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Salonsalmi A, Kouvonen A, Rahkonen O, Lahelma E, Lallukka T. Work-family conflicts and sickness absence-a register-linked cohort study among young and early midlife employees. Eur J Public Health 2024; 34:316-321. [PMID: 38332545 PMCID: PMC10990516 DOI: 10.1093/eurpub/ckae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Work-family conflicts (WFC) have been associated with poor mental health, poor self-rated health and sickness absence. However, studies on short sickness absence are lacking and more information is needed also about long sickness absence regarding the direction of WFC, and potential explaining factors particularly among young and early middle-aged employees. METHODS The Helsinki Health Study baseline survey (2017) among 19- to 39-year-old municipal employees (N = 3683, 80% women, response rate 51.5%) was linked to employer's sickness absence data. The associations of work-to-family conflicts (WTFC) and family-to-work conflicts (FTWC) with short (1-7 days) and long (over 7 days) sickness absence were analyzed using negative binomial regression analysis. Covariates were age, gender, family-related factors and work-related factors. Stratified analyses by occupational class were performed. The results are presented as rate ratios and their 95% confidence intervals. RESULTS High WTFC were associated with short (1.25, 1.12-1.40) and long (1.37, 1.11-1.70) sickness absence. High FTWC were also associated with short (1.12, 1.03-1.22) and long (1.24, 1.06-1.45) sickness absence. Adjustment for family-related factors strengthened the associations, whereas adjustment for work-related factors abolished the associations between WTFC and sickness absence. Associations between WFC and sickness absence were observed among two lowest occupational classes only. CONCLUSION WFC are associated with both short and long sickness absence. Work-related factors including the quality of supervisory work and shift work play a role in the association. Intervention studies could determine if improvements in combining work and family life lead to a reduction in sickness absence.
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Affiliation(s)
- Aino Salonsalmi
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Pietiläinen O, Harkko J, Jousilahti P, Kouvonen A, Rahkonen O, Lahelma E, Lallukka T. Trajectories of hospitalizations after age-based statutory retirement. Eur J Ageing 2023; 20:41. [PMID: 37897541 PMCID: PMC10613168 DOI: 10.1007/s10433-023-00786-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 10/30/2023] Open
Abstract
Retirement years are ideally spent in good health. We aimed to produce new information using person-oriented methods by identifying groups of statutory retirees who did or did not achieve this objective and the factors that distinguish these groups from each other. Our particular focus was on the years directly after the transition into retirement, and the pre-retirement factors that explained the development of health, using a more severe health-related outcome-hospitalization. We studied the retirement, hospitalizations, education, and work characteristics of former employees of the City of Helsinki, Finland (N = 6569), from complete registers. We used group-based trajectory models and identified groups of constant low, constant high, decreasing, and temporarily occurring hospitalizations, and one group of increasing hospitalizations among women and two groups of earlier and later increasing hospitalizations among men. Multinomial regression models showed that among women, belonging to groups with less favourable health was associated with secondary education, older age at retirement, and reduced working hours. Education and work characteristics before retirement both contribute to the development of health, as indicated by hospitalizations directly after retirement. Our findings show that socioeconomic inequalities in health are persistent and should also be addressed after transition into retirement.
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Affiliation(s)
- Olli Pietiläinen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Tukholmankatu 8 B, P.O. Box 20, 00014, Helsinki, Finland.
| | - Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Ossi Rahkonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Tukholmankatu 8 B, P.O. Box 20, 00014, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, Faculty of Medicine, University of Helsinki, Tukholmankatu 8 B, P.O. Box 20, 00014, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, Faculty of Medicine, University of Helsinki, Tukholmankatu 8 B, P.O. Box 20, 00014, Helsinki, Finland
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3
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Lallukka T, Lahelma E, Pietiläinen O, Kuivalainen S, Laaksonen M, Rahkonen O, Lahti J. Trajectories in physical functioning by occupational class among retiring women: the significance of type of retirement and social and health-related factors. J Epidemiol Community Health 2023; 77:362-368. [PMID: 37028924 DOI: 10.1136/jech-2022-219963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Occupational class inequalities in physical functioning and their changes after retirement are poorly understood. We examined occupational class trajectories in physical functioning 10 years before and after transition to old-age and disability retirement. We included working conditions and behavioural risk factors as covariates, given their established link to health and retirement. METHODS We used the Helsinki Health Study cohort data from surveys 2000-2002 to 2017, and included 3901 women, who were employed by the City of Helsinki, Finland, and retired during the follow-up. Mixed-effect growth curve models were used to examine changes in RAND-36 Physical Functioning subscale (range 0-100) 10 years before and after the retirement date by occupational class. RESULTS Old-age (n=3073) and disability retirees (n=828) lacked class differences in physical functioning 10 years before retirement. By retirement transition, physical functioning declined and class inequalities emerged, the predicted scores being 86.1 (95% CI 85.2 to 86.9) for higher class and 82.2 (95% CI 81.5 to 83.0) for lower class old-age retirees, and 70.3 (95% CI 67.8 to 72.9) for higher class and 62.2 (95% CI 60.4 to 63.9) for lower class disability retirees. Physical functioning declined and class inequalities slightly widened among old-age retirees after the retirement, whereas among disability retirees the decline plateaued and class inequalities narrowed over time after retirement. Physical work and body mass index somewhat attenuated the class inequalities after adjustment. CONCLUSIONS Class inequalities in physical functioning widened after old-age retirement and narrowed after disability retirement. The examined work and health-related factors contributed weakly to the inequalities.
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Affiliation(s)
- Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | | | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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Salonsalmi A, Mauramo E, Rahkonen O, Pietiläinen O, Lahelma E. Joint association of socioeconomic circumstances and minor mental health problems with antidepressant medication. Eur J Public Health 2022; 32:535-541. [PMID: 35656708 PMCID: PMC9341681 DOI: 10.1093/eurpub/ckac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Disadvantageous socioeconomic circumstances and minor mental health problems have both been associated with mental disorders, such as depression, but their joint contribution remains unknown. Methods The Helsinki Health Study baseline survey (2000–02) of 40- to 60-year-old employees was linked with antidepressant medication data from registers of the Social Insurance Institution of Finland. The analyses were made using logistic regression with first prescribed antidepressant medication purchase during a 10-year follow-up as the outcome. Minor mental health problems were measured by the emotional well-being scale of the RAND-36. Odds ratios were calculated for joint association of the lowest quartile of the emotional well-being scale of the RAND-36 and socioeconomic circumstances. Childhood (parental education and childhood economic difficulties), conventional (education, occupational class and income) and material (housing tenure and current economic difficulties) socioeconomic circumstances were examined. This study included 5450 participants. Results Minor mental health problems dominated the joint associations. Minor mental health problems were associated with antidepressant medication irrespective of socioeconomic circumstances whereas only low income, current economic difficulties and living in rented housing showed an association without minor mental health problems at baseline. Marital status, working conditions and BMI and health behaviours had only minimal contributions to the associations. Conclusions Minor mental health problems were consistently and strongly associated with antidepressant medication and dominated the joint associations with socioeconomic circumstances. Paying attention to minor mental health problems might help prevent mental disorders such as depression.
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Affiliation(s)
- Aino Salonsalmi
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Elina Mauramo
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Salonsalmi A, Rahkonen O, Lahelma E, Pietiläinen O, Lallukka T. Associations between low parental education, childhood adversities and sickness absence in midlife public sector employees. Scand J Public Health 2022:14034948221087996. [PMID: 35546096 DOI: 10.1177/14034948221087996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Parental education and childhood adversities are associated with long-term work disability but their contribution to sickness absence is largely unknown. We aimed to examine the associations between parental education, childhood adversities and self-certified and medically-certified sickness absence among midlife employees. METHODS The Helsinki Health Study baseline survey data (2000-2002) of 40-to-60-year-old municipal employees were linked with sickness absence data from the employer's register. Self-certified (1-3 days) and medically-certified (>3 days) sickness absence spells were followed from 2003 until the end of 2008. The study included 5728 employees. The analyses were made by Poisson regression and the results are presented as rate ratios (RRs) and their 95% confidence intervals (CIs). RESULTS Low maternal education was associated with self-certified sickness absence (RR 1.32, 95% CI 1.13-1.55) among women only whereas both low maternal (1.49, 1.26-1.77) and low paternal education (1.48, 1.32-1.67) were associated with medically-certified sickness absence. Adjustment for own occupational class mainly abolished these associations. Having experienced any childhood adversity was associated with self-certified (1.18, 1.12-1.25) and medically-certified (1.22, 1.15-1.30) sickness absence. In addition, childhood economic difficulties, childhood illness, parental divorce, parental mental illness, parental alcohol problems and bullying were each associated both with self-certified and with medically-certified sickness absence. The associations mainly remained after adjustments for occupational class, marital status, working condition, body mass index and health behaviours. CONCLUSIONS Low parental education and childhood adversities contributed to midlife sickness absence. Promoting well-being of families with children might help sustain adult work ability and prevent sickness absence still in midlife.
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Affiliation(s)
- Aino Salonsalmi
- Department of Public Health, University of Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Finland
| | | | - Tea Lallukka
- Department of Public Health, University of Helsinki, Finland
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6
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Lahelma E. Book Review: Johan P. Mackenbach, Health Inequalities. Persistence and Change in European Welfare States. Health (London) 2022. [DOI: 10.1177/1363459320944733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eero Lahelma
- Professor, Department of Public Health, University of Helsinki, Helsinki, Finland
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7
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Lahelma E, Rahkonen O, Lallukka T. Commercialization challenges open science. Eur J Public Health 2022; 32:337-338. [PMID: 35362525 PMCID: PMC9159314 DOI: 10.1093/eurpub/ckac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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8
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Lahelma E, Rahkonen O. The emergence of international comparisons of health inequalities as reflected in the Scandinavian Journal of Public Health during its five decades. Scand J Public Health 2022; 50:835-842. [PMID: 35350950 PMCID: PMC9578074 DOI: 10.1177/14034948221079061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aims: We examined the development of research articles published in the Scandinavian Journal of Public Health and its predecessors Acta Socio-Medica Scandinavica and the Scandinavian Journal of Social Medicine from 1969 until 2020 to be able to identify the place of international comparisons of socioeconomic inequalities in health in the journal. Methods: Altogether 3237 research articles were screened to yield 126 comparative research articles. Examining full texts of the comparative articles led to 13 articles reporting comparisons of health inequalities. Results: The first one came out in 1972, but the rest only after the mid-1990s. The most common socioeconomic indicator was education, but also occupational class and income was used. The most common health indicator was self-rated health. The articles compared Nordic countries with each other, but also with non-Nordic countries. Although the number of comparative studies on health inequalities was relatively small, there were examples of well-designed studies using advanced methodology. We examined only published journal articles over the past five decades, not submitted but rejected papers. Conclusions: In the Scandinavian Journal of Public Health and its predecessors, comparisons of health inequalities were few and emerged relatively late, that is, during the past two decades.
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Affiliation(s)
- Eero Lahelma
- Department of Public Health, University of Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Finland
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9
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Kronholm E, Marshall NS, Mänty M, Lahti J, Lahelma E, Pietiläinen O, Rahkonen O, Lallukka T. Associations of Sleep and Health Functioning with Premature Exit from Work: A Cohort Study with a Methodological Emphasis. Int J Environ Res Public Health 2021; 18:ijerph18041725. [PMID: 33578989 PMCID: PMC7916758 DOI: 10.3390/ijerph18041725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
Sleep and functioning are associated with a risk of early workforce exit. However, patterns of change in sleep and functioning through time have not been investigated using person-oriented approaches to show what features of sleep and functioning are associated with an early exit. We examined the pattern of interactions between sleep and health functioning characterizing homogenous subgroups of employees and their associations with premature work exit. An additional aim was to provide a tutorial providing detailed description on how to apply these models, compared to traditional variable based risk factors. We analyzed data from 5148 midlife employees of the City of Helsinki, Finland, surveyed over three phases (2000–02, 2007, and 2012). Using repeated measures latent class analyses (RMLCA) we classified people into groups based on their trajectories in sleep and functioning. We identified four longitudinal groups: (1) Stable good sleep and functioning (reference), (2) Persistent sleep problems and good or moderate functioning, (3) Poor functioning with good sleep, and (4) Problematic sleep and health functioning. Compared to group 1, elevated risk was found in all classes with group 4 being the worst. In conclusion, focusing on person-orientated patterns of interactions between sleep and functioning helped produce qualitatively different and quantitatively stronger predictions than using conventional risk factor methodology. Thus, longitudinal person-oriented approaches may be a more powerful method for quantifying the role of sleep and health functioning as risks for premature exit from work.
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Affiliation(s)
- Erkki Kronholm
- Finnish Institute of Occupational Health, P.O. Box 40, 00032 Helsinki, Finland;
| | - Nathaniel S. Marshall
- Sydney Nursing School, University of Sydney, Sydney, NSW 2006, Australia;
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, 431 Glebe Pt Rd., Glebe, NSW 2036, Australia
| | - Minna Mänty
- Department of Public Health, University of Helsinki, Tukholmankatu 8B, P.O. Box 20, 00014 Helsinki, Finland; (M.M.); (J.L.); (E.L.); (O.P.); (O.R.)
- City of Vantaa, Unit of Statistics and Research, Asematie 7, 01300 Vantaa, Finland
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, Tukholmankatu 8B, P.O. Box 20, 00014 Helsinki, Finland; (M.M.); (J.L.); (E.L.); (O.P.); (O.R.)
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Tukholmankatu 8B, P.O. Box 20, 00014 Helsinki, Finland; (M.M.); (J.L.); (E.L.); (O.P.); (O.R.)
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Tukholmankatu 8B, P.O. Box 20, 00014 Helsinki, Finland; (M.M.); (J.L.); (E.L.); (O.P.); (O.R.)
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Tukholmankatu 8B, P.O. Box 20, 00014 Helsinki, Finland; (M.M.); (J.L.); (E.L.); (O.P.); (O.R.)
| | - Tea Lallukka
- Finnish Institute of Occupational Health, P.O. Box 40, 00032 Helsinki, Finland;
- Department of Public Health, University of Helsinki, Tukholmankatu 8B, P.O. Box 20, 00014 Helsinki, Finland; (M.M.); (J.L.); (E.L.); (O.P.); (O.R.)
- Correspondence: ; Tel.: +358-505-704-399
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10
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Abstract
Aims: Chronic pain is a notable burden on public health, with
past and present factors contributing to it. This study aimed to examine the
associations between childhood adversities and chronic pain.
Methods: Data on seven childhood adversities, chronic pain
and disabling pain were derived from questionnaire surveys conducted in 2000,
2001 and 2002 among 40- to 60-year-old employees (response rate of 67%) of the
City of Helsinki, Finland. The study included 8140 employees (80% women).
Logistic regression was used in the analyses, and the results are presented as
odds ratios (OR) and their 95% confidence intervals (CI). Age, sex, the father’s
education, the participant’s education, marital status, working conditions,
sleep problems and common mental disorders were included as covariates.
Results: In the age-adjusted models, childhood economic
difficulties (OR=1.60, 95% CI 1.41–1.81), childhood illness (OR=1.74, 95% CI
1.45–2.08), parental divorce (OR=1.26, 95% CI 1.07–1.48), parental alcohol
problems (OR=1.34, 95% CI 1.18–1.52) and bullying at school or among peers
(OR=1.59, 95% CI 1.37–1.89) were associated with chronic pain. Working
conditions, sleep problems and common mental disorders each slightly attenuated
the associations between childhood adversities and chronic pain. Childhood
economic difficulties among women (OR=1.72, 95% CI 1.40–2.10), childhood illness
(OR=1.40, 95% CI 1.07–1.82) and bullying at school or by peers (OR=1.91 95% CI
1.48–2.46) were also associated with disabling pain.
Conclusions:Childhood adversities were associated with chronic pain in mid-life, and
the associations mainly remained after adjustments. Investing in the
well-being of children might prevent pain and promote well-being in
mid-life.
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Affiliation(s)
- Aino Salonsalmi
- Department of Public Health, University of Helsinki, Finland
| | | | - Eero Lahelma
- Department of Public Health, University of Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Finland
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11
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Lallukka T, Shiri R, Pietiläinen O, Kausto J, Sumanen H, Halonen JI, Lahelma E, Rahkonen O, Mänty M, Kouvonen A. Timing of Entry into Paid Employment, Adverse Physical Work Exposures and Health: The Young Helsinki Health Study. Int J Environ Res Public Health 2020; 17:ijerph17217854. [PMID: 33120885 PMCID: PMC7662500 DOI: 10.3390/ijerph17217854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 01/07/2023]
Abstract
It is not well known how the timing of entry into paid employment and physical work exposures contribute to different health outcomes in young employees. Thus, we determined the associations of age at entry into paid employment and physical work exposures with general and mental health in young employees and determined whether associations differ by behavior-related risk factors. Data were collected via online and mailed surveys in autumn 2017 from employees of the City of Helsinki aged 18–39 years (n = 5897; 4630 women and 1267 men, response rate 51.5%). Surveys comprised measures of age at entry into paid employment, seven working conditions, behavior-related risk factors and health outcomes (self-rated health [SRH] and common mental disorders [CMD] as generic indicators of physical and mental health). Logistic regression analysis was used. After full adjustment, age at entry was not associated with the health outcomes; however, in additional analyses, younger age at first employment was associated with smoking and obesity (OR 3.00, 95% CI 2.34–3.85 and 1.67, 95% CI 1.32–2.11 for those started working at age of ≤18 years, respectively). Of the working conditions, sitting and standing were positively associated with poor SRH and CMD and uncomfortable working postures with CMD. Working conditions were broadly similarly associated with health outcomes among those with and without behavior-related risk factors. Although we found little support for modification by behavior-related risk factors, overweight, obesity and smoking were associated with poor SRH and binge drinking and smoking with CMD. Additionally, moderate and high levels of leisure-time physical activity were inversely associated with poor SRH. In conclusion, early entry into paid employment appears not to associate to immediate poorer health in young employees, although it was associated with smoking and obesity even after full adjustment. Exposure to physically heavy work and uncomfortable working postures may increase the risk of adverse health outcomes.
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Affiliation(s)
- Tea Lallukka
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland; (R.S.); (J.K.)
- Correspondence: ; Tel.: +358-505-704-399
| | - Rahman Shiri
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland; (R.S.); (J.K.)
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
| | - Johanna Kausto
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland; (R.S.); (J.K.)
| | - Hilla Sumanen
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
- Department of Health Care and Emergency Care, South Eastern Finland University of Applied Sciences, 48220 Kotka, Finland
| | - Jaana I. Halonen
- Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland;
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
| | - Minna Mänty
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
- Department of Strategy and Research, City of Vantaa, 01030 Vantaa, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland;
- Research Institute of Psychology, SWPS University of Social Sciences and Humanities, 53-238 Wroclaw, Poland
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12
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Mauramo E, Lallukka T, Mänty M, Sumanen H, Pietiläinen O, Lahelma E, Rahkonen O. Diagnosis-Specific Sickness Absence and Subsequent Common Mental Disorders: A Register-Linkage Cohort Study among Finnish Public Sector Employees. Int J Environ Res Public Health 2020; 17:ijerph17030782. [PMID: 32012684 PMCID: PMC7037035 DOI: 10.3390/ijerph17030782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/14/2020] [Accepted: 01/23/2020] [Indexed: 11/16/2022]
Abstract
Sickness absence is associated with poor health outcomes, but little is known about its consequences for general mental health. This study examined the associations between diagnosis-specific sickness absence and subsequent common mental disorders (CMD). Register data on medically certified all-cause sickness absence and sickness absence due to mental disorders and musculoskeletal diseases from 2004-2007 were linked to the Helsinki Health Study 2007 and 2012 survey data on City of Helsinki employees in Finland (N = 3560). Using logistic regression and multinomial logistic regression, we analysed the associations between the total number of reimbursed sickness absence days in 2004-7 and CMD General Health Questionnaire 12) in 2007 and 2012 and CMD changes. Sickness absence due to mental disorders (age- and sex-adjusted odds ratio (OR)range: 2.16 to 2.93), musculoskeletal diseases (OR range: 2.79 to 2.93) and all-cause sickness absence (OR range: 1.48 to 3.20) were associated with CMD in 2007. In 2012, associations with lower ORs were observed. Associations were also found with changing and especially repeated (OR range: 1.49 to 3.40) CMD. The associations remained after adjusting for work-related covariates and health behaviours. Diagnosis-specific sickness absence showed persistent associations with subsequent CMD and their changes. Attention should be paid to both the short- and long-term consequences of sickness absence for employee mental health.
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Affiliation(s)
- Elina Mauramo
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (T.L.); (M.M.); (H.S.); (O.P.); (E.L.); (O.R.)
- Correspondence:
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (T.L.); (M.M.); (H.S.); (O.P.); (E.L.); (O.R.)
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland
| | - Minna Mänty
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (T.L.); (M.M.); (H.S.); (O.P.); (E.L.); (O.R.)
| | - Hilla Sumanen
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (T.L.); (M.M.); (H.S.); (O.P.); (E.L.); (O.R.)
- Unit of Health Care and Emergency Care, South-Eastern Finland University of Applied Sciences, 48220 Kotka, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (T.L.); (M.M.); (H.S.); (O.P.); (E.L.); (O.R.)
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (T.L.); (M.M.); (H.S.); (O.P.); (E.L.); (O.R.)
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (T.L.); (M.M.); (H.S.); (O.P.); (E.L.); (O.R.)
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13
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Halonen JI, Lallukka T, Kujanpää T, Lahti J, Kanerva N, Pietiläinen O, Rahkonen O, Lahelma E, Mänty M. The contribution of physical working conditions to sickness absence of varying length among employees with and without common mental disorders. Scand J Public Health 2020; 49:141-148. [PMID: 31960756 PMCID: PMC7917561 DOI: 10.1177/1403494820901411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aims: The aim was to examine whether the contribution of physical
work exposures to the risk of sickness absence (SA) is different between those
with and without common mental disorders (CMD). Methods: We used
questionnaire data on four work exposures and CMD from 6159 participants of the
Helsinki Health Study cohort with 12,458 observations from three surveys
(2000–2002, 2007 and 2012). We formed combination exposures for the work
exposures (hazardous exposures, physical workload, computer and shift work) with
CMD. Associations with SA of different length were examined with negative
binomial regression models. Results: We observed stronger
associations for CMD with SA than for the individual work exposures. The
strength of the associations for hazardous exposures and physical workload
increased with length of SA, especially when the participant also had CMD. The
strongest associations for the combined exposures were observed for SA ⩾15 days,
the rate ratios being 2.63 (95% CI 2.27–3.05) among those with hazardous
exposure and CMD, and 3.37 (95% CI 2.93−3.88) among those with heavy physical
workload and CMD. Conclusions: Employees with hazardous exposures or
physical workload combined with CMD were at the highest risk of SA compared
with those without these exposures or with only one exposure.
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Affiliation(s)
- Jaana I Halonen
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tero Kujanpää
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Noora Kanerva
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Minna Mänty
- Department of Public Health, University of Helsinki, Helsinki, Finland.,City of Vantaa, Vantaa, Finland
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14
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Halonen JI, Mänty M, Pietiläinen O, Kujanpää T, Kanerva N, Lahti J, Lahelma E, Rahkonen O, Lallukka T. Physical working conditions and subsequent disability retirement due to any cause, mental disorders and musculoskeletal diseases: does the risk vary by common mental disorders? Soc Psychiatry Psychiatr Epidemiol 2020; 55:1021-1029. [PMID: 31893288 PMCID: PMC7395011 DOI: 10.1007/s00127-019-01823-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/24/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Physical work exposures and common mental disorders (CMD) have been linked to increased risk of work disability, but their joint associations with disability retirement due to any cause, mental disorders or musculoskeletal diseases have not been examined. METHODS The data for exposures and covariates were from the Finnish Helsinki Health Study occupational cohort surveys in 2000-2002, 2007 and 2012. We used 12,458 observations from 6159 employees, who were 40-60 years old at baseline. CMD were measured by the General Health Questionnaire (GHQ-12, cut-off point 3+). Four self-reported work exposures (hazardous exposures, physical workload, computer and shift work) were combined with CMD and categorized as "neither", "work exposure only", "CMD only", and "both". Associations with register-based disability retirement were assessed with Cox proportional hazards models for sample survey data adjusting for confounders over 5-year follow-up. Additionally, synergy indices were calculated for the combined effects. RESULTS Those reporting CMD and high physical workload had a greater risk of disability retirement due to any cause (HR 4.26, 95% CI 3.60-5.03), mental disorders (HR 5.41, 95% CI 3.87-7.56), and musculoskeletal diseases (HR 4.46, 95% CI 3.49-5.71) when compared to those with neither. Synergy indices indicated that these associations were synergistic. Similar associations were observed for CMD and hazardous exposures, but not for combined exposures to CMD and computer or shift work. CONCLUSIONS Identification of mental health problems among employees in physically demanding jobs is important to support work ability and reduce the risk of premature exit from work due to disability.
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Affiliation(s)
- Jaana I Halonen
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland.
- Finnish Institute of Occupational Health, Työterveyslaitos, 40, 00032, Helsinki, Finland.
- Finnish Institute for Health and Welfare, 30, 00271, Helsinki, Finland.
| | - Minna Mänty
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Tero Kujanpää
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, 8000, 90014, Oulu, Finland
| | - Noora Kanerva
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
- Finnish Institute of Occupational Health, Työterveyslaitos, 40, 00032, Helsinki, Finland
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15
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Ervasti J, Pietiläinen O, Rahkonen O, Lahelma E, Kouvonen A, Lallukka T, Mänty M. Joint contribution of rotation of the back and repetitive movements to disability pension using job exposure matrix data. Eur J Public Health 2019; 29:1079-1084. [PMID: 31168605 DOI: 10.1093/eurpub/ckz108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Heavy physical effort at work has been linked with disability pension, but the contribution of other ergonomic job exposures is less studied. We studied the independent and joint contributions of long-term exposure to (i) rotation of the back and (ii) repetitive movements to disability pension, particularly due to musculoskeletal disorders. METHODS Exposures were measured with the Helsinki Health Study Job Exposure Matrix during 1996-2005 and linked to register data on employees of the City of Helsinki, Finland (n = 18 585). Outcomes were followed up during 2006-2015. Competing risk survival analyses were performed and synergy indices computed, adjusting for sociodemographic factors. RESULTS Long-term exposure to rotation of the back was associated with disability pension due to any cause [age and sex-adjusted subhazard ratio (SHR) 2.39, 95% confidence interval (CI) 1.73-3.30], and specifically disability pension due to musculoskeletal disorders (SHR = 3.39, 95% CI 1.52-7.56) when compared to employees exposed to neither of the two exposures. Repetitive movements alone did not increase the risk of disability pension (all-cause SHR = 1.08, 95% CI 0.84-1.38, musculoskeletal SHR = 1.65, 95% CI 0.91-2.97). Employees with exposure to both rotation of the back and repetitive movements had the highest risk of disability pension due to musculoskeletal disorders (SHR = 5.98, 95% CI 3.85-9.28), but the interaction between exposures was additive rather than synergistic. Adjustment for education diluted the associations by 42-108%. CONCLUSION Long-term exposure to awkward work postures increased the risk of disability pension. Educational inequalities largely account for differences in occupational exposures.
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Affiliation(s)
- Jenni Ervasti
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland.,Administrative Data Research Centre - Northern Ireland (ADRC-NI), Queen's University Belfast, Belfast, UK
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Minna Mänty
- Department of Public Health, University of Helsinki, Helsinki, Finland.,City of Vantaa, Vantaa, Finland
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16
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Lahelma E, Pietiläinen O, Pentala-Nikulainen O, Helakorpi S, Rahkonen O. 36-year trends in educational inequalities in self-rated health among Finnish adults. SSM Popul Health 2019; 9:100504. [PMID: 31720362 PMCID: PMC6838467 DOI: 10.1016/j.ssmph.2019.100504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/27/2019] [Accepted: 10/16/2019] [Indexed: 12/29/2022] Open
Abstract
Health inequalities exist across countries and populations, but little is known about their long-term trends and even less about factors shaping the trends. We examined the magnitude of absolute and relative educational inequalities in self-rated health over 36 years among Finnish adults, considering individual covariates and macro-economic fluctuations. Our data were derived from representative annual cross-sectional surveys in 1979-2014 conducted among adult men and women. Participants aged 25-64 were included and nine periods used (n = 8870-14235). Our health outcome was less-than-good self-rated health (SRH) and our socioeconomic indicator was completed years of education as a continuous variable. Educational inequalities in self-rated health were analysed using the relative index of inequality (RII) and the slope index of inequality (SII). Nine time-variant sociodemographic and health-related covariates were included in the analyses. Linear trends suggested stable or slightly curvilinear overall trends in both absolute and relative health equalities over 36 years. Among men, absolute and relative inequalities narrowed immediately after economic recession in Finland in 1993-1994. Among women, inequalities narrowed during financial crisis in 2008-2009. Adjusting for most covariates reduced the magnitude of inequalities throughout the nine periods, but affected little the temporal patterning of health inequalities. Educational inequalities in self-rated health remained during 36 years in Finland. While among men and women health inequalities narrowed during and after recessions, they widened soon back to the pre-recession level. The perseverance of the trends calls for novel and powerful measures to tackle health inequalities.
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Affiliation(s)
- Eero Lahelma
- Department of Public Health, P.O.Box 20 (Tukholmankatu 8 2B), 00014, University of Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, P.O.Box 20 (Tukholmankatu 8 2B), 00014, University of Helsinki, Finland
| | | | - Satu Helakorpi
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, P.O.Box 20 (Tukholmankatu 8 2B), 00014, University of Helsinki, Finland
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17
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Lahelma E, Pietiläinen O, Chandola T, Hyde M, Rahkonen O, Lallukka T. Occupational social class trajectories in physical functioning among employed women from midlife to retirement. BMC Public Health 2019; 19:1525. [PMID: 31727156 PMCID: PMC6857143 DOI: 10.1186/s12889-019-7880-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 11/01/2019] [Indexed: 01/22/2023] Open
Abstract
Background Prior analyses of class differences in health trajectories among employees have often omitted women and transitions to retirement. We examined social class trajectories in physical functioning among Finnish female employees from midlife to retirement age, and whether transitions to retirement modified these trajectories. Methods Data were derived from mail surveys at Phases 1–3 (2000–2012) among employees of the City of Helsinki, Finland, aged 40–60 at baseline (n = 8960, 80% women, response rates 69–83%). We included respondents to any of the Phases 1–3 aged 40–72 (n = 6976). We distinguished higher and lower social classes, and employment statuses, i.e. employed, mandatorily retired and disability-retired. Short Form 36 physical component summary was used to measure physical functioning. Mixed-effect growth curve models were used to assess the association of social class and employment status with functioning over age. Results For employed women, physical functioning deteriorated faster in the lower than in the higher class, with class trajectories widening in ages 40–65. After mandatory retirement, functioning deteriorated in both classes, whereas after disability retirement, functioning improved. Across employment statuses, functioning converged at older ages, and the disability-retired caught up with the better functioning of the employed and mandatorily retired. Employment status modified the trajectories, as among the continuously employed and mandatorily retired women functioning deteriorated, but among the disability-retired, trajectories improved and reached a similar level with employed and mandatorily retired women. Social class inequalities remained in all employment status groups. Conclusions Overall, our results suggest evidence for the cumulative disadvantage model, with accumulating work exposures among lower classes potentially contributing to their trajectories of ill health.
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Affiliation(s)
- Eero Lahelma
- Department of Public Health, University of Helsinki, P.O. Box 20, (Tukholmankatu 8 2B), 00014, Helsinki, Finland.
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, P.O. Box 20, (Tukholmankatu 8 2B), 00014, Helsinki, Finland
| | - Tarani Chandola
- Cathie Marsh Institute and Social Statistics, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Martin Hyde
- Centre for Innovative Ageing, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, P.O. Box 20, (Tukholmankatu 8 2B), 00014, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, P.O. Box 20, (Tukholmankatu 8 2B), 00014, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
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18
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Lahti J, Mauramo E, Lahelma E, Lallukka T, Pietiläinen O, Salmela J, Salonsalmi A, Rahkonen O. Healthy behaviours and risk of all-cause mortality. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Healthy behaviours are associated with better health in general but less is known about the combined associations of multiple healthy behaviours with mortality risk. We aimed to examine the associations of combined healthy behaviours with mortality risk over a 15-year follow-up among middle-aged employees.
Methods
Survey data, collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, was linked with complete register data on mortality from Statistics Finland (response rate 67%, written informed consent for register linkages 74%). Healthy behaviours included high leisure-time physical activity, non-smoking, no binge drinking and healthy food habits. Each healthy behaviour were dichotomized and assigned a value of one for healthy and zero for unhealthy. The number of healthy behaviours were summed together (score range 0-4). Cox regression models were fitted, and the follow-up continued until the end of 2015 (n = 6336). Confounders included age, sex, marital status, socioeconomic position and self-rated health.
Results
Of the respondents, 7% reported four healthy behaviours, 27% three, 34% two, 22% one and 9% no healthy behaviours. A total of 281 deaths occurred during the follow-up. Each healthy behaviour was individually associated with a reduced mortality risk, non-smoking having the strongest and healthy diet the weakest association. The combined association showed that those without any of the healthy behaviours (HR 2.8, 95% CI 1.51-5.29) and those with only one healthy behaviour (HR 1.89, 95% CI 1.04-3.43) had a higher mortality risk than those with four healthy behaviours. Instead, those with at least two healthy behaviours were not at an increased risk of mortality.
Conclusions
A low number of healthy behaviours predicted mortality among middle-aged employees. Efforts should be made to promote multiple healthy behaviours among the middle-aged to enhance health and prevent premature mortality.
Key messages
Almost one third of the respondents had no or only one healthy behaviour. A low number of healthy behaviours was associated with an increased risk of mortality.
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Affiliation(s)
- J Lahti
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Mauramo
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - T Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - J Salmela
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - A Salonsalmi
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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19
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Salonsalmi A, Lallukka T, Lahelma E, Pietiläinen O, Rahkonen O. Childhood adversities and chronic pain among midlife employees. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Chronic pain is common among employees. Childhood adversities are known determinants of adult health but their association with chronic pain in adulthood is largely unknown. We aimed to examine the associations between childhood adversities and chronic pain among midlife employees.
Methods
Data on seven childhood adversities and chronic pain (pain having lasted at least 3 months) were derived from the baseline survey of the Helsinki Health Study collected in 2000 to 2002 among 40 to 60-year-old employees of the City of Helsinki in Finland. The study included 8140 employees of whom 80% were women. The analyses were made by logistic regression and the results are presented as odds ratios (OR) and their 95% confidence intervals (CI). Age, gender, father’s education, own education, marital status, working conditions, sleep problems and common mental disorders were included as covariates.
Results
Economic difficulties in the childhood family (OR 1.60, 95% CI 1.41-1.81), childhood illness (1.74, 1.45-2.08), parental divorce (1.26, 1.07-1.48), parental alcohol problems (1.34, 1.18-1.52) and bullying in school or among peers (1.59, 1.37-1.89) were associated with an increased odds of chronic pain in midlife. Adjusting for father’s education, own education and marital status did not contribute to the associations. Working conditions, sleep problems and common mental disorders slightly attenuated the associations between childhood adversities and chronic pain.
Conclusions
Childhood adversities associate to chronic pain in midlife. The results suggest that promoting well-being among children might lead to less pain decades after childhood.
Key messages
Childhood adversities are associated with chronic pain in adulthood. Considering well-being among children might lead to less pain decades after childhood.
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Affiliation(s)
- A Salonsalmi
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - T Lallukka
- Finnish Institute of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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20
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Mauramo E, Salmela J, Kanerva N, Lahelma E, Lallukka T, Pietiläinen O, Rahkonen O, Salonsalmi A, Lahti J. Joint associations of fruit and vegetable consumption and physical activity with mortality risk. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Fruit and vegetable consumption (FVC) and leisure-time physical activity (LTPA) are associated with better health outcomes but less is known about their joint associations with the risk of mortality. We examined the joint associations of FVC and LTPA with premature mortality among midlife and ageing municipal employees, adjusting for key covariates.
Methods
Survey data collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, were linked with complete register data on mortality from Statistics Finland (4961 women, 1373 men; response rate 67%; written consent for register linkages 74%). FVC was dichotomised into daily or non-daily, and LTPA into high (>14 MET-hours/week including vigorous exercise) or low. Covariates included age, sex, marital status, socioeconomic position, binge drinking, smoking and self-rated health. Cox regression models were fitted. The follow-up continued until the event of death or the end of 2015.
Results
A total of 281 deaths occurred during the follow-up. The mortality rate was 7.1% in men and 3.7% in women. A gender interaction was found, showing differing associations for women and men. Men with both daily FVC and high LTPA had the lowest mortality risk (HR 0.19, 95% CI 0.06-0.63) after adjusting for covariates. Men with high LTPA and non-daily FVC also had a lower mortality risk (HR 0.51, 95% CI 0.29-0.90) compared to those with non-daily FVC and low LTPA. Women with daily FVC and high LTPA had a lower mortality risk initially, but after adjusting for covariates no statistically significant associations were observed.
Conclusions
The joint associations of FVC and LTPA with premature mortality differed between women and men. This could be related to gender differences in e.g. the causes of death, and further studies are needed to clarify this. Increasing FVC and LTPA might prevent premature mortality among men.
Key messages
Fruit and vegetable consumption jointly with physical activity decreased the risk of premature mortality among men only. Further studies are needed to clarify the gender difference which could be related to for example death causes.
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Affiliation(s)
- E Mauramo
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - J Salmela
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - N Kanerva
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - T Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - A Salonsalmi
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - J Lahti
- Department of Public Health, University of Helsinki, Helsinki, Finland
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21
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Lallukka T, Kronholm E, Pekkala J, Jäppinen S, Blomgren J, Pietiläinen O, Lahelma E, Rahkonen O. Work participation trajectories in 1098748 Finns: determinants and the incidence of sickness absence. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Early exit from paid employment is a notable public health and societal challenge. Previous research has largely focused on the relationships among variables instead of the relationships among individuals with different work participation history. Person-oriented methods enable to identify latent groups of individuals who are likely to follow similar development in their work participation over time. We thus aimed to identify work participation trajectories during early and midlife careers and their social determinants. A further aim was to determine the cumulative incidence of sickness absence due to key diagnostic groups, mental disorders and musculoskeletal diseases within the trajectories.
Methods
Young (25-38 years at baseline, n = 495663) and midlife (39-52 years at baseline, n = 603085) Finnish people, working in 2004, were followed up through 2013, with registers of the Social Insurance Institution, and the Statistics Finland. The registers provided data for the outcome (work participation) and its determinants and sickness absence. Latent class growth analysis was used to identify trajectories.
Results
Three distinctive trajectories were identified: temporary exit, permanent exit, and continuously employed people. As compared to the other trajectories, those belonging to the permanent exit trajectory were more likely men, manual workers and had a lower income. The cumulative incidence of sickness absence due to mental disorders was highest in the permanent exit trajectory group. For musculoskeletal diseases, the cumulative incidence of sickness absence increased in the permanent exit trajectory mainly in the older age groups.
Conclusions
Distinct group-based trajectories of early work exit can be identified in a representative cohort of initially employed people. Focusing on the determinants of premature exit and early intervention to tackle increasing sickness absence may promote work participation particularly in the most vulnerable groups.
Key messages
Distinct trajectories of premature exit from paid employment can be identified in a nationally representative cohort of initially employed people from Finland. Focusing on the determinants and reasons of premature long-term labor market exit may help promote work participation particularly in the most vulnerable groups.
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Affiliation(s)
- T Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - E Kronholm
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - J Pekkala
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - S Jäppinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
- The Social Insurance Institution of Finland (Kela), Helsinki, Finland
| | - J Blomgren
- The Social Insurance Institution of Finland (Kela), Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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22
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Lahelma E, Pietiläinen O, Pentala-Nikulainen O, Helakorpi S, Rahkonen O. Monitoring inequalities in self-rated health over 36 years among Finnish women and men. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Health inequalities across countries and populations are well established, but little is known about their long-term trends and even less about factors shaping the trends. We examined the magnitude of absolute and relative educational inequalities in self-rated health over 36 years among adult Finns, considering individual covariates and macro-economic fluctuations.
Methods
Data were derived from representative annual surveys in 1979-2014 among men and women and covered ages 25-64. Nine periods were used (n = 8870-14235). Our health outcome was less-than-good self-rated health and our socioeconomic indicator was completed years of education as a continuous variable. Nine time-variant sociodemographic and health-related covariates were included. Educational inequalities in self-rated health were examined by relative index of inequality (RII) and slope index of inequality (SII).
Results
Linear trends suggested stable overall development in both relative and absolute health equalities during 36 years. Period specific analyses showed that among men relative and absolute inequalities narrowed immediately after economic recession in Finland in 1993-94, and among women, inequalities narrowed during global financial crisis in 2008-09. Adjusting for covariates reduced the magnitude of inequalities throughout the nine periods, but affected little the period specific patterning of health inequalities.
Conclusions
Educational inequalities in self-rated health persisted during 36 years in Finland. While among men and women health inequalities narrowed during and after recessions, they widened soon back to the pre-recession level. The perseverance calls for powerful measures to tackle health inequalities, such as preventing unhealthy behaviours, obesity and unemployment in particular among the lower educated.
Key messages
Health inequalities have persisted in Finland over 36 years, with unhealthy behaviors and unemployment affecting their magnitude. Health inequalities narrowed during economic recessions, but widened soon back to pre-recession level.
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Affiliation(s)
- E Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - S Helakorpi
- National Institute for Health and Welfare, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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23
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Lallukka T, Kronholm E, Pekkala J, Jäppinen S, Blomgren J, Pietiläinen O, Lahelma E, Rahkonen O. Work participation trajectories among 1,098,748 Finns: reasons for premature labour market exit and the incidence of sickness absence due to mental disorders and musculoskeletal diseases. BMC Public Health 2019; 19:1418. [PMID: 31666045 PMCID: PMC6821029 DOI: 10.1186/s12889-019-7753-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early exit from paid employment is a notable public health and societal challenge. Previous research has largely focused on the relationships among variables instead of the relationships among individuals with different work participation history. Person-oriented methods enable to identify latent groups of individuals who are likely to follow similar development in their work participation over time. We thus aimed to identify work participation trajectories during early and midlife careers and their social determinants using large nationally representative data comprising over 1 million initially employed individuals and a 10-year follow-up for their work participation. A further aim was to determine the cumulative incidence of sickness absence due to key diagnostic groups, mental disorders and musculoskeletal diseases within the trajectories. METHODS Young (25-38 years at baseline, n = 495,663) and midlife (39-52 years at baseline, n = 603,085) Finnish people, all working in 2004, were followed up through 2013, with registers of the Social Insurance Institution, and the Statistics Finland. The registers provided data for work participation and its determinants, as well as for computing the cumulative incidence of sickness absence. Latent class growth analysis was used to identify trajectories. RESULTS Three distinctive trajectories were identified: temporary exit, permanent exit, and continuously employed people. As compared to the other trajectories, those belonging to the permanent exit trajectory were more likely men, manual workers and had a lower income. The cumulative incidence of sickness absence due to mental disorders was highest in the permanent exit trajectory group. For musculoskeletal diseases, the cumulative incidence of sickness absence increased in the permanent exit trajectory mainly in the older age groups. CONCLUSION Distinct group-based trajectories of early work exit can be identified in a representative cohort of initially employed people. Focusing on the determinants of premature exit and early intervention to tackle increasing sickness absence may promote work participation particularly in the most vulnerable groups.
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Affiliation(s)
- Tea Lallukka
- Department of Public Health, University of Helsinki, P. O. Box 20, FIN-00014, Helsinki, Finland. .,Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
| | - Erkki Kronholm
- Finnish Institute of Occupational Health, Helsinki and Turku, Finland
| | - Johanna Pekkala
- Department of Public Health, University of Helsinki, P. O. Box 20, FIN-00014, Helsinki, Finland
| | - Sauli Jäppinen
- Department of Public Health, University of Helsinki, P. O. Box 20, FIN-00014, Helsinki, Finland.,The Social Insurance Institution of Finland (Kela), Helsinki, Finland
| | - Jenni Blomgren
- The Social Insurance Institution of Finland (Kela), Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, P. O. Box 20, FIN-00014, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, P. O. Box 20, FIN-00014, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, P. O. Box 20, FIN-00014, Helsinki, Finland
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24
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Lahelma E, Rahkonen O. Class and health in changing societies: the need for novel approaches. J Epidemiol Community Health 2019; 74:1-2. [PMID: 31615891 DOI: 10.1136/jech-2019-213325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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25
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Salonsalmi A, Pietiläinen O, Lahelma E, Rahkonen O. Childhood adversities, parental education and disability retirement among Finnish municipal employees. PLoS One 2019; 14:e0219421. [PMID: 31323034 PMCID: PMC6641080 DOI: 10.1371/journal.pone.0219421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Aino Salonsalmi
- Department of Public Health, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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26
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Hiilamo A, Butterworth P, Shiri R, Ropponen A, Pietiläinen O, Mänty M, Kouvonen A, Lahelma E, Rahkonen O, Lallukka T. Within-individual analysis of pain and sickness absence among employees from low and high occupational classes: a record linkage study. BMJ Open 2019; 9:e026994. [PMID: 30928960 PMCID: PMC6475189 DOI: 10.1136/bmjopen-2018-026994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Pain is linked to an increased risk of sickness absence (SA); however, the extent to which unmeasured time-invariant differences explain this association is yet unknown. Therefore, we determined the within-individual associations between pain and short-term (in the survey year) and long-term (2 years following the survey years) SA risk in high and low occupational classes while controlling for the potential bias due to unobservable time-invariant characteristics. METHODS The Helsinki Health Study data consisting of midlife public sector employees with mailed surveys from up to four time points, and SA record linkage were used (3983 persons). The within-individual estimates were calculated using hybrid negative binomial regression models. RESULTS Acute/subacute pain was associated with a 13% increase in the rate of short-term SA days (incidence rate ratio 1.13 [95% CI 1.01 to 1.27]), while the association was somewhat stronger for chronic pain (1.32 [1.19-1.47]). For the employees in the low occupational class, these associations were robust (1.29 [1.10-1.50] for acute/subacute and 1.43 [1.23-1.66] for chronic pain), whereas only chronic pain was associated with SA among those in the high occupational class (1.25 [1.08-1.46]). Chronic pain was also associated with SA days in the long term without occupational class differences. Similar results were obtained for multisite pain (pain in several locations). CONCLUSIONS These results indicate that particularly chronic and multisite pain have a within-individual link to SA but ignoring unobservable differences between those reporting pain and those not might yield overstated effect sizes. Pain might have a different relation to SA in low and high occupational classes.
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Affiliation(s)
- Aapo Hiilamo
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Peter Butterworth
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Victoria, Australia
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Minna Mänty
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Development and Innovation, Laurea University of Applied Sciences, Unit of Research, Vantaa, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- SWPS University of Social Sciences and Humanities, Wroclaw, Poland
- Administrative Data Research Centre-Northern Ireland (ADRC-NI), Queen's University Belfast, Belfast, UK
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
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27
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Hiilamo A, Shiri R, Kouvonen A, Mänty M, Butterworth P, Pietiläinen O, Lahelma E, Rahkonen O, Lallukka T. Common mental disorders and trajectories of work disability among midlife public sector employees - A 10-year follow-up study. J Affect Disord 2019; 247:66-72. [PMID: 30654267 DOI: 10.1016/j.jad.2018.12.127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/09/2018] [Accepted: 12/24/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We examined trajectories of work disability, indicated by sickness absence and disability retirement, among midlife public sector employees with and without common mental disorders (CMD) at baseline. We also examined adverse childhood events, occupational class, long-standing illness and health behaviour as determinants of the trajectories. METHODS A sample from the Helsinki Health Study was extracted comprising 2350 employees. Baseline characteristics were obtained from mail surveys conducted in 2000-2 and 2007. CMD were measured by the General Health Questionnaire. Participants were followed between the ages of 50-59. Work disability trajectories were modelled by the annual number of work disability months in group-based trajectory analysis. Multinomial regression was used to predict trajectory group memberships. RESULTS Three trajectories were identified: no work disability (consisting 59% of the all employees), stable/low (31%) and high/increasing disability (10%). Employees with CMD were more likely to belong to the stable/low (odds ratio 1.73 [95% confidence interval 1.37-2.18]), and the high/increasing (2.55 [1.81-3.59]) trajectories. Stratified models showed that the determinants of the trajectories were largely similar for those with CMD compared to those without CMD except that obesity was a somewhat stronger predictor of the high/increasing trajectory among employees with CMD. LIMITATIONS The focus on midlife public sector employees limits the generalisability to other employment sectors and younger employees. CONCLUSIONS CMD were strongly associated with a trajectory leading to early exit from employment and a stable/low work disability trajectory. These findings have implications for interventions promoting work ability of employees with mental ill-health.
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Affiliation(s)
- Aapo Hiilamo
- Finnish Institute of Occupational Health, Arinatie 3, 00370, Helsinki, Finland.
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Arinatie 3, 00370, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland; Administrative Data Research Centre - Northern Ireland (ADRC-NI), Queen's University Belfast, Belfast, UK
| | - Minna Mänty
- Department of Public Health, University of Helsinki, Helsinki, Finland; Laurea University of Applied Sciences, Unit of Research, Development and Innovation, Vantaa, Finland
| | - Peter Butterworth
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia; Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Victoria, Australia
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Finnish Institute of Occupational Health, Arinatie 3, 00370, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland
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28
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Mauramo E, Lahti J, Lallukka T, Lahelma E, Pietiläinen O, Rahkonen O. Changes in common mental disorders and diagnosis-specific sickness absence: a register-linkage follow-up study among Finnish municipal employees. Occup Environ Med 2019; 76:230-235. [PMID: 30674604 DOI: 10.1136/oemed-2018-105423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/11/2018] [Accepted: 12/22/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study examined the associations between changes in common mental disorders (CMD) and subsequent diagnosis-specific sickness absence (SA) among midlife and ageing municipal employees. METHODS Data from the Helsinki Health Study phase I (2000-2002) and phase II (2007) surveys among employees of the City of Helsinki, Finland, were linked with prospective register data from the Social Insurance Institution of Finland on diagnosis-specific (mental, musculoskeletal, other causes) SA (n=3890). Associations between change in CMD (General Health Questionnaire 12) from phase I to phase II and the first SA event in 2007-2014 were analysed using Cox regression modelling. Sociodemographic, work and health-related covariates from phase I, and SA from the year preceding phase I were controlled for. RESULTS Having CMD at one or two time points, that is, favourable and unfavourable change in CMD and repeated CMD, were all associated with a higher risk of SA due to mental, musculoskeletal and other diagnoses compared with women and men with no CMD. Favourable change in CMD reduced the risk of SA when compared with repeated CMD. The strongest associations were observed for repeated CMD (HR range: 1.44 to 5.05), and for SA due to mental diagnoses (HR range: 1.15 to 5.05). The associations remained after adjusting for the covariates. CONCLUSIONS Changing and repeated CMD increased the risk of SA due to mental, musculoskeletal and other diagnoses. CMD should be tackled to prevent SA and promote work-ability among ageing employees.
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Affiliation(s)
- Elina Mauramo
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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29
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Ervasti J, Pietiläinen O, Rahkonen O, Lahelma E, Kouvonen A, Lallukka T, Mänty M. 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. Int Arch Occup Environ Health 2018; 92:337-345. [PMID: 30511342 PMCID: PMC6420465 DOI: 10.1007/s00420-018-1393-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/27/2018] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Jenni Ervasti
- Department of Public Health, University of Helsinki, Helsinki, Finland. .,Finnish Institute of Occupational Health, PB 18, 00032, Helsinki, Finland.
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland.,Administrative Data Research Centre-Northern Ireland (ADRC-NI), Queen's University Belfast, Belfast, UK
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Finnish Institute of Occupational Health, PB 18, 00032, Helsinki, Finland
| | - Minna Mänty
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Laurea University of Applied Sciences, Vantaa, Finland
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30
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Salonsalmi A, Pietiläinen O, Lahelma E, Rahkonen O. Childhood conditions and midlife disability retirement due to mental disorders. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - E Lahelma
- University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- University of Helsinki, Helsinki, Finland
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31
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Kronholm E, Marshall N, Mänty M, Lahti J, Lahelma E, Rahkonen O, Lallukka T. Sleep, functioning and premature exit from labour market: repeated measures latent class analysis. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Kronholm
- Finnish Institute of Occupational Health, Turku, Finland
| | | | - M Mänty
- Laurea University of Applied Sciences, Vantaa, Finland
- University of Helsinki, Helsinki, Finland
| | - J Lahti
- University of Helsinki, Helsinki, Finland
| | - E Lahelma
- University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- University of Helsinki, Helsinki, Finland
| | - T Lallukka
- Finnish Institute of Occupational Health, Turku, Finland
- University of Helsinki, Helsinki, Finland
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32
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Holstila A, Lahti J, Salonsalmi A, Lahelma E, Rahkonen O. Changes in alcohol drinking before and after the statutory retirement: a longitudinal cohort study. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Holstila
- Department of Public Health, Helsinki, Finland
| | - J Lahti
- Department of Public Health, Helsinki, Finland
| | | | - E Lahelma
- Department of Public Health, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, Helsinki, Finland
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33
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Svärd A, Pipping H, Lahti J, Mänty M, Rahkonen O, Lahelma E, Lallukka T. Joint association of overweight and common mental disorders with disability retirement in Finland. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | - M Mänty
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Laurea University of Applied Sciences, Vantaa, Finland
| | - O Rahkonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - E Lahelma
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - T Lallukka
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Finnish Institute of Occupational Health, Helsinki, Finland
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34
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Roos ET, Lallukka T, Lahelma E, Rahkonen O. Joint associations between smoking and obesity as determinants of premature mortality among midlife employees. Eur J Public Health 2018; 27:135-139. [PMID: 28177439 DOI: 10.1093/eurpub/ckw111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Eira T Roos
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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35
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Svärd A, Lahti J, Mänty M, Roos E, Rahkonen O, Lahelma E, Lallukka T. Weight change among normal weight, overweight and obese employees and subsequent diagnosis-specific sickness absence: A register-linked follow-up study. Scand J Public Health 2018; 48:155-163. [PMID: 30269682 PMCID: PMC7042496 DOI: 10.1177/1403494818802990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims: Obesity and weight change are associated with sickness
absence; however, less is known about the diagnoses for sickness absence. We
examined the association between stable and changing weight by body mass index
groups with sickness absence due to any, musculoskeletal and mental diagnoses
among midlife female and male employees. Methods: The Finnish
Helsinki Health Study phase 1 survey took place in 2000–2002 (response rate 67%)
and phase 2 in 2007 (response rate 83%). Based on self-reported body mass index,
we calculated the weight change between phases 1 and 2 (body mass index change
⩾5%). The data were linked with registers of the Social Insurance Institution of
Finland, including information on diagnoses (ICD-10) for sickness absence >9
days. We used a negative binom ial model to examine the association with
sickness absence among 3140 women and 755 men during the follow-up (2007–2013).
Results are presented as rate ratios. Covariates were age, sociodemographic
factors, workload, health behaviors and prior sickness absence.
Results: Weight-gain (rate ratio range=1.27–2.29),
overweight (rate ratio range=1.77–2.02) and obesity (rate ratio range=2.16–2.29)
among women were associated with a higher rate of sickness absence due to
musculoskeletal diseases, compared to weight-maintaining normal-weight women.
Similarly, obesity among men was associated with sickness absence due to
musculoskeletal diseases (rate ratio range=1.55–3.45). Obesity among women (rate
ratio range=1.54–1.72) and weight gain among overweight men (rate ratio=3.67;
confidence interval=1.72–7.87) were associated with sickness absence due to
mental disorders. Conclusions: Obesity and weight gain
were associated with a higher rate of sickness absence, especially due to
musculoskeletal diseases among women. Preventing obesity and weight gain
likely helps prevent sickness absence.
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Affiliation(s)
- Anna Svärd
- Department of Public Health, University of Helsinki, Finland
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, Finland
| | - Minna Mänty
- Department of Public Health, University of Helsinki, Finland.,Unit of Research, Development and Innovation, Laurea University of Applied Sciences, Finland
| | - Eira Roos
- Department of Public Health, University of Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Finland.,Finnish Institute of Occupational Health, Finland
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36
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Hu Y, van Lenthe FJ, Platt S, Bosdriesz JR, Lahelma E, Menvielle G, Regidor E, Santana P, de Gelder R, Mackenbach JP. The Impact of Tobacco Control Policies on Smoking Among Socioeconomic Groups in Nine European Countries, 1990-2007. Nicotine Tob Res 2018; 19:1441-1449. [PMID: 27613922 DOI: 10.1093/ntr/ntw210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/06/2016] [Indexed: 11/15/2022]
Abstract
Background It is uncertain whether tobacco control policies have contributed to a narrowing or widening of socioeconomic inequalities in smoking in European countries during the past two decades. This paper aims to investigate the impact of price and non-price related population-wide tobacco control policies on smoking by socioeconomic group in nine European countries between 1990 and 2007. Methods Individual-level education, occupation and smoking status were obtained from nationally representative surveys. Country-level price-related tobacco control policies were measured by the relative price of cheapest cigarettes and of cigarettes in the most popular price category. Country-level non-price policies were measured by a summary score covering four policy domains: smoking bans or restrictions in public places and workplaces, bans on advertising and promotion, health warning labels, and cessation services. The associations between policies and smoking were explored using logistic regressions, stratified by education and occupation, and adjusted for age, Gross Domestic Product, period and country fixed effects. Results The price of popular cigarettes and non-price policies were negatively associated with smoking among men. The price of the cheapest cigarettes was negatively associated with smoking among women. While these favorable effects were generally in the same direction for all socioeconomic groups, they were larger and statistically significant in lower socioeconomic groups only. Conclusions Tobacco control policies as implemented in nine European countries, have probably helped to reduce the prevalence of smoking in the total population, particularly in lower socioeconomic groups. Widening inequalities in smoking may be explained by other factors. Policies with larger effects on lower socioeconomic groups are needed to reverse this trend. Implications Socioeconomic inequalities in smoking widened between the 1990s and the 2000s in Europe. During the same period, there were intensified tobacco control policies in many European countries. It is uncertain whether tobacco control policies have contributed to a narrowing or widening of socioeconomic inequalities in smoking in European countries. This study shows that tobacco control policies as implemented in the available European countries have helped to reduce the prevalence of smoking in the total population, particularly in lower socioeconomic groups. Widening inequalities in smoking may be explained by other factors.
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Affiliation(s)
- Yannan Hu
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Stephen Platt
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Jizzo R Bosdriesz
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Gwenn Menvielle
- Sorbonne Universités, Université Pierre et Marie Curie (Paris 6), INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), Paris, France
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Paula Santana
- Centro de Estudos de Geografia e de Ordenamento do Territorio (CEGOT), Departamento de Geografia, Colégio de S. Jerónimo, Universidade de Coimbra, Coimbra, Portugal
| | - Rianne de Gelder
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Virtanen M, Jokela M, Madsen IE, Magnusson Hanson LL, Lallukka T, Nyberg ST, Alfredsson L, Batty GD, Bjorner JB, Borritz M, Burr H, Dragano N, Erbel R, Ferrie JE, Heikkilä K, Knutsson A, Koskenvuo M, Lahelma E, Nielsen ML, Oksanen T, Pejtersen JH, Pentti J, Rahkonen O, Rugulies R, Salo P, Schupp J, Shipley MJ, Siegrist J, Singh-Manoux A, Suominen SB, Theorell T, Vahtera J, Wagner GG, Wang JL, Yiengprugsawan V, Westerlund H, Kivimäki M. Long working hours and depressive symptoms: systematic review and meta-analysis of published studies and unpublished individual participant data. Scand J Work Environ Health 2018; 44:239-250. [PMID: 29423526 DOI: 10.5271/sjweh.3712] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives This systematic review and meta-analysis combined published study-level data and unpublished individual-participant data with the aim of quantifying the relation between long working hours and the onset of depressive symptoms. Methods We searched PubMed and Embase for published prospective cohort studies and included available cohorts with unpublished individual-participant data. We used a random-effects meta-analysis to calculate summary estimates across studies. Results We identified ten published cohort studies and included unpublished individual-participant data from 18 studies. In the majority of cohorts, long working hours was defined as working ≥55 hours per week. In multivariable-adjusted meta-analyses of 189 729 participants from 35 countries [96 275 men, 93 454 women, follow-up ranging from 1-5 years, 21 747 new-onset cases), there was an overall association of 1.14 (95% confidence interval (CI) 1.03-1.25] between long working hours and the onset of depressive symptoms, with significant evidence of heterogeneity (I 2=45.1%, P=0.004). A moderate association between working hours and depressive symptoms was found in Asian countries (1.50, 95% CI 1.13-2.01), a weaker association in Europe (1.11, 95% CI 1.00-1.22), and no association in North America (0.97, 95% CI 0.70-1.34) or Australia (0.95, 95% CI 0.70-1.29). Differences by other characteristics were small. Conclusions This observational evidence suggests a moderate association between long working hours and onset of depressive symptoms in Asia and a small association in Europe.
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Affiliation(s)
- Marianna Virtanen
- Finnish Institute of Occupational Health, PO Box 40, 00032 Työterveyslaitos, Finland.
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38
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Mänty M, Kouvonen A, Lallukka T, Lahti J, Lahelma E, Rahkonen O. Changes in physical and mental health functioning during retirement transition: a register-linkage follow-up study. Eur J Public Health 2018; 28:805-809. [DOI: 10.1093/eurpub/cky013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Minna Mänty
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Research, Development and Innovation, Laurea University of Applied Sciences, Vantaa, Finland
| | - Anne Kouvonen
- Department of Social Research, University of Helsinki, Helsinki, Finland
- SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland
- Administrative Data Research Centre – Northern Ireland, Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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39
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Pekkala J, Rahkonen O, Pietiläinen O, Lahelma E, Blomgren J. Sickness absence due to different musculoskeletal diagnoses by occupational class: a register-based study among 1.2 million Finnish employees. Occup Environ Med 2018; 75:296-302. [DOI: 10.1136/oemed-2017-104571] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 12/22/2017] [Accepted: 01/16/2018] [Indexed: 12/30/2022]
Abstract
ObjectivesThose in lower occupational classes have an increased risk of sickness absence due to musculoskeletal diseases (MSDs), but studies examining the associations simultaneously across specified diagnostic groups within MSDs are lacking. We examined occupational class differences in the occurrence and length of long-term sickness absence due to different musculoskeletal diagnoses.MethodsA 70% random sample of employed Finns aged 25–64 years old at the end of 2013 was linked to data on sickness absence of over 10 working days obtained from The Social Insurance Institution of Finland and occupational class from Statistics Finland. Sickness absences due to MSDs initiated in 2014 were followed until the end of each episode for female (n=675 636) and male (n=604 715) upper non-manuals, lower non-manuals and manual workers. Negative binomial hurdle models were used to analyse the associations.ResultsWithin the studied MSDs, the most common causes of absence were back disorders, particularly back pain, and shoulder disorders. Osteoarthritis, disc disorders and rheumatoid arthritis induced the longest episodes of absence. Clear hierarchical class differences were found throughout, but the magnitude of the differences varied across the diagnostic causes. The largest class differences in the occurrence were detected in shoulder disorders and back pain. The class differences in length were greatest in rheumatoid arthritis, disc disorders and, among men, also in hip osteoarthritis.ConclusionsHierarchical occupational class differences were found across different MSDs, with large differences in back and shoulder disorders. Occupational class and diagnosis should be considered when attempting to reduce sickness absence due to MSDs.
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40
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Roos E, Lallukka T, Lahelma E, Rahkonen O. The joint associations of smoking and obesity with subsequent short and long sickness absence: a five year follow-up study with register-linkage. BMC Public Health 2017; 17:978. [PMID: 29282110 PMCID: PMC5745910 DOI: 10.1186/s12889-017-4997-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 12/14/2017] [Indexed: 11/25/2022] Open
Abstract
Background Both smoking and obesity are separately associated with sickness absence. Unhealthy lifestyle habits and health conditions may occur concurrently yet studies focusing on their joint association are few. This study examined the joint associations of smoking and obesity with sickness absence (SA). Methods A mail survey among employees of the City of Helsinki, Finland, during 2000–2002 included data on obesity, smoking and covariates (N = 8960, response rate 67%, 80% women). These data were prospectively linked with register data on self- (1–3 days) and medically certified (4 days or longer) SA among those consenting to the linkage (n = 6986). Pregnant, underweight and those with missing data on key variables were excluded (n = 138). The total number of participants included in the analyses was 6847. The follow-up time was 5 years. Poisson regression was used to calculate rate ratios (RR). Results Among women and men smoking and obesity were associated with self-certified SA. Among women there was a joint association with self-certified SA (obese smokers RR 1.81, 95% CI 1.59–2.07). Among women and men smoking and obesity were jointly associated with medically certified SA (for obese smoking women RR 2.23, 95% CI 1.93–2.57, for obese smoking men RR 2.69, 95% CI 2.03–3.55). Associations remained after adjustments for socioeconomic position, working conditions, health behaviours and self-rated health. Conclusion Both smoking and obesity are jointly associated with all lengths of sickness absence. Support measures for smoking cessation and prevention of obesity could likely to reduce SA.
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Affiliation(s)
- Eira Roos
- Department of Public Health, University of Helsinki, Post Box 20, 00014, Helsinki, Finland.
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Post Box 20, 00014, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Post Box 20, 00014, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Post Box 20, 00014, Helsinki, Finland
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41
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Abstract
Background: This paper seeks to examine changes in health inequalities in Finland from the mid-1980s to the mid-1990s. To improve our understanding of the contribution of employment status changes to class and educational differences in health within the context of changing labour market conditions, we examined the differences in ill health among social classes, educational groups, and employment status groups. Methods: The data was derived from nation-wide Finnish Surveys on Living Conditions from 1986 and 1994. Analyses included the age range 25- 64 years. Health was measured using limiting long-standing illness and perceived health as below good. Results are presented as age-standardized prevalence percentages and odds ratios from logistic regression analyses. Results: The pattern and size of relative social inequalities in ill health have remained generally stable during the eight-year study period in Finland. Differences between social classes have changed only slightly. Differences between educational groups have declined somewhat among men, but have remained stable among women. Compared with the employed, health among the unemployed, housewives, and pensioners has improved for both men and women. Analysing social class differences within both the employed and the non-employed showed only negligible changes. Conclusions: Changes in social inequalities in health as indicated by class and educational differentials among Finnish men and women have mostly been negligible. The observed changes are likely to have been affected by the 1990s' labour market crisis in Finland. The rapidly increasing mass unemployment is unlikely to have been very individually selective in the short run. However, in the longer run, to the extent that unemployment remains high, this trend can be expected to change as re-entry to paid employment is likely to be more individually selective.
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Affiliation(s)
- Kristiina Manderbacka
- National Research and Development, Centre for Welfare
and Health, Health Services Research, Helsinki, , Department of Public Health University of Helsinki,
Finland
| | - Eero Lahelma
- Department of Public Health University of Helsinki,
Finland
| | - Ossi Rahkonen
- Department of Social Policy, University of Helsinki,
Finland
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42
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Abstract
The Nordic countries, referring here to Denmark, Finland, Norway, and Sweden, have often been viewed as a group of countries with many features in common, such as geographical location, history, culture, religion, language, and economic and political structures. It has also been habitual to refer to a ``Nordic model' ' of welfare states comprising a large public sector, active labour market policies, high costs for social welfare as well as high taxes, and a general commitment to social equality (1). Recent research suggests that much of this ``Nordicness'' appears to remain despite the fact that the Nordic countries have experienced quite different changes during the 1980s and 1990s (2). How this relates to changes in health inequalities is in the focus of this supplement.
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Affiliation(s)
- Eero Lahelma
- Department of Public Health, Medical Sociology, University
of Helsinki, P.O. Box 41, FIN-00014 UNIVERSITY OF HELSINKI, Finland
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43
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Lahti J, Kanerva N, Haaramo P, Pietiläinen O, Lahelma E, Rahkonen O, Mänty M. Healthy behaviours and health functioning: a follow-up study among middle-aged employees. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Lahti
- University of Helsinki, Helsinki, Finland
| | - N Kanerva
- University of Helsinki, Helsinki, Finland
| | - P Haaramo
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - E Lahelma
- University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- University of Helsinki, Helsinki, Finland
| | - M Mänty
- University of Helsinki, Helsinki, Finland
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44
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Jäppinen S, Blomgren J, Pekkala J, Pietiläinen O, Lahelma E, Rahkonen O. Gender differences in diagnosis-specific sickness absence in middle-aged Finnish working population. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Jäppinen
- University of Helsinki, Helsinki, Finland
| | - J Blomgren
- The Social Insurance Institution of Finland, Helsinki, Finland
| | - J Pekkala
- University of Helsinki, Helsinki, Finland
| | | | - E Lahelma
- University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- University of Helsinki, Helsinki, Finland
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45
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Pekkala J, Rahkonen O, Pietiläinen O, Lahelma E, Blomgren J. Sickness absence due to musculoskeletal diagnoses by occupational class in Finland: a register study. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Pekkala
- University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- University of Helsinki, Helsinki, Finland
| | | | - E Lahelma
- University of Helsinki, Helsinki, Finland
| | - J Blomgren
- The Social Insurance Institution of Finland, Helsinki, Finland
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46
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Lahti J, Mänty M, Roos E, Rahkonen O, Lahelma E, Lallukka T, Svärd A. Weight gain and subsequent diagnosis-specific sickness absence: A register-linked follow-up study. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Lahti
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - M Mänty
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - E Roos
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - E Lahelma
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - T Lallukka
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - A Svärd
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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47
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Lallukka T, Lahelma E, Rahkonen O, Mauramo E. Common mental disorders and sickness absence: a register-linkage study among Finnish employees. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Lallukka
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - E Lahelma
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Mauramo
- Department of Public Health, University of Helsinki, Helsinki, Finland
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48
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Svärd A, Lahti J, Roos E, Rahkonen O, Lahelma E, Lallukka T, Mänty M. Correction to: Obesity, change of body mass index and subsequent physical and mental health functioning: a 12-year follow-up study among ageing employees. BMC Public Health 2017; 17:816. [PMID: 29041966 PMCID: PMC5644067 DOI: 10.1186/s12889-017-4828-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Anna Svärd
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland.
| | - Jouni Lahti
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland
| | - Eira Roos
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Minna Mänty
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland.,Laurea University of Applied Sciences, Unit of Research, Development and Innovation, Vantaa, Finland
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49
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Svärd A, Lahti J, Roos E, Rahkonen O, Lahelma E, Lallukka T, Mänty M. Obesity, change of body mass index and subsequent physical and mental health functioning: a 12-year follow-up study among ageing employees. BMC Public Health 2017; 17:744. [PMID: 28950839 PMCID: PMC5615472 DOI: 10.1186/s12889-017-4768-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background Studies suggest an association between weight change and subsequent poor physical health functioning, whereas the association with mental health functioning is inconsistent. We aimed to examine whether obesity and change of body mass index among normal weight, overweight and obese women and men associate with changes in physical and mental health functioning. Methods The Helsinki Health Study cohort includes Finnish municipal employees aged 40 to 60 in 2000–02 (phase 1, response rate 67%). Phase 2 mail survey (response rate 82%) took place in 2007 and phase 3 in 2012 (response rate 76%). This study included 5668 participants (82% women). Seven weight change categories were formed based on body mass index (BMI) (phase 1) and weight change (BMI change ≥5%) (phase 1–2). The Short Form 36 Health Survey (SF-36) measured physical and mental health functioning. The change in health functioning (phase 1–3) score was examined with repeated measures analyses. Covariates were age, sociodemographic factors, health behaviours, and somatic ill-health. Results Weight gain was common among women (34%) and men (25%). Weight-gaining normal weight (−1.3 points), overweight (−1.3 points) and obese (−3.6 points) women showed a greater decline in physical component summary scores than weight-maintaining normal weight women. Among weight-maintainers, only obese (−1.8 points) women showed a greater decline than weight-maintaining normal weight women. The associations were similar, but statistically non-significant for obese men. No statistically significant differences in the change in mental health functioning occurred. Conclusion Preventing weight gain likely helps maintaining good physical health functioning and work ability.
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Affiliation(s)
- Anna Svärd
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland.
| | - Jouni Lahti
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland
| | - Eira Roos
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Minna Mänty
- Department of Public Health, Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), P.O. Box 20, 00014, Helsinki, Finland.,Laurea University of Applied Sciences, Unit of Research, Development and Innovation, Vantaa, Finland
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50
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Pekkala J, Blomgren J, Pietiläinen O, Lahelma E, Rahkonen O. Occupational class differences in diagnostic-specific sickness absence: a register-based study in the Finnish population, 2005-2014. BMC Public Health 2017; 17:670. [PMID: 28830389 PMCID: PMC5568169 DOI: 10.1186/s12889-017-4674-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 08/08/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Musculoskeletal diseases and mental disorders are major causes of long-term sickness absence in Western countries. Although sickness absence is generally more common in lower occupational classes, little is known about class differences in diagnostic-specific absence over time. Focusing on Finland during 2005-2014, we therefore set out to examine the magnitude of and changes in absolute and relative occupational class differences in long-term sickness absence due to major diagnostic causes. METHODS A 70-per-cent random sample of Finns aged 25-64 linked to register data on medically certified sickness absence (of over 10 working days) in 2005-2014 was retrieved from the Social Insurance Institution of Finland. Information on occupational class was obtained from Statistics Finland and linked to the data. The study focused on female (n = 658,148-694,142) and male (n = 604,715-642,922) upper and lower non-manual employees and manual workers. The age-standardised prevalence, the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were calculated for each study year to facilitate examination of the class differences. RESULTS The prevalence of each diagnostic cause of sickness absence declined during the study period, the most common causes being musculoskeletal diseases, mental disorders and injuries. The prevalence of other causes under scrutiny was less than 1 % annually. By far the largest absolute and relative differences were in musculoskeletal diseases among both women and men. Moreover, the absolute differences in both genders (p < 0.0001) and the relative differences in men (p < 0.0001) narrowed over time as the prevalence declined most among manual workers. Both genders showed modest and stable occupational class differences in mental disorders. In the case of injuries, no major changes occurred in absolute differences but relative differences narrowed over time in men (p < 0.0001) due to a strong decline in prevalence among manual workers. Class differences in the other studied diagnostic causes under scrutiny appeared negligible. CONCLUSIONS By far the largest occupational class differences in long-term sickness absence concerned musculoskeletal diseases, followed by injuries. The results highlight potential targets for preventive measures aimed at reducing sickness absence and narrowing class differences in the future.
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Affiliation(s)
- Johanna Pekkala
- Department of Public Health, University of Helsinki, P.O. Box 20 (Tukholmankatu 8B), 00014 Helsinki, Finland
| | - Jenni Blomgren
- The Social Insurance Institution of Finland, P.O. Box 450, (Nordenskiöldinkatu 12), FIN-00056 KELA, Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, P.O. Box 20 (Tukholmankatu 8B), 00014 Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, P.O. Box 20 (Tukholmankatu 8B), 00014 Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, P.O. Box 20 (Tukholmankatu 8B), 00014 Helsinki, Finland
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