Unemployed and disabled for work: identifying 3-year labour market pathways from the beginning of a sickness absence using sequence and cluster analyses in a register-based longitudinal study in Finland.

OBJECTIVES: This study followed the labour market pathways of unemployed persons who started a sickness absence (SA) spell. We aimed to unravel subgroups based on altering labour market states and to identify covariates of these subgroups. DESIGN: Register-based longitudinal study, with nine labour market states and 36-month units. SETTING AND PARTICIPANTS: All Finnish persons aged 18-59 years with an SA in 2016 who were unemployed at the start of the SA spell (N=12 639). OUTCOME MEASURES: Sequence analysis was used to study transitions between nine labour market states based on monthly register data on permanent and temporary (full and partial) disability pensions (DP), rehabilitation, all-cause SA, unemployment and employment. Individuals were grouped into clusters based on cluster analysis and intersequence distances. Multinomial regression analysis was used to examine covariates of cluster memberships. RESULTS: Six clusters with the following pathway identities were found: (1) recurring unemployment (44%); (2) employment after a short SA (18%); (3) rehabilitation, recurring SA and unemployment (12%); (4) unknown sources of income (11%); (5) permanent DP after a prolonged SA (9%) and (6) temporary DP after a prolonged SA (7%).Compared with the reference cluster 2, all other clusters were associated with less employment days and having a chronic illness before the SA spell, SA based on a mental disorder and a rejected DP application during the follow-up. In addition, the clusters had some unique covariates. CONCLUSIONS: Unemployed persons starting an SA are a heterogeneous group, with different labour market pathways. For many, the combination of unemployment and work disability means low chances for employment or regained work ability during the following years. Unemployed persons with poorer health, long history outside employment, older age, low educational level, a rejected DP application and a mental disorder could benefit from targeted support.

Determinants of disability pension applications and awarded disability pensions in Finland, 2009 and 2014.

Aims: Examining the non-medical determinants of applying for and being awarded disability pension is important for assessing the functionality of the disability pension system. We examined how demographic and socioeconomic factors as well as factors related to the disability process associate with the probability of applying for disability pension and the probability of applicants being awarded pension in 2009 and 2014. Methods: 70% random samples of Finnish non-retired residents aged 18-64 in 2009 (n = 2,076,881) and in 2014 (n = 2,097,790) were analysed with logistic regression analysis. The application rates were 0.9% in 2009 and 0.7% in 2014, and the rates of awarded pensions were 80.6% in 2009 and 72.2% in 2014. Results: Being an upper-level non-manual employee and having more employment during the preceding four calendar years decreased the odds of applying for disability pension but increased the odds of being awarded one. Older age increased the odds of both applying for and being awarded pension. Compared to applications based on mental disorders, those applying due to neoplasms and diseases of the circulatory system had increased odds of being awarded pension whereas those applying due to musculoskeletal diseases or injuries had decreased odds. Only minor temporal changes were found in the determinants of applying for or being awarded disability pension. Conclusions: With a greater probability of disability pension applications but also a lower probability of being awarded pension, the occupational disability process involves a comprehensive disadvantage for lower socioeconomic status groups.

Sources of income following a rejected disability pension application: a sequence analysis study.

Purpose: To identify different income trajectories after a rejected disability pension application and to analyze socio-demographic and disability process related determinants of these trajectories.Methods: Finnish residents aged 18-58 years with a first rejected disability pension application in 2010 (N = 3683) were followed for 48 months with register data. We performed a sequence analysis of six income sources (employment, unemployment benefit, sickness allowance, rehabilitation benefit, awarded disability pensions, other/unknown). Multinomial logistic regression was used in analyses.Results: Four clusters were identified, displaying unemployment, awarded disability pension, employment, or unknown source as the primary source of post-rejection income. Transitions between income sources were frequent, especially in the employment and unemployment clusters. Using the awarded pension cluster as the reference group, previous unemployment raised the odds of unemployment cluster membership the most. Similarly, previous employment raised the odds of employment cluster the most. A somatic rather than mental disorder and being under 50 years old raised the odds of being in the unemployment and employment clusters.Conclusions: After a rejected disability pension, main income paths include unemployment benefits, re-applied disability pension, and fragmented employment. Labor market and sickness history and age are associated with the probability of these paths.Implications for RehabilitationRejected disability pension applicants should be offered medical or vocational rehabilitation, to enable sustained labor market participation.Partial disability pension, supported by rehabilitation is one solution when a full-time labor market participation is not a realistic option.

Gambling expenditure by game type among weekly gamblers in Finland.

BACKGROUND: Excessive expenditure and financial harms are core features of problem gambling. There are various forms of gambling and their nature varies. The aim was to measure gambling expenditure by game type while controlling for demographics and other gambling participation factors. A further aim was to find out how each game type was associated with gambling expenditure when the number of game types played is adjusted for. METHODS: Using data from the 2015 Finnish Gambling survey on adult gamblers (n = 3555), multiple log-linear regression was used to examine the effects of demographics, gambling participation, and engaging in different game types on weekly gambling expenditure (WGE) and relative gambling expenditure (RGE). RESULTS: Male gender, lower education level, higher gambling frequency and higher number of game types increased both WGE and RGE, while younger age decreased WGE but increased RGE. Furthermore, seven specific game types increased both WGE and RGE. Weekly horse race betting and non-monopoly gambling had the strongest increasing effect on expenditure. Betting games and online poker were associated with higher expenditure even when they were played less often than weekly. Among weekly gamblers the highest mean WGE was recorded for those who played non-monopoly games (146.84 €/week), online poker (59.61 €/week), scratch games (51.77 €/week) and horse race betting (48.67 €/week). Those who played only 1-2 game types a week had the highest mean WGE and RGE on horse race betting and other betting games. CONCLUSIONS: It seems that overall gambling frequency is the strongest indicator of high gambling expenditure. Our results showed that different game types had different effect sizes on gambling expenditure. Weekly gambling on horse races and non-monopoly games had the greatest increasing effect on expenditure. However, different game types also varied based on their popularity. The extent of potential harms caused by high expenditure therefore also varies on the population level. Based on our results, future prevention and harm minimization efforts should be tailored to different game types for greater effectiveness.