Climacteric status at age 46 is associated with poorer work ability, lower 2-year participation in working life, and a higher 7-year disability retirement rate: a Northern Finland Birth Cohort 1966 study.

OBJECTIVE: To study the association between an advanced climacteric status at 46 years of age and current perceived work ability, the consequent 2-year accumulation of disability and unemployment days, and the 7-year incidence of disability pensions. METHODS: Study participants (n = 2,661) were recruited from the Northern Finland Birth Cohort 1966 study's 46-year follow-up in 2012. The participants' perceived work ability was investigated using the Work Ability Score (0-7 = poor vs 8-10 = good), along with potential covariates. Data concerning their consequent disability days, unemployment days, and disability pensions were collected from national registers. The association between their climacteric status at age 46 years, work ability, and working life participation was assessed using regression models. RESULTS: The climacteric women were more often smokers and more often had a lower level of education. The odds ratio for poor perceived work ability was 1.41 (95% CI, 1.06-1.87), and the incidence rate ratios for disability and unemployment days during the 2-year follow-up were 1.09 (95% CI, 1.07-1.11) and 1.16 (95% CI, 1.14-1.18), respectively, for the climacteric women compared with the preclimacteric women in models adjusted for smoking and education. The 7-year hazard ratio for disability pensions was 1.72 (95% CI, 1.02-2.91) for the climacteric women. CONCLUSIONS: An earlier menopausal transition is associated with poorer perceived work ability, and it predicts lower recorded work participation and a higher disability pension rate in subsequent years.

The Örebro Musculoskeletal Pain Screening Questionnaire-Short Form and 2-year follow-up of registered work disability.

BACKGROUND: The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) was developed to identify psychological and functioning-related risk factors among individuals with musculoskeletal pain at risk of work disability. This study aimed to examine whether the short version of the ÖMPSQ (ÖMPSQ-SF) can be used for this purpose, using registry-based outcomes. METHODS: The ÖMPSQ-SF was completed by the members of the Northern Finland Birth Cohort 1966 at the age of 46 years (baseline). These data were enriched with national registers, including information on sick leaves and disability pensions (indicators of work disability). The associations between the ÖMPSQ-SF categories (low-, medium- and high risk) and work disability over a 2-year follow-up were analysed using negative binomial regression and binary logistic regression models. We made adjustments for sex, baseline education level, weight status and smoking. RESULTS: Overall, 4063 participants provided full data. Of these, 90% belonged to the low-risk, 7% to the medium-risk and 3% to the high-risk group. Compared to the low-risk group, the high-risk group had a 7.5 [Wald 95% confidence interval (CI) 6.2-9.0] times higher number of sick leave days and 16.1 (95% CI 7.1-36.8) times higher odds of disability pension after adjustments in the 2-year follow-up. CONCLUSIONS: : Our study suggests that the ÖMPSQ-SF could be used for predicting registry-based work disability at midlife. Those allocated to the high-risk group seemed to have a particularly great need of early interventions to support their work ability.

Lost individual income due to severe health events: life-course perspective in the Northern Finland Birth Cohort 1966.

BACKGROUND: Severe health events may lead to reduced income among survivors. Importantly, individuals' risks for both severe health events and for lower income are shaped by early life course. Our aim was to consider early-life factors in determining lost individual income after stroke, heart attack and cancer between ages 18 and 50. METHODS: A population-based Northern Finland Birth Cohort 1966 (N = 12 058) was used. Early-life factors were collected since mid-pregnancy until age 16 years and used to match all persons with stroke, heart attack, or cancer (n = 995) with four controls. Registered annual individual income development 15 years before and after the event was compared between cases and propensity score matched controls using time-to-event mixed models, stratified for sex. RESULTS: Compared to controls, a new decreasing income trend emerged among women after stroke (logarithmic income per time -0.54; 95% CI -0.88 to -0.20), whereas men getting stroke showed declining earnings already by the time of the event, further declining after stroke (-1.00, -1.37 to -0.63). Getting heart attack was associated with a new declining trend both in women (-0.68; -1.28 to -0.09) and men (-0.69, -1.05 to -0.32). Income declined also among control men (-0.24, -0.34 to -0.14), who had higher income but were less educated than control women. CONCLUSIONS: Stroke and heart attack but not cancer have exogenous deleterious effects on individual economy, independently of early-life factors. The effects accelerate by time. Negative income trend in control men shows that severe health events do not explain all decrease in income.

Women with polycystic ovary syndrome have poorer work ability and higher disability retirement rate at midlife: a Northern Finland Birth Cohort 1966 study.

Objective: Polycystic ovary syndrome (PCOS) presents with multiple comorbidities potentially affecting function. This was the first general population-based study to evaluate work ability, participation in working life, and disability retirement in middle-aged women with and without PCOS. Design: This is a cohort study. Methods: Women with PCOS (n = 280) and women without PCOS symptoms or diagnosis (n = 1573) were identified in the Northern Finland Birth Cohort in 1966 and were evaluated for self-rated work ability and potential confounders at age 46. Next, incidence rate ratios (IRRs) for disability and unemployment days were extracted from national registers during a prospective 2-year follow-up. Lastly, we assessed hazard ratios (HRs) for disability retirement between 16 and 52 years of age from national registers. Results: The women with PCOS reported poorer ability to work at age 46, especially due to poorer health. During the 2-year follow-up period, the affected women gained on average an additional month of disability and unemployment days, corresponding to an approximately 25% higher risk for both disability (IRR (95% CI): 1.25 (1.22-1.27)) and unemployment days (IRR (95% CI): 1.26 (1.23-1.28)) in models adjusted for health and socioeconomic factors. Lastly, we found a two-fold higher cumulative risk for disability retirement by age 52 compared to non-PCOS women (HR (95% CI): 1.98 (1.40-2.80)), which remained after adjusting for confounding factors (aHR (95% CI): 1.55 (1.01-2.38)). Conclusions: PCOS is associated with lower participation in working life already in midlife. Acknowledging PCOS-related multimorbidity, concerted efforts are needed to support sustainable careers for women with PCOS.

Work-related stress and well-being in association with epigenetic age acceleration: A Northern Finland Birth Cohort 1966 Study.

Recent evidence indicates consistent association of low socioeconomic status with epigenetic age acceleration, measured from DNA methylation. As work characteristics and job stressors are crucial components of socioeconomic status, we investigated their association with various measures of epigenetic age acceleration. The study population included employed and unemployed men and women (n=604) from the Northern Finland Birth Cohort 1966. We investigated the association of job strain, effort-reward imbalance and work characteristics with five biomarkers of epigenetic aging (Hannum, Horvath, PhenoAge, GrimAge, and DunedinPoAm). Our results indicate few significant associations between work stress indicators and epigenetic age acceleration, limited to a range of ±2 years, and smoking recording the highest effect on GrimAge age acceleration biomarker between current and no smokers (median difference 4.73 years (IQR 1.18, 8.41). PhenoAgeAA was associated with job strain active work (ß=-1.301 95%CI -2.391, -0.212), slowing aging of less than 1.5 years, and working as white-collar slowed aging six months (GrimAgeAA ß=-0.683, 95%CI -1.264, -0.102) when compared to blue collars. Association was found for working for more than 40 hours per week that increased the aging over 1.5 years, (HorvathAA ß =2.058 95%CI 0.517,3.599, HannumAA ß=1.567, 95%CI 0.415,2.719). The pattern of associations was different between women and men and some of the estimated effects are inconsistent with current literature. Our results provide the first evidence of association of work conditions with epigenetic aging biomarkers. However, further epidemiological research is needed to fully understand how work-related stress affects epigenetic age acceleration in men and women in different societies.

Modeling the Multidimensional Predictors of Multisite Musculoskeletal Pain Across Adulthood-A Generalized Estimating Equations Approach.

Background: Multisite pain is commonly chronic and often lacks its initial role as a potential tissue damage signal. Chronic pain among working-age individuals is a risk for disability and imposes a major burden on health care systems and society. As effective treatments for chronic pain are largely lacking, better identification of the factors associated with pain over working years is needed. Methods: Members of the Northern Finland Birth Cohort 1966 participated in data collection at the ages of 31 (n = 4,028) and 46 (n = 3,429). Using these two time points, we performed a multivariable analysis of the association of socioeconomic, occupational, psychological and lifestyle factors (i.e., low education, living alone, low household income, unemployment, occupational physical exposures [hard physical labor, leaning forward, back twisting, constant moving, lifting loads of ≥ 1 kg], physical inactivity, regular smoking, regular drinking, overweight, and psychiatric symptoms) with the number of musculoskeletal pain sites (i.e., upper extremity, lower extremity, lower back, and the neck-shoulder region; totalling 0-4 pain sites). The data were analyzed using generalized estimating equations. Results: At the age of 31, multisite pain was reported by 72.5% of men and 78.6% of women. At the age of 46, the prevalence of multisite pain was 75.7% among men and 82.7% among women. Among men, the number of pain sites was positively associated with age (rate ratio 1.05, 95% confidence interval 1.01-1.08), low household income (1.05, 1.01-1.08), unemployment (1.13, 1.06-1.19), any occupational exposure (1.17, 1.12-1.22), regular smoking (1.06, 1.02-1.11), and psychiatric symptoms (1.21, 1.17-1.26). Among women, the number of pain sites was positively associated with age (1.06, 1.04-1.10), unemployment (1.10, 1.05-1.15), any occupational exposure (1.10, 1.06-1.13), regular smoking (1.06, 1.02-1.10), overweight (1.08, 1.05-1.11), and psychiatric symptoms (1.19, 1.15-1.22); living alone was negatively associated with the number of pain sites (0.95, 0.91-0.99). Conclusion: Of the studied predictors, psychiatric symptoms, occupational physical exposures and unemployment were most strongly associated with multisite pain among both sexes. The results of this study deepen the understanding of the underlying factors of and comorbidities behind multisite pain, and help develop pain relief and rehabilitation strategies for working-age individuals with multisite pain.

Physical heaviness of work and sitting at work as predictors of mortality: a 26-year follow-up of the Helsinki Birth Cohort Study.

OBJECTIVES: To examine the relationships of late-career physical heaviness of work and sitting at work with mortality. A national-level job exposure matrix was used to determine the occupation-specific level of physical heaviness and sitting. DESIGN: Prospective cohort study between years 1990 and 2015. SETTING: Community. PARTICIPANTS: 5210 men and 4725 women from the Helsinki Birth Cohort Study with an occupational code at baseline (ages 45-57 years). PRIMARY AND SECONDARY OUTCOME MEASURES: Total, cardiovascular (International Classification of Diseases 10th Revision I00-I99), cancer (C00-C97) and external (S00-Y84) mortality. RESULTS: The exposures, physical heaviness and sitting had a non-linear, inverse relationship. During the 26-year follow-up, 1536 men and 759 women died. Among men, physical heaviness of work was positively associated and sitting at work was negatively associated with all-cause, cardiovascular and external cause mortality but they were not associated with cancer mortality. The HRs for men in the highest quartile of physical heaviness of work compared with men in the lowest quartile were 1.54 (1.31-1.80) for all-cause mortality, 1.70 (1.30-2.23) for cardiovascular mortality and 3.18 (1.75-5.78) for external cause mortality (adjusted for age and years of education). Compared with the lowest quartile, the HRs for the highest quartile of sitting at work among men were 0.71 (0.61-0.82) for all-cause mortality, 0.59 (0.45-0.77) for cardiovascular mortality and 0.38 (0.22-0.66) for external cause mortality. In women, neither physical heaviness of work nor sitting at work was associated with mortality. CONCLUSIONS: Men in physically heavy work at their late-work career are at higher risk of death than men in physically light work.

Socioeconomic and health-related childhood and adolescence predictors of entry into paid employment.

BACKGROUND: Most studies on prolonging working careers have explored later career, while less is known about social and particularly health-related determinants of entry into labour market. We examined social and health-related factors from childhood and adolescence as predictors of age at entry into paid employment and early occupational class, and whether own education moderates these associations. METHODS: The Northern Finland Birth Cohort 1986 was followed from birth until the end of 2015. We included 8542 participants (52% male) who had had a minimum of 6-month employment that was defined by registered earning periods. As socioeconomic predictors, we examined low parental education at age 7 and low household income at age 16. Behaviour- and health-related factors at age 16 included smoking, alcohol use, physical inactivity, overweight, length of sleep and not having breakfast, while mental health problems included symptoms of anxiety and depression, attention problems and social problems. The analyses for significant predictors were further stratified by register-based level of completed own education by age 28-29 (low/high). RESULTS: After adjustments, low parental education, smoking and having been drunk were significant predictors of early entry into paid employment (≤18 vs. ≥24 years), especially among those who later obtained high education. Low parental education and smoking were predictors of low or non-specified (vs. high) occupational class in the first job. Mental health problems were not associated with either outcome. CONCLUSIONS: Socioeconomic background and unhealthy lifestyle contribute to early entry into the labour market and low occupational status in the first job.

Accumulated exposure to unemployment is related to impaired glucose metabolism in middle-aged men: A follow-up of the Northern Finland Birth Cohort 1966.

AIMS: We explored whether registered unemployment is associated with impaired glucose metabolism in general population. METHODS: Based on Northern Finland Birth Cohort 1966 at 46 years, we analyzed the oral glucose tolerance tests of 1970 men and 2544 women in relation to their preceding three-year employment records in three categories of unemployment exposure: no (employed), low (≤1-year) and high exposure (>1-year). RESULTS: Among men, pre-diabetes was found in 19.2% of those with no unemployment, 23.0% with low and 27.0% with high exposure, the corresponding figures for screen-detected type 2 diabetes were 3.8%, 3.8% and 9.2% (p<0.01). Among women, analogous figures for pre-diabetes were 10.0%, 12.6% and 16.2% and for screen-detected type 2 diabetes 1.7%, 3.4% and 3.6% (p<0.01). Men with high exposure to unemployment had a higher risk for pre-diabetes (OR 1.61, CI 95% 1.03-2.51) and screen-detected type 2 diabetes (OR 2.58 95% CI 1.23-5.44) than employed men, after adjustment for education, smoking, alcohol intake, physical activity and body mass index. Among women, associations were attenuated in the adjusted models. CONCLUSIONS: High exposure to unemployment may predispose to type 2 diabetes in middle-aged men. For clinicians, awareness of the patient's unemployment status may be helpful in recognizing undiagnosed cases.

Effect of occupational physical activities on vertebral dimensions in midlife in the Northern Finland Birth Cohort 1966.

OBJECTIVES: The vertebral cross-sectional area (CSA) is a major determinant of vertebral strength. Since leisure-time physical activity (LTPA) is known to affect vertebral CSA, we hypothesised that engagement in physical activity at work might have similar effects on vertebral size. We aimed to examine the association between various adulthood occupational physical activities (OPA) and vertebral CSA, and to evaluate the association between OPA intensity and vertebral CSA. METHODS: We used the prospective population-based Northern Finland Birth Cohort 1966. Our sample consisted of 712 participants with a mean age of 46.8 years. We assessed their engagement in various individual physical work activities at the ages of 31 and 46, and created overall OPA categories (high, moderate and low intensity), which we used in the analyses to study their association with vertebral CSA in middle age. Linear regression was used as the statistical method with adjustments for LTPA, vertebral height, body mass index and smoking. RESULTS: A statistically significant association was found between occupational sitting and smaller vertebral CSA in men, but only at the age of 31 (49.2 mm2 smaller among those who sit often vs rarely (95% CI -96.0 to -2.4)). No significant differences were detected between OPA categories and vertebral CSA (p>0.05). Thus, we found no consistent association between OPA and vertebral size among either sex. CONCLUSIONS: OPA seems to have very little effect on vertebral size. Our results suggest that the effect of LTPA on vertebral size is different to that of OPA.

Perceived Work Ability in the Light of Long-Term and Stress-Related Unhealthy Behaviors-a Prospective Cohort Study.

BACKGROUND: Most of the few studies that exist on the longitudinal associations between health behaviors and work ability target to single health behaviors. PURPOSE: To investigate how lifetime clusters of unhealthy behaviors associate with perceived work ability in early midlife. METHODS: The study population consisted of 46-year-old men and women (n = 3107) born in Northern Finland in 1966. Their current perceived work ability compared to lifetime best, and their unhealthy behaviors (physical inactivity, smoking, and alcohol consumption) were assessed by questionnaires. We determined clusters of unhealthy behaviors at the ages of 14, 31, and 46 and created lifetime development trajectories of health behaviors. We also assessed stress-related eating and drinking at the ages of 31 and 46. Cross-tabulations and multivariate logistic regression models were used to investigate the associations between clusters of health behaviors, stress-related eating and drinking, and work ability at 46 years. The analyses were controlled for basic education and physical strenuousness of work, psychosocial job characteristics, perceived work ability, and BMI (kg/m(2)) at 31 years. RESULTS: Four health behavior trajectories emerged: always healthy, moderate (reference group), deteriorated. and always unhealthy. Among men, always unhealthy behaviors [OR (95 % confidence interval) 2.81 (1.35, 5.86)], and among women, deteriorated health behaviors [1.67 (1.07, 2.58)] associated with poor perceived work ability at 46 years. In addition, stress-related eating and drinking associated independently with poor perceived work ability at 46 years [men 2.58 (1.62, 4.12) and women 2.48 (1.70, 3.61)]. CONCLUSION: Long-lasting and stress-related unhealthy behaviors increase the risk of poor work ability in midlife.

Job strain and adverse health behaviors: the Finnish Public Sector Study.

OBJECTIVE: The objective of this study was to explore the association between job strain and the co-occurrence of adverse health behaviors; smoking, heavy drinking, obesity, and physical inactivity. METHODS: The authors studied cross-sectional data of 34,058 female and 8154 male public sector employees. RESULTS: Multinomial logistic regression models adjusted for sex, age, basic education, marital status, and type of job contract showed that high job strain and passive jobs were associated with 1.3 to 1.4 times higher odds of having > or =3 (vs 0) adverse health behaviors. Among men, low job control was associated with a 1.3-fold likelihood and among women active jobs were associated with a 1.2-fold likelihood of having > or =3 (vs 0) adverse behaviors. High demands were associated with a higher likelihood of co-occurrence of one to two (vs 0) adverse behaviors among women. CONCLUSIONS: Job strain conditions may be associated with the co-occurrence of adverse health behaviors that contribute to preventable chronic diseases. CLINICAL SIGNIFICANCE: Adverse job conditions may increase the likelihood of co-occurring health risk behaviors. Reducing work stress by increasing job control and decreasing psychologic demands might help efforts to promote healthy lifestyles.