Do health literacy, physical health and past rehabilitation utilization explain educational differences in the subjective need for medical rehabilitation? Results of the lidA cohort study.

BACKGROUND: Medical rehabilitation can be helpful for maintaining workers' health and work ability. Its contribution to longer working lives is of high economic relevance in aging populations. In Germany, individuals must apply for rehabilitative measures themselves. Therefore, the subjective need for rehabilitation (SNR) is a prerequisite for rehabilitation access. A low education level is associated with poor health, lower health literacy and more frequent utilization of health services. In the present study, we investigated whether lower educational levels are also associated with a greater SNR and whether health literacy, past rehabilitation utilization and physical health play a mediating role in this path in older employees. METHODS: 3,130 socially insured older employees (born in 1959 or 1965) who participated in the German prospective lidA (leben in der Arbeit) cohort-study in 2011, 2014 and 2018 were included. A causal mediation analysis with an inverse odds weighting approach was performed with the SNR as the dependent variable; educational level as the independent variable; and health, health literacy and past rehabilitation utilization as the mediating variables. Sociodemographic variables were adjusted for. RESULTS: The SNR was significantly greater in subjects with a low education level, poor physical health, inadequate health literacy and those who had utilized rehabilitation in the past. For health literacy, past rehabilitation utilization and physical health, a significant partial mediating effect on the SNR was found for employees with low compared to those with high education levels. However, the combined mediating effect of all the mediators was lower than the sum of their individual effects. Among those with medium or high education levels, none of the variables constituted a significant mediator. CONCLUSIONS: The path between a low education level and a high SNR is mediated by inadequate health literacy, past rehabilitation utilization and poor physical health; these factors do not act independently of each other. Promoting health education may lower the SNR by improving physical health and health literacy. While improving physical health is beneficial for individuals, improved health literacy can be economically advantageous for the health system by reducing inappropriate expectations of rehabilitation benefits and subsequent applications for rehabilitation.

[Workload and Rehabilitation Needs of Older Workers with and without Migrant Background - Results of the lidA Cohort Study]. / Arbeitsbelastungen und Rehabilitationsbedarf bei älteren Erwerbstätigen mit und ohne Migrationshintergrund ­ Ergebnisse der lidA Kohortenstudie.

BACKGROUND: The need for rehabilitation measures will increase in the future due to increasing retirement age and demographic changes. In addition, the need for rehabilitation measures is determined, among other things, by the strenuousness of work. The aim of the present study was to investigate whether employees with a migrant background (EmM) are exposed to strenuous work more often and have a higher need for rehabilitation than employees without a migrant background (EoM). MATERIAL AND METHODS: The lidA study is a nationwide, prospective cohort study focusing on work, age, health and labour force participation. Study subjects (2443 female, 2281 male) were socially secured employees, born in 1959 or 1965. They were personally interviewed with computer assistance. Data from the first study wave (2011) were used. Multiple logistic regression analyses adjusted for socio-demographic factors (age, gender, education and household equivalent income) were carried out to estimate the influence of migrant background, nationality and high workloads on the need for rehabilitation. RESULTS: First generation EmMs were particularly affected by high workloads compared to EoM. The subjectively experienced workloads of EoM and EmM of the second generation were on a comparable level. In contrast, there were no differences between EmM with German and foreign citizenship. After adjustment for sociodemographic and workload-related factors, a higher need for rehabilitation was shown for the first-generation EmM (not significant) in comparison with the second-generation EoM and EmM, but not for EmM with foreign citizenship in comparison with EmM with German citizenship. DISCUSSION: First-generation EmMs are exposed to strenuous work significantly more often and have a higher need for rehabilitation. However, the migrant background itself is not a determinant for increased rehabilitation needs. The significantly higher need for rehabilitation can rather be explained by the strenuousness of work and socio-demographic characteristics that are more frequent in first-generation EmM. Differentiated considerations of the subgroups of EmM are important to identify special needs and to avoid undersupply (e. g. due to access barriers).