Can psychosocial risk factors mediate the association between precarious employment and mental health problems in Sweden? Results from a register-based study.

OBJECTIVES: The aim of this study was to examine the mediating effect of the psychosocial work environment on the association between precarious employment (PE) and increased risk of common mental disorders (CMD), substance use disorders and suicide attempts. METHODS: This longitudinal register-study was based on the working population of Sweden, aged 25-60 years in 2005 (N=2 552 589). Mediation analyses based on a decomposition of counterfactual effects were used to estimate the indirect effect of psychosocial risk factors (PRF) (mediators, measured in 2005) on the association between PE (exposure, measured in 2005) and the first diagnosis of CMD, substance use disorders, and suicide attempts occurring over 2006-2017. RESULTS: The decomposition of effects showed that the indirect effect of the PRF is practically null for the three outcomes considered, among both sexes. PE increased the odds of being diagnosed with CMD, substance use disorders, and suicide attempts, among both men and women. After adjusting for PE, low job control increased the odds of all three outcomes among both sexes, while high job demands decreased the odds of CMD among women. High job strain increased the odds of CMD and suicide attempts among men, while passive job increased the odds of all three outcomes among women. CONCLUSION: The results of this study did not provide evidence for the hypothesis that psychosocial risks could be the pathways linking precarious employment with workers` mental health. Future studies in different social contexts and labour markets are needed.

The role of working conditions in educational differences in all-cause and ischemic heart disease mortality among Swedish men.

OBJECTIVES: This study aims to investigate the extent to which low job control and heavy physical workload in middle age explain educational differences in all-cause and ischemic heart disease (IHD) mortality while accounting for important confounding factors. METHODS: The study is based on a register-linked cohort of men who were conscripted into the Swedish military at around the age of 18 in 1969/1970 and were alive and registered in Sweden in 2005 (N=46 565). Cox proportional hazards regression models were built to estimate educational differences in all-cause and IHD mortality and the extent to which this was explained by physical workload and job control around age 55 by calculating the reduction in hazard ratio (HR) after adjustments. Indicators of health, health behavior, and other factors measured during conscription were accounted for. RESULTS: We found a clear educational gradient for all-cause and IHD mortality (HR 2.07 and 2.47, respectively, for the lowest compared to the highest education level). A substantial part was explained by the differential distribution of the confounding factors. However, work-related factors, especially high physical workload, also played important explanatory roles. CONCLUSION: Even after accounting for earlier life factors, low job control and especially high physical workload seem to be important mechanistic factors in explaining educational inequalities in all-cause and IHD mortality. It is therefore important to find ways to reduce physical workload and increase job control in order to decrease inequalities in mortality.

The impact of cardiorespiratory fitness and physical workload on disability pension-a cohort study of Swedish men.

OBJECTIVE: Understanding the impact of physical capacity in combination with high physical workload could be beneficial for the prevention of health-related exits from work. Therefore, the aim of this study was to investigate the separate and combined effects of low cardiorespiratory fitness and high physical workload on disability pension (DP) due to any cause, musculoskeletal disorders (MSD), and cardiovascular diseases (CVD). METHODS: A total of 279 353 men born between 1951 and 1961 were followed regarding DP between 2006 and 2020, ages 45-64. Cardiorespiratory fitness was assessed during military conscription, using an ergometer bicycle test. Physical workload was based on a job-exposure matrix (JEM) linked to occupational title in 2005. Cox regression models estimated separate and combined associations with DP. RESULTS: Low cardiorespiratory fitness and high physical workload were associated with increased risk of DP. For all cause DP, the fully adjusted hazard ratio and 95% confidence interval for those with low cardiorespiratory fitness was 1.38 (1.32-1.46) and for those with high physical workload 1.48 (1.39-1.57). For all cause and MSD DP, but not for CVD DP, the combination of low cardiorespiratory fitness and high physical workload resulted in higher risks than when adding the effect of the single exposures. CONCLUSION: Both low cardiorespiratory fitness in youth and later exposure to high physical workload were associated with an increased risk of DP, where workers with the combination of both low cardiorespiratory fitness and a high physical workload had the highest risks (all-cause and MSD DP).

Do early life factors explain the educational differences in early labour market exit? A register-based cohort study.

BACKGROUND: Socioeconomic inequalities in labour market participation are well established. However, we do not fully know what causes these inequalities. The present study aims to examine to what extent factors in childhood and late adolescence can explain educational differences in early labour market exit among older workers. METHODS: All men born in 1951-1953 who underwent conscription examination for the Swedish military in 1969-1973 (n = 145 551) were followed from 50 to 64 years of age regarding early labour market exit (disability pension, long-term sickness absence, long-term unemployment and early old-age retirement with and without income). Early life factors, such as cognitive ability, stress resilience, and parental socioeconomic position, were included. Cox proportional-hazards regressions were used to estimate the association between the level of education and each early labour market exit pathway, including adjustment for early life factors. RESULTS: The lowest educated men had a higher risk of exit through disability pension (HR: 2.72), long-term sickness absence (HR: 2.29), long-term unemployment (HR: 1.45), and early old-age retirement with (HR: 1.29) and without income (HR: 1.55) compared to the highest educated men. Factors from early life explained a large part of the educational differences in disability pension, long-term sickness absence and long-term unemployment but not for early old-age retirement. Important explanatory factors were cognitive ability and stress resilience, whilst cardiorespiratory fitness had negligible impact. CONCLUSIONS: The association between education and early exit due to disability pension, long-term sickness absence and long-term unemployment was to a large part explained by factors from early life. However, this was not seen for early old-age retirement. These results indicate the importance of taking a life-course perspective when examining labour market participation in later working life.

Trajectories of psychosocial working conditions and all-cause and cause-specific mortality: a Swedish register-based cohort study.

OBJECTIVES: While psychosocial working conditions have been associated with morbidity, their associations with mortality, especially cause-specific mortality, have been less studied. Additionally, few studies considered the time-varying aspect of exposures. We aimed to examine trajectories of job demand-control status in relation to all-cause and cause-specific mortality, including cardiovascular diseases (CVD), suicide, and alcohol-related mortality. METHODS: The study population consisted of around 4.5 million individuals aged 16-60 years in Sweden in 2005. Job control and demands were respectively measured using job exposure matrices (JEM). Trajectories of job control and demands throughout 2005-2009 were identified using group-based trajectory modelling, and job demand-control categories were subsequently classified. Deaths in 2010-2019 were recorded in the national cause of death register. Cox regression models were used. RESULTS: A total of 116 242 individuals died in 2010-2019. For both job control and demands, we identified four trajectories, which were parallel to each other and represented four levels of exposures. Low control and passive jobs were associated with higher all-cause, CVD, and suicide mortality among both men and women. High strain jobs were associated with higher all-cause and CVD mortality among men, while low control, passive jobs, and high strain jobs were associated with higher alcohol-related mortality among women. CONCLUSIONS: The trajectories identified may suggest stable levels of job control and demands over time. Poor psychosocial working conditions are related to all-cause and cause-specific mortality, and these patterns vary to some extent between men and women.

Job demands and job control and their associations with disability pension-a register-based cohort study of middle-aged and older Swedish workers.

OBJECTIVES: Job demands and control at work and their combination, job strain, have been studied in relation to risk of disability pension (DP) previously. In the present study, based on registry data, we aimed to deepen the knowledge by analyzing major disease groups among the DPs, dose-response shape of the associations, and potential confounding effects of physical workload. METHODS: Approximately 1.8 million workers aged 44 or older and living in Sweden in 2005 were followed up for 16 years, up to a maximum of 65 years of age. We linked mean values of job demands and job control, estimated in a job-exposure matrice (JEM) by gender, to individuals through their occupational titles in 2005. These values were categorized by rank order, and, for the construction of job-strain quadrants, we used a median cut-off. Associations with DP were estimated in Cox proportional-hazards models. RESULTS: In models accounting for covariates including physical workload, low levels of job control were associated with higher risk of DP among both men and women. This association was most clear for DP with a psychiatric diagnosis, although a dose-response shape was found only among the men. High levels of job demands were associated with decreased risk of DP across diagnoses among men, but the same association varied from weak to non-existing among women. The high- and passive job-strain quadrants both showed increased risk of DP with a psychiatric diagnosis. CONCLUSION: The results suggest that, at the occupational level, low job control, but not high job demands, contributes to an increased incidence of DP, particularly regarding DP with a psychiatric diagnosis.

Combined exposure to heavy physical workload and low job control and the risk of disability pension: A cohort study of employed men and women in Sweden.

OBJECTIVE: To investigate the separate and combined effects of overall heavy physical workload (PWL) and low decision authority on all-cause disability pension (DP) or musculoskeletal DP. METHODS: This study uses a sample of 1,804,242 Swedish workers aged 44-63 at the 2009 baseline. Job Exposure Matrices (JEMs) estimated exposure to PWL and decision authority. Mean JEM values were linked to occupational codes, then split into tertiles and combined. DP cases were taken from register data from 2010 to 2019. Cox regression models estimated sex-specific Hazard Ratios (HR) with 95% confidence intervals (95% CI). The Synergy Index (SI) estimated interaction effects. RESULTS: Heavy physical workload and low decision authority were associated with an increased risk of DP. Workers with combined exposure to heavy PWL and low decision authority often had greater risks of all-cause DP or musculoskeletal DP than when adding the effects of the single exposures. The results for the SI were above 1 for all-cause DP (men: SI 1.35 95%CI 1.18-1.55, women: SI 1.19 95%CI 1.05-1.35) and musculoskeletal disorder DP (men: SI 1.35 95%CI 1.08-1.69, women: 1.13 95%CI 0.85-1.49). After adjustment, the estimates for SI remained above 1 but were not statistically significant. CONCLUSION: Heavy physical workload and low decision authority were separately associated with DP. The combination of heavy PWL and low decision authority was often associated with higher risks of DP than would be expected from adding the effects of the single exposures. Increasing decision authority among workers with heavy PWL could help reduce the risk of DP.

Precarious employment at a young age and labor-market marginalization during middle-adulthood: A register-linked cohort study.

OBJECTIVE: The present study aims to investigate the association between exposure to precarious employment three years after graduation and the risk of labor market marginalization (LMM) ten years later. METHODS: A registered-linked cohort study based on the Swedish Work, Illness, and Labor-market Participation (SWIP) cohort was conducted among all individuals born between 1973 and 1976, who were registered in Sweden the year they turned 27 years old (N=365 702). Information on the exposure of labor market establishment three years after graduating from school and outcome of LMM ten years after graduating was collected from nationwide registers. Relative risk ratios (RRR) with 95% confidence intervals (CI) were obtained by multinominal logistic regression. RESULTS: After considering important covariates, young adults in precarious employment three years after graduation were at an increased risk of future long-term unemployment (RRR 2.31), later precarious employment (RRR 2.85), and long-term sickness absence/disability pension (RRR 1.43) compared to individuals who had obtained standard employment arrangements within three years of graduating. Young precariously employed men had a slightly strong association compared to females with regards to all outcomes. CONCLUSION: The result of this study suggests that both young men and women in precarious employment three years after graduation are more likely to have a weaker attachment to the labor force later in life compared to individuals of the same age in standard employment. This is important as the prevalence of precarious employment is increasing globally, and young adults appear to be especially vulnerable.

Precarious employment and occupational injuries in Sweden between 2006 and 2014: a register-based study.

BACKGROUND: Precarious employment (PE) has been suggested as a risk factor for occupational injuries (OIs). However, several issues such as under-reporting and time at risk pose obstacles to obtaining unbiased estimates of risk OBJECTIVE: To investigate if PE is a risk factor for OIs in Sweden. METHODS: This register-based study included employed workers aged 18-65, resident in Sweden between 2006 and 2014. PE was operationalised as a multidimensional construct (score) and by its five items (contract insecurity, contractual temporariness, multiple jobs/multiple sectors, income level, collective bargaining agreement). Our outcome was OI in the following year. Pooled ORs for OIs in relation to PE and PE items were calculated by means of multivariate logistic regression models for women and men separately. RESULTS: Precarious workers were at lower risk of OIs as compared with non-precarious workers among both males and females (OR <1) also when applying weights for under-reporting and adjusting for time at risk (part-time work). Male agencies workers had a higher risk of OIs (OR 1.19, 95% CI 1.15 to 1.23), as did male and female workers in multiple jobs/sectors (OR 1.25, 95% CI 1.23 to 1.28 and OR 1.10, 95% CI 1.07 to 1.13 respectively), and female workers in the low-income groups (OR 1.11, 95% CI 1.09 to 1.12). Low coverage of collective bargaining agreements was associated with a lower risk of OIs for both men and women (OR 0.30, 95% CI 0.29 to 0.31 and OR 0.26, 95% CI 0.24 to 0.27, respectively). CONCLUSIONS: While several mechanisms may explain why precarious workers in Sweden present lower risks of OIs, several dimensions of PE such as temp agency work and multiple job-holding could be important risk factors for OIs and merit further research.

Trends in Precarious Employment in Sweden 1992-2017: A Social Determinant of Health.

The aim of this study was to identify trends in precarious employment in the Swedish workforce from 1992 to 2017. This is a repeated cross-sectional study, analyzing the total working population aged 16-75 in Sweden at five-year intervals. We used version 2.0 of the Swedish Register-based Operationalization of Precarious Employment, covering the following dimensions: employment insecurity, income inadequacy, lack of rights and protection. The proportion in precarious employment increased from 9.7 to 12% between 1992 and 2017, a relative increase of 24%. The prevalence was higher among those of lower age, of low education, and immigrants. Differences between sexes converged, and there were slightly more precarious men than women in 2017. The relative increase was most pronounced among men, especially those with low educational attainment and of European origin. The increasing proportion of precarious employees is a clear challenge to the tripartite Nordic model, which requires sufficient trade-union bargaining power.

Does a change to an occupation with a lower physical workload reduce the risk of disability pension? A cohort study of employed men and women in Sweden.

OBJECTIVE: This study aimed to examine if a change to an occupation with a lower physical workload reduces the risk of all-cause disability pension (DP) and musculoskeletal DP (MDP). METHODS: This study used a sample of 359 453 workers who were registered as living in Sweden in 2005 and aged 44-63 in 2010. Exposure to physical workload was measured from 2005-2010 by linking a mean value from a job exposure matrix to occupational codes. The mean values were then split into quartiles. All included participants had high exposure to physical workload (top quartile) from 2005-2007. A change in physical workload was measured as a change to (i) any lower quartile or (ii) medium-high or low quartiles from 2008-2010. DP cases were taken from register data from 2011-2016. Crude and multivariate Cox proportional-hazards regression models estimated sex-specific hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: Compared to workers with consistently high physical workload, a change to any lower quartile of physical workload was associated with a decreased risk of all-cause DP (men: HR 0.59, 95% CI 0.46-0.77, women: HR 0.63, 95% CI 0.52-0.76) and MDP (men: HR 0.52, 95% CI 0.31-0.89, women: HR 0.61, 95% CI 0.44-0.84). Older workers had the largest decreased risk for MDP. Generally, changing from high to low physical workload was associated with a greater reduced risk of DP than changing from high to medium-high physical workload. CONCLUSIONS: Changing to an occupation with lower exposure to physical workload was associated with reduced risks of DP and MDP among both sexes.

Job control, job demands and job strain and suicidal behaviour among three million workers in Sweden.

OBJECTIVE: To investigate the association between job control, job demands and their combination (job strain) and suicide attempts and deaths among male and female workers in Sweden. METHODS: Job control and demands were measured separately for men and women using a job exposure matrix, which was linked to around three million individuals based on their occupational title in 2005. Suicide attempts and deaths were measured in the hospital and cause of death registers from 2006 to 2016. HRs were estimated using discrete proportional hazards models with annually updated age as the time axis. Models were adjusted for sociodemographic, family, health, labour market and childhood factors, as well as the time-varying effects of unemployment, sick leave and family factors during follow-up. RESULTS: Low job control was associated with an increased risk of suicide attempts and deaths among both men and women while high job demands tended to be associated with a decreased risk. The combination of job control and job demands (job strain) reflected the increased risk of low control jobs and the decreased risk of high demand jobs. Associations were attenuated but still present after adjustments. CONCLUSIONS: Low job control is related to suicide attempts and deaths, and this is only partially explained by important covariates measured both prebaseline and during follow-up. Attempts to increase job control among workers may be beneficial in preventing suicide.

Death of a Parent and the Risk of Ischemic Heart Disease and Stroke in Denmark and Sweden.

Importance: Increasing evidence suggests that parental death is associated with unhealthy behaviors and mental ill-health. Knowledge regarding the link between parental death and the risk of ischemic heart disease (IHD) and stroke remains limited. Objectives: To investigate whether parental death is associated with an increased risk of IHD and stroke and whether these associations differ by the characteristics of the loss. Design, Setting, and Participants: This population-based cohort study, involving linkages between several nationwide registers, included 3 766 918 individuals born between 1973 and 1998 in Denmark and between 1973 and 1996 in Sweden. Participants were followed up until 2016 in Denmark and 2014 in Sweden. Data were analyzed from December 2019 to May 2021. Exposures: Death of a parent. Main Outcomes and Measures: Diagnosis with or death due to IHD or stroke. Poisson regression was used to analyze the associations between parental death and IHD and stroke risk. Results: Altogether, 48.8% of the participants were women, and 42.7% were from Denmark. A total of 523 496 individuals lost a parent during the study period (median age at loss, 25 years; IQR, 17-32 years). Parental death was associated with a 41% increased risk of IHD (incidence rate ratio [IRR], 1.41; 95% CI, 1.33-1.51) and a 30% increased risk of stroke [IRR, 1.30; 95% CI, 1.21-1.38). The associations were observed not only if the parent died because of cardiovascular or other natural causes but also in cases of unnatural deaths. The associations were stronger when both parents had died (IHD: IRR, 1.87; 95% CI, 1.59-2.21; stroke: IRR, 1.64; 95% CI, 1.35-1.98) than when 1 parent had died (IHD: IRR, 1.37; 95% CI, 1.28-1.47; stroke: IRR, 1.27; 95% CI, 1.19-1.36) but did not differ substantially by the offspring's age at loss or the deceased parents' sex. The risk of acute myocardial infarction was highest in the first 3 months after loss. Conclusions and Relevance: In this cohort study, parental death in the first decades of life was associated with an increased risk of IHD and stroke. The associations were observed not only in cases of parental cardiovascular and other natural deaths but also in cases of unnatural deaths. Family members and health professionals may need to pay attention to the cardiovascular disease risk among parentally bereaved individuals.

Educational qualification differences and early labor market exit among men: the contribution of labor market marginalization measured across the working life.

BACKGROUND: The present study aims to investigate the association between educational qualification and early labor market exit among men and to examine the contribution of labor market marginalization measured across the working life on this association. METHOD: A register-linked cohort study was conducted including men who completed military service in 1969/70 (born between 1949 and 1951) and were alive at age 55 and not disability pension beneficiaries (n = 40 761). Information on the highest level of educational qualification and the outcome of early exit (disability pension, sickness absence, unemployment, and early old-age pension) was obtained from Swedish nationwide registers between the ages of 55 and 64 years. Labor market marginalization was defined as periods of long-term unemployment and sickness absence over the working life and up to follow-up. Cox regression analyses were used to obtain hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: Low-educated men were more likely to leave the labor force early due to disability pension or sickness absence (HR: 2.48), unemployment (HR: 2.09), and early old-age pension with- (HR:1.25) and without -income (HR: 1.58). Labor market marginalization across the working life explained a large part of the association for the more involuntary early exit routes (disability pensions, sickness absence, unemployment) and explained very little with regards to the more voluntary early exit routes (early old-age pension with and without income). CONCLUSION: Exposure to labor market marginalization across the working life was important in explaining educational differences in early labor market exit due to disability pension or sickness absence and unemployment. This study underscores the importance of identifying and implementing preventive measures in the workplace (e.g. adaptions) to prevent new spells of sickness absence and unemployment, especially among low educated individuals.

Long-term sick leave for back pain, exposure to physical workload and psychosocial factors at work, and risk of disability and early-age retirement among aged Swedish workers.

PURPOSE: To assess the risk of disability and early-age retirement associated with previous long-term sickness absence for back pain (back-pain SA), exposure to high physical workload, low job control, high demands and high strain, and to evaluate effect modification by work factors on the relationship between back-pain SA and premature retirement. METHODS: All employed Swedish residents born 1946-1955 (n = 835,956) were followed up from 2010 to 2016 for disability (DP) and early-age pension (EAP). Associations of premature retirement with exposure to work factors and back-pain SA in the 3 years before follow-up were estimated through proportional hazards models. Retirement, back-pain SA and covariates were assessed through administrative sources, and exposure to work factors through a job-exposure matrix. RESULTS: In both genders, back-pain SA was associated with DP (> 1 episode: HR 3.23 among men; HR 3.12 among women) and EAP (> 1 episode: HR 1.24 among men; HR 1.18 among women). Higher physical workload and lower job control were also associated with an increased DP risk in both genders, whereas higher job demands showed a decreased risk. For EAP, associations with work factors were weak and inconsistent across genders. No effect modification by work factors was found, except for a negative effect modification by job strain on DP risk among women, i.e. a reduced effect of back-pain SA with increasing exposure. CONCLUSION: Back-pain SA was a significant predictor of both DP and EAP, while work factors were consistently associated only with DP. Our results indicate that the joint effect of back-pain SA and work factors on DP is additive and does not support effect modification by work factors.

Psychosocial workplace factors and alcohol-related morbidity: a prospective study of 3 million Swedish workers.

BACKGROUND: Psychosocial workplace factors may be associated with alcohol-related morbidity, but previous studies have had limited opportunities to take non-occupational explanatory factors into account. The aim of this study is to investigate associations between job control, job demands and their combination (job strain) and diagnosed alcohol-related morbidity while accounting for several potentially confounding factors measured across the life-course, including education. METHODS: Job control, job demands and job strain were measured using the Swedish job exposure matrix measuring psychosocial workload on the occupational level linked to over 3 million individuals based on their occupational titles in 2005 and followed up until 2016. Cox regression models were built to estimate associations with alcohol-related diagnoses recorded in patient registers. RESULTS: Low job control was associated with an increased risk of alcohol-related morbidity, while high job demands tended to be associated with a decreased risk. Passive and high-strain jobs among men and passive jobs among women were also associated with an increased risk of alcohol diagnoses. However, all associations were found to be weakened in models adjusted for other factors measured prospectively over the life-course, especially in models that included level of education. CONCLUSION: The associations between low job control and high job demands, and the risk of alcohol-related morbidity reflect underlying socioeconomic differences to some extent. Lower job control, however, remained associated with a higher risk of alcohol-related morbidity.

Fathers' alcohol consumption and risk of substance-related disorders in offspring.

BACKGROUND: Few studies have assessed how children are affected by parental alcohol consumption without clinically diagnosed alcohol problems, especially in relation to more long-term and severe consequences. The aim is to investigate how fathers' alcohol use is related to the risk for substance-related disorders in offspring. METHOD: A prospective cohort study of 64 710 Swedish citizens whose fathers were conscripted for compulsory military training at ages 18-20 in 1969/70. Information on fathers' alcohol consumption, frequency of intoxication and apprehended for drunkenness, was collected during conscription. Offspring was followed for substance-related disorders from age 12 to end of follow up in 2009. RESULTS: All measures of fathers' alcohol use were significantly and positively associated with risk for substance-related disorders in offspring. The associations were to a large extent explained by other risk factors in childhood. In the fully adjusted model, those with fathers in the highest alcohol consumption quintile still had a 63% higher risk (HR=1.63 CI 1.26-2.12) of substance-related disorders compared to those whose fathers' reported abstinence. The highest risk was found among offspring to fathers with alcohol-related disorders or that had been apprehended for drunkenness, with a more than two-fold increased risk for substance-related disorders. CONCLUSIONS: Despite the lower risk found among offspring to fathers with sub-clinical drinking when compared to those with alcohol-related disorders, the former group accounts for a much larger proportion of all cases of substance-related disorders in the population, prompting universal prevention efforts targeting the level of total alcohol consumption in society.

Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study.

BACKGROUND: The aim is to identify trajectories of precarious employment (PE) over time in Sweden to examine associations of these with the subsequent risk of myocardial infarction (MI) and stroke. METHODS: This is a nation-wide register-based cohort study of 1,583,957 individuals aged 40 to 61 years old residing in Sweden between 2003-2007. Trajectories of PE as a multidimensional construct and single PE components (contractual employment relationship, temporariness, income levels, multiple job holding, probability of coverage by collective agreements) were identified for 2003-2007 by means of group-based model trajectories. Risk Ratios (RR) for MI and stroke according to PE trajectories were calculated by means of generalized linear models with binomial family. FINDINGS: Adjusted estimates showed that constant PE and borderline PE trajectories increased the risk of MI (RR: 1·08, CI95%:1·05-1·11 and RR:1·13, CI95%: 1·07-1·20 respectively) and stroke (RR:1·14, CI95%: 1·10-1·18 and HR:1·24, CI95%: 1·16-1·33 respectively) among men. A higher risk of stroke in men was found for the following unidimensional trajectories: former agency employees (RR:1·32, CI95%:1·04-1·68); moving from high to a low probability of having collective agreements (RR: 1·10, CI95%:1·01-1·20). Having constant low or very low income was associated to an increased risk of MI and Stroke for both men and women. INTERPRETATION: The study findings provide evidence that PE increases the risk of stroke and possibly MI. It highlights the importance of being covered by collective bargaining agreements, being directly employed and having sufficient income levels over time. FUNDING: The Swedish Research Council for Health, Working Life and Welfare, no. 2019-01226.

Under-reporting of non-fatal occupational injuries among precarious and non-precarious workers in Sweden.

BACKGROUND: Under-reporting of occupational injuries (OIs) among precariously employed workers in Sweden challenges effective surveillance of OIs and targeted preventive measures. OBJECTIVE: To estimate the magnitude of under-reporting of OIs among precarious and non-precarious workers in Sweden in 2013. METHODS: Capture-recapture methods were applied using the national OIs register and records from a labour market insurance company. Employed workers 18-65 resident in Sweden in 2013 were included in the study (n=82 949 OIs). Precarious employment was operationalised using the national labour market register, while injury severity was constructed from the National Patient Register. Under-reporting estimates were computed stratifying by OIs severity and by sociodemographic characteristics, occupations and precarious employment. RESULTS: Under-reporting of OIs followed a dose-response pattern according to the levels of precariousness (the higher the precarious level, the higher the under-reporting) being for the precarious group (22.6%, 95% CI 21.3% to 23.8%), followed by the borderline precarious (17.6%, 95% CI 17.1% to 18.2%) and lastly the non-precarious (15.0%, 95% CI 14.7% to 15.3%). Under-reporting of OIs, decreased as the injury severity increased and was higher with highest level of precariousness in all groups of severity. We also observed higher under-reporting estimates among all occupations in the precarious and borderline precarious groups as compared with the non-precarious ones. CONCLUSIONS: This is the first register-based study to empirically demonstrate in Sweden that under-reporting of OIs is 50% higher among precariously employed workers. OIs under-reporting may represent unrecognised injuries that especially burden precariously employed workers as financial, health and social consequences shift from the employer to the employee.

Occupational stress and pregnancy-related hypertension and diabetes: Results from a nationwide prospective cohort.

OBJECTIVES: Using a large, national, prospective cohort, while adjusting for other work exposures, this study aims to investigate whether exposure to occupational stress during pregnancy is associated with hypertensive disorders of pregnancy (HDP) and gestational diabetes. METHODS: Our cohort consisted of 1 102 230 singleton births between 1994-2014 in Sweden, based on high-quality register data of Swedish pregnancies. Exposure to occupational stress was obtained from a job exposure matrix (JEM) constructed from 12 questions pertaining to the psychosocial work environment from the 1997-2013 cycles of Swedish Work Environment Survey, including approximately 75 000 individuals. We utilized the decision authority, demands, and social support indices. Decision authority and demands were combined to categorize occupations into low, active, passive, and high strain work. We estimated relative risks (RR) and adjusted for relevant confounders, such as age, smoking and other work exposures. RESULTS: Occupations with lower levels of decision authority were associated with increased risks of 12-23% for HDP and preeclampsia and 36-58% for gestational diabetes compared to occupations with the highest levels of decision authority. Passive occupations had increased risks of 10% for HDP and preeclampsia and 15% for gestational diabetes when compared to low strain jobs. No significant associations were found for high strain occupations. CONCLUSIONS: As a whole, occupational stress was not consistently associated with pregnancy outcomes in our study. However, decision authority was associated with an increased risk for pregnancy-related complications. Further studies should investigate whether improvements in working conditions can help decrease these risks.