Dual trajectories of short-term and long-term sickness absence and their social- and health-related determinants among women in the public sector

BACKGROUND

Short- and long-term sickness absence (SA) vary in their determinants. We examined short- and long-term SA contemporaneously as two interconnected phenomena to characterize their temporal development, and to identify employees with increasing SA at an early stage.

METHODS

We extracted 46- to 55-year-old employed women from the Helsinki Health Study occupational cohort during 2000-17 (N = 3206) and examined the development of short- (1-14 days) and long-term (>14 days) SA using group-based dual trajectory modelling. In addition, we investigated the associations of social-, work- and health-related factors with trajectory group membership.

RESULTS

For short-term SA, we selected a three-group solution: 'no short-term SA' (50%), 'low frequency short-term SA' (40%), and 'high frequency short-term SA' (10%) (7 spells/year). For long-term SA, we also selected three trajectory groups: 'no long-term SA' (65%), 'low long-term SA' (27%), and 'high long-term SA' (8%). No SA in the short-term SA model, indicated a high probability of no SA in the long-term model and vice versa. The developmental pattern was far less certain if participant was assigned to a trajectory of high SA in either one of the models (short- or long-term SA model). Low occupational class and poor health behaviours were associated with the trajectory groups with more SA.

CONCLUSION

SA does not increase with age among most employees. If either SA rate was high, the developmental patterns were heterogenous. Employers' attention to health behaviours might aid in reducing both short- and long-term SA.

Long-term sickness absence trajectories among ageing municipal employees - the contribution of social and health-related factors

BACKGROUND

The ageing work force is heterogeneous, following distinct development in work ability. This study aims to identify trajectories of long-term sickness absence (SA) in later careers and to examine potentially modifiable factors associated with the development of SA.

METHODS

Data comprised of municipal employees of the city of Helsinki aged 50-60 years during 2004-2018 (N = 4729, 80% women). The developmental trajectories of long-term (> 10 working days) SA were examined with Group-based trajectory modelling (GBTM) using SA records of the Social Insurance Institution of Finland during 2004-2018. All-cause and diagnosis-specific (mental disorder- and musculoskeletal disease-related) SA days were analysed. The association of social and health-related factors with trajectory membership was examined using multinomial logistic regression (odds ratios and 95% confidence intervals).

RESULTS

A model with three trajectories was selected for both all-cause and diagnosis-specific SA. Regarding all-cause long-term SA trajectories, 42% had no long-term SA, 46% had low levels of SA, and 12% had a high rate of SA during follow-up. Lower occupational class, reporting smoking, overweight or obesity, moderate or low leisure-time physical activity, and sleep problems were associated with a higher likelihood of belonging to the trajectory with a high rate of SA in both all-cause and diagnosis-specific models.

CONCLUSIONS

Most ageing employees have no or little long-term SA. Modifiable factors associated with trajectories with more SA could be targeted when designing and timing interventions in occupational healthcare.

Separate and joint associations of chronic pain, multisite pain and mental health with sickness absence among younger employees: a register based longitudinal study

BACKGROUND

Pain conditions and poorer mental health are associated with work disability. However, few studies have examined the association of concurrent pain and poorer mental health with sickness absence among younger employees. We examined separate and joint associations of chronic pain, multisite pain, and mental health with total and long-term all-cause sickness absence days among younger Finnish municipal employees.

METHODS

The Young Helsinki Health-study data were collected in 2017 from 19-39-year-old employees of the City of Helsinki, Finland. Chronic (≥ 3 months) and multisite (≥ 2 body sites) pain and mental health (RAND-36 emotional wellbeing subscale dichotomized by median score) were self-reported (n = 3911). Chronic pain, multisite pain and mental health were analyzed separately and combined. Register data on total (≥ 1 workdays) and long-term (≥ 11 workdays) sickness absence days during the following year were obtained. Negative binomial regression analyses were performed with sociodemographic, socioeconomic, and health-related factors as confounders. Gender interaction and synergistic indices were examined.

RESULTS

Chronic multisite pain was associated with long-term sickness absence days (rate ratio [RR] 2.51, 95% CI 1.17-5.42). Chronic pain (RR 5.04, 95% CI 2.14-11.87) and multisite pain (RR 4.88, 95% CI 2.30-10.33) were associated with long-term sickness absence days among employees with poorer mental health. There was a synergistic interaction between gender and multisite pain for total sickness absence days (synergy index 1.80, 95% CI 1.27-2.54), with stronger associations among women.

CONCLUSIONS

Chronic and multisite pain are associated with long-term sickness absence among younger employees, particularly among women and employees with concurrent poorer mental health. Consideration of this knowledge at workplaces and in healthcare could help to identify and support employees at increased risk of later sickness absence.

Pain and mental health - separate and joint associations with sickness absence among young employees

Background

Both pain and mental illness associate with work disability. However, few studies have examined the association of concurrent pain and mental distress with sickness absence (SA). We examined separate and joint associations of chronic pain, multisite pain, and mental distress with total and long-term all-cause SA among young and midlife municipal employees.

Methods

As part of the Young Helsinki Health study, baseline data were collected in 2017 from 19-39-year-old employees of the City of Helsinki, Finland. Chronic (≥3 months) pain, multisite (≥2 body sites) pain and mental distress (RAND-36 emotional wellbeing subscale below median) were reported by 3911 respondents. Register data on total (>1 day) and long-term ((>11 workdays) SA for the following year were obtained from the employer and the Social Insurance Institute of Finland with respondents’ informed consent. Negative binomial regression analyses were performed with sociodemographic, socioeconomic, and health-related factors as confounders. The interaction of gender was examined.

Results

Chronic pain, multisite pain, and mental distress were associated with total SA. Chronic multisite pain was associated with long-term SA (rate ratio [RR] 2.51, 95% CI 1.17-5.42), and chronic pain (RR 5.04, 95% CI 2.14-11.87) and multisite pain (RR 4.88, 95% CI 2.30-10.33) with long-term SA among those with mental distress. For women, there was a synergistic interaction of multisite pain to the association with total SA (synergy index 1.80, 95% CI 1.27-2.54).

Conclusions

Chronic and multisite pain associate with SA among young and midlife employees. The associations are generally stronger among women and particularly among those with concurrent mental distress. Interventional studies are needed to confirm if early symptom recognition and support could reduce sickness absence.

Key messages

• Chronic pain and pain at multiple body sites associate with sickness absence among young and midlife employees, particularly among women and those with concurrent mental distress.

• Interventional studies are needed to confirm if sickness absence could be reduced by early recognizing pain and mental distress among employees and providing preventive and therapeutic services.

Trajectories of working hours in later careers and their association with social and health-related factors: a follow-up study

BACKGROUND

The aim was to identify working hours' trajectories in later work careers over a follow-up of 15-17 years and to examine their association with social factors and health.

METHODS

A subsample from the Helsinki Health Study was extracted comprising employees of the City of Helsinki, Finland. Growth mixture modelling was used to identify different working hour trajectories. Age, gender, occupational class, marital status, health behaviour, physical and mental functioning and current pain were associated with trajectory membership. Relative risks (RRs) and their 95% confidence intervals (CIs) were estimated.

RESULTS

A two-trajectory model was selected: 'Stable regular working hours' (90%) and 'Shorter and varying working hours' (10%). Women (RR 1.40, 95% CI 1.09-1.78), the oldest employees (RR 2.71, 95% CI 2.06-3.57), managers and professionals (RR 1.56, 95% CI 1.20-2.02), those reporting non-drinker (RR 1.66, 95% CI 1.32-2.10), those reporting sleeping more than 8 h per night (RR 1.74 95% CI 1.25-2.42) and those reporting poor mental functioning (RR 1.39 95% CI 1.15-1.68) had higher likelihood of belonging to the trajectory 'Shorter and varying working hours'. There were no differences between the trajectories in marital status, smoking, body mass index, current pain or physical functioning. However, routine non-manual workers (RR 0.74, 95% CI 0.55-0.98), and semi-professionals (RR 0.70, 95% CI 0.50-0.96) had lower likelihood of belonging to this trajectory.

CONCLUSIONS

Trajectories of working hours in later work career differ by age, gender and occupational class but also by health behaviours and mental health functioning.

Occupational Class Differences in Long-Term Sickness Absence Due to Breast Cancer during 2005-2013: A Population-Based Study among Finnish Women

Breast cancer is the most common cancer among women in Western countries with clear socioeconomic differences. Higher occupational class is associated with higher breast cancer incidence but with better survival from the disease, whereas lower occupational class is associated with higher risk of sickness absence. We are not aware of previous studies examining changes over time in occupational class differences in sickness absence due to breast cancer. This paper focuses on occupational class differences in the incidence and duration of sickness absence due to breast cancer over the period of 2005-2013. Age-adjusted occupational class differences in the cumulative incidence and duration of sickness absence due to breast cancer were calculated utilising a nationally representative 70% random sample of employed Finnish women aged 35-64 years (yearly N varying between 499,778 and 519,318). The results show that higher occupational class was associated with higher annual cumulative incidence of sickness absence due to breast cancer. Lower occupational class was associated with longer duration of absence. Occupational class differences in both cumulative incidence and duration of absence remained broadly stable. As a conclusion, these results suggest that measures should be targeted particularly to promotion of work capacity among employees with breast cancer in lower occupational classes.