and health, 3,226 with a migration background (immigrants or first generation descendants of immigrants) and 56,242 without a migration background. Effort-reward imbalance was assessed by self-report. Migration background and long-term sickness absence (spells ≥6 weeks) were assessed by national register data. Using Cox regression, we estimated the association between effort-reward imbalance and onset of long-term sickness absence during 12 months follow-up separately for participants with and without a migration background, adjusted for age, sex, education and previous long-term sickness absence.

Results

The effort-reward imbalance score at baseline was similar for respondents with and without a migration background. The hazard ratio for long-term sickness absence during follow-up per 1 standard deviation increment in effort-reward imbalance at baseline was 1.26 (95% CI: 1.16-1.37) and 1.16 (95% CI: 1.13-1.20) for respondents with and without a migration background, respectively.

Conclusions

Work stress, measured by effort-reward imbalance, is associated with an increased risk of long-term sickness absence in workers with and without a migration background in Denmark. Although the estimate was higher in workers with a migration background, confidence intervals overlapped indicating that associations were similar in both groups. The results suggest that prevention activities on effort-reward imbalance and long-term sickness absence should not be prioritized by migration background but should be offered to the whole workforce.

Key messages

Work stress, measured by effort-reward imbalance, is associated with an increased risk of long-term sickness absence in workers with and without a migration background in Denmark. The results suggest that prevention activities on effort-reward imbalance and long-term sickness absence activities should be offered to the whole workforce.