Narrative review of occupational exposures and noncommunicable diseases.

OBJECTIVE: Within the scope of the Exposome Project for Health and Occupational Research on applying the exposome concept to working life health, we aimed to provide a broad overview of the status of knowledge on occupational exposures and associated health effects across multiple noncommunicable diseases (NCDs) to help inform research priorities. METHODS: We conducted a narrative review of occupational risk factors that can be considered to have "consistent evidence for an association," or where there is "limited/inadequate evidence for an association" for 6 NCD groups: nonmalignant respiratory diseases; neurodegenerative diseases; cardiovascular/metabolic diseases; mental disorders; musculoskeletal diseases; and cancer. The assessment was done in expert sessions, primarily based on systematic reviews, supplemented with narrative reviews, reports, and original studies. Subsequently, knowledge gaps were identified, e.g. based on missing information on exposure-response relationships, gender differences, critical time-windows, interactions, and inadequate study quality. RESULTS: We identified over 200 occupational exposures with consistent or limited/inadequate evidence for associations with one or more of 60+ NCDs. Various exposures were identified as possible risk factors for multiple outcomes. Examples are diesel engine exhaust and cadmium, with consistent evidence for lung cancer, but limited/inadequate evidence for other cancer sites, respiratory, neurodegenerative, and cardiovascular diseases. Other examples are physically heavy work, shift work, and decision latitude/job control. For associations with limited/inadequate evidence, new studies are needed to confirm the association. For risk factors with consistent evidence, improvements in study design, exposure assessment, and case definition could lead to a better understanding of the association and help inform health-based threshold levels. CONCLUSIONS: By providing an overview of knowledge gaps in the associations between occupational exposures and their health effects, our narrative review will help setting priorities in occupational health research. Future epidemiological studies should prioritize to include large sample sizes, assess exposures prior to disease onset, and quantify exposures. Potential sources of biases and confounding need to be identified and accounted for in both original studies and systematic reviews.

What have we learned about risk assessment and interventions to prevent work-related musculoskeletal disorders and support work participation?

OBJECTIVE: The Scandinavian Journal of Work, Environment & Health (SJWEH) was established half a century ago. This paper provides an overview of research on musculoskeletal disorders (MSD) published over these 50 years. Three themes are described: risk assessment, interventions to prevent work-related MSD, and interventions to support work participation. Finally, implications for future research are highlighted. METHODS: A systematic literature search was performed for all papers on MSD published in SJWEH. Each paper was coded on several criteria including research topic, type of MSD, risk factor(s), and number of citations. Findings were tabulated, and discussions within the author team defined the main results and future research directions. RESULTS: The search resulted in 1056 papers, of which 474 were included. The most reported-on MSD was low-back pain (LBP, 18%) and the most reported-on work-related risk factors were physically demanding work (14%) and psychosocial factors (12%). Research has contributed to improving case definitions, refining work-related exposure criteria, and recognizing the varying importance of physical and psychosocial factors across different MSD. Research on the association between work-related risk factors and LBP continues to emerge. Effective interventions for prevention of MSD are characterised by sufficient exposure reduction, while supporting work participation requires integrating health care, with multidisciplinary actions directed at factors involving the worker, employer, and workplace. CONCLUSION: Research has provided valuable insights into risk assessment, interventions for preventing work-related MSD, and supporting work participation. Intervention studies remain warranted and new areas include adopting whole-system approaches to prevent work-related MSD and promoting the concept of musculoskeletal health.

Contribution of compositional changes in the workforce to sickness absence trends in Finland.

In this study, we assessed whether the long-term decrease in sickness absences in Finland is explained by observed and unobserved compositional changes in the workforce. Utilizing register-based panel data on Finnish wage earners aged 30-62, we examined the annual onset of compensated sickness absence (granted after 10 weekdays) in the period 2005-2016. We applied random effects models adjusting for changes in the observed sociodemographic and occupational characteristics of the study population. We also applied fixed effects models, with corrections of the estimates for cohort ageing, to additionally account for the unobserved time-invariant characteristics of the study population over the years. Of the observed characteristics, increasing educational level partly explained the decreasing trend in sickness absences, and the further contribution of the occupational class was weak. Additionally, accounting for unobserved individual characteristics further explained the decreasing trend in sickness absences among those aged 30-47 years and led to a reverse increasing trend among those aged 48-62 years irrespective of sex and employment sector. Particularly for those over 47 years old, the decrease in sickness absences appeared to be more strongly influenced by compositional changes in characteristics that are established before fully entering the labour market - such as educational level as well as unmeasured individual characteristics that remain unchanged after childhood and early adulthood - than in the work environment or other factors contributing at working age. Sickness absence trends fluctuated during economic cycles, which did not appear to be explained by immediate changes in the observed or unobserved characteristics. Different mechanisms are likely to explain long-term sickness absence trends and trends around economic cycles. Attempts to improve work ability and labour market inclusion in long-term should rely more on increasing educational levels among the workforce and on interventions carried out early during the life course.

Labour market trajectories after part-time sickness absence: a nationwide cohort study from Finland.

OBJECTIVES: The use of part-time sickness absence (pSA) enables return to part-time work from full sickness absence. However, subsequent labour market outcomes of pSA users depend on various individual and work-related characteristics. We investigated labour market paths of private and public sector employees after having a pSA spell. Moreover, we examined individual and work-related factors associated with following them. DESIGN: Longitudinal register-based cohort study. SETTING: Finnish employed population. PARTICIPANTS: 9896 receivers of partial sickness allowance aged 45-56 in the years 2010-2014. OUTCOME: We constructed labour market trajectories based on the proportion of time spent in various labour market statuses measured over 3 years after the end of the pSA spell using multiresponse trajectory analysis. We then examined how different individual and work-related factors were associated with assignment to the different trajectory groups using logistic regression analyses. RESULTS: The majority of the pSA users followed paths where work participation was consistently elevated (Sustained Work group, 40.4%), or only slightly reduced (Slightly Reduced Work group, 31.6%). Moreover, more than 1/10th of the users followed a path where receiving partial work disability benefits became predominant (Partial Work Disability group, 12.5%). The rest followed paths where other non-employment (Other Non-Employed group, 7.8%) or full work disability (Full Work Disability group, 7.7%) became the prevailing status. Lower educational level and income predicted assignment to all other groups than the Sustained Work group. Additional predictors were identified, yet these differed between the trajectory groups. CONCLUSIONS: The majority of the pSA users maintained a connection to working life, yet weaker working life paths were also identified. The paths were determined by various individual and work-related factors that can help health professionals and employers to better target support measures particularly towards individuals whose connection to working life is at risk to weaken after the use of pSA.

Does previous sickness absence affect work participation after vocational labour market training? A difference-in-differences propensity score matching approach.

BACKGROUND: Reduced work ability is relatively common among job seekers and it can hinder future labour market attachment. A commonly used measure to increase employability is the use of active labour market programmes. While vocational labour market training (LMT) has been shown to be an effective way to increase work participation among job seekers, there is still uncertainty about how LMT works in different population groups, for example, among persons with a work disability history. METHODS: We used nationally representative Finnish register data on 16 062 LMT participants in 2008-2015 aged 25-59 with a history of sickness absence (SA) and propensity score matched participants without such history. For matching, we used information on sociodemographic and work-related factors. We used difference-in-differences analysis to investigate the differential changes in work participation before and after LMT between those with and those without SA history. RESULTS: Having a history of SA was associated with a lower gain in work participation after LMT, but the magnitude varied by sex, employment history and follow-up time. In women, having a history of SA contributed to 3.9-6.2 percentage points smaller increase in work participation 1-3 years after LMT, depending on the employment history. In men, the corresponding numbers were 2.0-4.3 percentage points. The results were more pronounced if the SA was due to mental disorders. CONCLUSIONS: The results indicate that work disability, especially due to mental disorders, can hamper work participation after LMT and should be considered when planning employment-enhancing measures for job seekers.

Working life expectancy and working years lost among users of part- and full-time sickness absence in Finland.

OBJECTIVES: The use of part-time sickness absence (pSA) instead of full-time sickness absence (fSA) is known to increase work participation. Yet, its effect on the total length of working lives remains unclear. We carried out a quasi-experiment to assess the impact of using pSA versus fSA on the length of working lives. METHODS: We used a register-based 70% random sample of the working-age population living in Finland on 31 December 2007 to (i) form propensity-score-matched groups of users of pSA and fSA and (ii) calculate their working life expectancy (WLE) and working years lost (WYL). We applied the Sullivan method based on daily measured time spent at work and other labor market statuses, followed up over a four-year period until the end of year 2017. The study population consisted of private and public sector employees with SA due to mental and musculoskeletal disorders, ie, the diagnostic groups where pSA has been primarily used. RESULTS: Among both genders, the pSA group had a significantly higher WLE at age 30 than the fSA group, with larger differences seen in mental disorders compared to musculoskeletal diseases and in the private versus public sector. Overall, the pSA group had fewer WYL due to unemployment and disability retirement but more expected years working with partial disability benefits than the fSA group. CONCLUSIONS: Based on beneficial working career effects, the use of pSA instead of fSA should always be recommended for persons with mental or musculoskeletal disorders where feasible.

Utilizing a Nordic Crosswalk for Occupational Coding in an Analysis on Occupation-Specific Prolonged Sickness Absence among 7 Million Employees in Denmark, Finland, Norway and Sweden.

We identified occupations with a high incidence of prolonged sickness absence (SA) in Nordic employees and explored similarities and differences between the countries. Utilizing data from national registers on 25-59-year-old wage-earners from Denmark, Finland, Norway and Sweden, we estimated the gender- and occupation-specific age-adjusted cumulative incidence of SA due to any cause, musculoskeletal diseases and mental disorders. To increase the comparability of occupations between the countries, we developed a Nordic crosswalk for occupational codes. We ranked occupational groups with the incidence of SA being statistically significantly higher than the population average of the country in question and calculated excess fractions with the employee population being the reference group. We observed considerable occupational differences in SA within and between the countries. Few occupational groups had a high incidence in all countries, particularly for mental disorders among men. In each country, manual occupations typically had a high incidence of SA due to any cause and musculoskeletal diseases, while service occupations had a high incidence due to mental disorders. Preventive measures targeted at specific occupational groups have a high potential to reduce work disability, especially due to musculoskeletal diseases. Particularly groups with excess SA in all Nordic countries could be at focus.

Has the share of the working life expectancy that is spent receiving a partial or full disability pension changed in Finland over the period 2005-2018? A longitudinal register-based study.

OBJECTIVES: The share of the overall working careers that is spent receiving disability benefits is unclear. We examined trends in full-time equivalent working life expectancy (FTE-WLE) among those with and without receiving a permanent full or partial disability pension in Finland, where certain amounts of work are allowed while receiving these pensions. DESIGN: Longitudinal register-based study. SETTING: Finnish population. PARTICIPANTS: Nationally representative 70% samples of the working-age population. OUTCOME: Using the Sullivan method, we examined annual FTE-WLE at age 45, truncated at age 63, in 2005-2018 by disability pension status. Full-time equivalent work participation was based on combined information on annual employment days and work income. RESULTS: Compared with those with no disability pension, disability pensioners had a larger relative (full and partial pensioners of both genders) and absolute (male partial pensioners) increase in the FTE-WLE between 2005 and 2018. In 2018, the FTE-WLE of both male and female full disability pensioners was around 3.5 months, being 6 months at its highest in musculoskeletal diseases. The FTE-WLE of partial disability pensioners was around 6.5 and 8 years among men and women, respectively, being around half of the corresponding expectancies of non-pensioners. The FTE-WLE of partial disability pensioners was considerable in musculoskeletal diseases and mental disorders and even higher in other diseases. Full disability pensioners spent a disproportionately large time in manual work, increasingly in the private sector, and partial pensioners in the public sector with lower non-manual and manual work, increasingly with the former. At the population level, the share of the FTE-WLE that is spent receiving a disability pension remained relatively small. CONCLUSIONS: Increased work participation while receiving a disability pension is likely to have had important implications for prolonging individual working careers but only minor contribution to the length of working lives at the population level.

Associations of employment sector and occupational exposures with full and part-time sickness absence: random and fixed effects analyses on panel data.

OBJECTIVE: We aimed to investigate the influence of unobserved individual characteristics in explaining the effects of work-related factors on full (fSA) and part-time sickness absence (pSA). METHODS: We used register-based panel data for the period 2005-2016 on a 70% random sample of the Finnish working-age population. The relationships between employment sector and occupational exposures (% exposed to physically heavy work and job control score based on job exposure matrices) and the annual onset of fSA and pSA were investigated among men and women. First, random effects (RE) models were applied controlling for observed sociodemographic factors and then fixed effects (FE) models that examine within-individual changes over time and thereby further account for unobserved time-invariant individual characteristics. RESULTS: In the RE analyses, public employment sector, physically heavy work and lower job control each increased the use of fSA and pSA among both genders. When unobserved individual characteristics were controlled for with the FE models, the effects on fSA attenuated. For pSA, the effects of employment sector and physical heaviness of work among women even reversed. The effect of lower job control on pSA remained especially among women. CONCLUSIONS: The role of individuals' unobserved characteristics in explaining the effects of work-related factors on SA should not be neglected. The effects of work-related factors are likely to be overestimated when using traditional approaches that do not account for unobserved confounding, ie, selection of individuals with a high likelihood of SA into particular work environments.

Does Work Disability Contribute to Trajectories of Work Participation before and after Vocational Labour Market Training for Job Seekers?

The contribution of ill-health to labour market participation in relation to vocational training is unclear. Using nationally representative Finnish register data on 42,691 vocational labour market trainees in 2008-2010, we constructed latent trajectory groups of work participation in the open labour market three years before and after training, identifying groups called "High-High", "High-Low", "Low-High", and "Low-Low". We plotted further patterns of labour market participation within these trajectory groups and, using multinomial logistic regression, examined assignment to these groups focusing on previous work disability status. Those with compared to those without previous work disability had previous employment more often and spent less time in economic inactivity within the two trajectory groups with low pre-training levels of work participation. Having a previous work disability was associated with assignment to the "High-Low" trajectory group of work participation instead of the "High-High" comparison group. The associations of other background factors with the assignment to the different trajectory groups were relatively similar amongst those with and without previous work disability. However, some of these associations were weaker amongst the former. Along with other key background factors, previous work disability should be accounted for when assessing the effects of vocational training.

The influence of occupational class and physical workload on working life expectancy among older employees.

Objective This study investigates the impact of physical workload factors and occupational class on working life expectancy (WLE) and working years lost (WYL) in a sample of older Finnish workers. Methods A 70% random sample of Finns in 2004 was linked to a job exposure matrix for physical workload factors and register information on occupational class and labor market status until 2014. Transitions between being at work, time-restricted work disability, unemployment, economic inactivity, disability retirement, retirement and death were estimated. A multistate Cox regression model with transition-specific covariates was used to estimate the WLE and WYL at age 50 up to 63 years for each occupational class and physical workload factor for men and women (N=415 105). Results At age 50, male and female manual workers had a WLE of 10.13 and 10.14 years, respectively. Among both genders, manual workers had one year shorter WLE at age 50 than upper non-manual employees. This difference was largely attributable to unemployment (men: 0.60, women: 0.66 years) and disability retirement (men: 0.28, women: 0.29 years). Self-employed persons had the highest WLE (11.08 years). Men and women exposed to four or five physical workload factors had about one year lower WLE than non-exposed workers. The difference was primarily attributable to ill-health-related reasons, including disability retirement (men: 0.45 years, women: 0.53 years) and time-restricted work disability (men: 0.23, women: 0.33 years). Conclusions Manual workers and those exposed to physical workload factors had the lowest WLE. The differences in WYL between exposure groups can primarily be explained by ill-health-based exit routes.

To what extent is severe osteoarthritis preventable? Occupational and non-occupational risk factors for knee and hip osteoarthritis.

OBJECTIVES: To explore the relative contribution of cumulative physical workload, sociodemographic and lifestyle factors, as well as prior injury to hospitalization due to knee and hip OA. METHODS: We examined a nationally representative sample of persons aged 30-59 years, who participated in a comprehensive health examination (the Health 2000 Study). A total of 4642 participants were followed from mid-2000 to end-2015 for the first hospitalization due to knee or hip OA using the National Hospital Discharge Register. We examined the association of possible risk factors with the outcome using a competing risk regression model (death was treated as competing risk) and calculated population attributable fractions for statistically significant risk factors. RESULTS: Baseline age and BMI as well as injury were associated with the risk of first hospitalization due to knee and hip OA. Composite cumulative workload was associated with a dose-response pattern with hospitalizations due to knee OA and with hospitalizations due to hip OA at a younger age only. Altogether, prior injury, high BMI and intermediate to high composite cumulative workload accounted for 70% of hospitalizations due to knee OA. High BMI alone accounted for 61% and prior injury only for 6% of hospitalizations due to hip OA. CONCLUSION: Our results suggest that overweight/obesity, prior injury and cumulative physical workload are the most important modifiable risk factors that need to be targeted in the prevention of knee OA leading to hospitalization. A substantial proportion of hospitalizations due to hip OA can be reduced by controlling excess body weight.

Occupational differences in disability retirement due to a shoulder lesion: do work-related factors matter?

OBJECTIVE: To identify occupations with a high risk of disability retirement due to a shoulder lesion and to examine the effect of physical and psychosocial work-related factors on occupational differences in disability retirement. METHODS: We followed Finnish wage earners aged 30-59 years (n = 1,135,654) from 2005 to 2014 for full disability retirement due to a shoulder lesion. The work-related exposures were assessed with job exposure matrices. We calculated age-adjusted incidence rates and hazard ratios to test for the association between occupation and disability retirement due to a shoulder lesion. We also examined the contribution of work-related exposures to the excess risk of disability retirement. RESULTS: As compared to professionals, the age-adjusted risk of disability retirement was increased among men in all occupational groups except managers and customer service clerks and among women in several occupational groups. Adjustment for education attenuated the occupational differences considerably, particularly among women. The physical work-related factors fully explained the excess risk of disability retirement due to a shoulder lesion among male finance and sales associate professionals and administrative secretaries as well as among agricultural and fishery workers. In women, the physical work-related factors fully explained the excess risk among construction workers, electricians and plumbers. For both genders, the contribution of psychosocial factors to excess risk of disability retirement was modest and seen for monotonous work only. CONCLUSIONS: A reduction of the level of physical work load factors as well as monotonousness of work has a potential to prevent work disability due to a shoulder lesion.

Occupational and non-occupational risk factors of sickness absence due to a shoulder lesion.

OBJECTIVES: To determine the associations of lifestyle factors and cumulative physical workload exposures with sickness absence (SA) due to a shoulder lesion and to calculate their population attributable fractions (PAF). METHODS: Our nationally representative cohort consisted of 4344 individuals aged 30-62 years who participated in the Finnish Health 2000 Survey. Education, smoking, chronic diseases and work exposures were assessed during interviews and leisure time physical activity with a questionnaire. Weight and height were measured. We followed the individuals for 15 years for the first SA due to a shoulder lesion. We used competing risk regression models. We calculated PAFs to assess the proportion of SA that was attributed to modifiable risk factors. RESULTS: In the entire study population, risk factors of SA were age, daily smoking, being exposed for more than 10 years to physically heavy work and being exposed for more than 10 years to at least two specific physical workload factors. The overall PAF for the modifiable risk factors was 49%. In men, number of specific cumulative exposures, obesity and daily smoking predicted SA with PAF values of 34%, 30% and 14%, respectively. Among women, being exposed for more than 10 years to physically heavy work, number of specific cumulative exposures and daily smoking accounted for 23%, 22% and 15% of SA, respectively. CONCLUSIONS: Reducing significantly prolonged exposure to physical workload factors, avoiding regular smoking in both genders and obesity in men has a high potential to prevent SA due to a shoulder lesion.

Effect of Osteoarthritis on Work Participation and Loss of Working Life-years.

OBJECTIVE: To examine to what extent disabling osteoarthritis (OA), leading to a prolonged sickness absence (SA), interferes with work participation and shortens working life-years. METHODS: A total of 4704 wage earners aged 30 to 59 years, whose SA due to OA started in 2006, were followed until October 31, 2014. Kaplan-Meier analysis was used to plot sustained (at least 28 consecutive days) return-to-work curves. The associations of potential determinants with early exit from paid employment were examined applying Cox proportional hazards regression analysis. Years expected to be spent in different work participation statuses until statutory retirement age were estimated based on daily work participation statuses using adapted Sullivan method. RESULTS: Persons with knee OA showed the fastest, and persons with hip OA the slowest, sustained return to work. Although most participants typically were at work during the first year of followup, a considerable proportion was permanently retired. Male sex, older age, low education, long initial SA, and having not returned to work sustainably, as well as receiving vocational rehabilitation, predicted early exit from paid employment during the followup. Overall, only 45-53% of potential working life-years were estimated to be spent at work, being highest for the oldest age group. CONCLUSION: Our study showed a considerable effect of OA on work participation and working life duration. Clinicians should avoid prescription of long SA or temporary work disability due to OA without a clear treatment or return-to-work plan.

Physical and psychosocial work exposures as risk factors for disability retirement due to a shoulder lesion.

OBJECTIVE: To assess the longitudinal associations of physical and psychosocial exposures with disability retirement due to a shoulder lesion. METHODS: In a nationwide register-based study, we followed 1 135 654 wage earners aged 30-59 years for the occurrence of disability retirement due to a shoulder lesion. The occupational exposures were assessed with job exposure matrices. We used a competing risk regression model to estimate HRs and their 95% CIs and to test for the association between the exposures and the outcome. We also calculated the attributable fraction of disability retirement due to occupational exposures. RESULTS: A total of 2472 persons had full disability retirement due to a shoulder lesion during the follow-up. Physically heavy work showed the strongest association with the outcome in both genders, in men with an HR of 2.90 (95% CI 2.37 to 3.55) and in women with an HR of 3.21 (95% CI 2.80 to 3.90). Of the specific physical exposures, working with hands above shoulder level was statistically significantly associated with disability retirement in men. When all physical exposures were taken into consideration, 46% and 41% of disability retirement due to a shoulder lesion were attributed to physical work load factors in men and women, respectively. In addition, 49% (men) and 35% (women) of disability retirement were attributed to psychosocial work-related factors. CONCLUSIONS: Our findings suggest that a considerable proportion of disability retirement due to a shoulder lesion could be prevented by reducing physical and psychosocial exposures at work to a low level.

Exposure to heavy physical work from early to later adulthood and primary healthcare visits due to musculoskeletal diseases in midlife: a register linked study.

OBJECTIVES: To examine whether exposure to heavy physical work from early to later adulthood is associated with primary healthcare visits due to cause-specific musculoskeletal diseases in midlife. DESIGN: Prospective cohort study. SETTING: Nationally representative Young Finns Study cohort, Finland. PARTICIPANTS: 1056 participants of the Young Finns Study cohort. EXPOSURE MEASURE: Physical work exposure was surveyed in early (18-24 years old, 1986 or 1989) and later adulthood (2007 and 2011), and it was categorised as: 'no exposure', 'early exposure only', 'later exposure only' and 'early and later exposure'. PRIMARY AND SECONDARY OUTCOME MEASURES: Visits due to any musculoskeletal disease and separately due to spine disorders, and upper extremity disorders were followed up from national primary healthcare register from the date of the third survey in 2011 until 2014. RESULTS: Prevalence of any musculoskeletal disease during the follow-up was 20%, that for spine disorders 10% and that for upper extremity disorders 5%. Those with physically heavy work in early adulthood only had an increased risk of any musculoskeletal disease (risk ratio (RR) 1.55, 95% CI 1.05 to 2.28) after adjustment for age, sex, smoking, body mass index, physical activity and parental occupational class. Later exposure only was associated with visits due to any musculoskeletal disease (RR 1.46, 95% CI 1.01 to 2.12) and spine disorders (RR 2.40, 95% CI 1.41 to 4.06). Early and later exposure was associated with all three outcomes: RR 1.99 (95% CI 1.44 to 2.77) for any musculoskeletal disease, RR 2.43 (95% CI 1.42 to 4.14) for spine disorders and RR 3.97 (95% CI 1.86 to 8.46) for upper extremity disorders. CONCLUSIONS: To reduce burden of musculoskeletal diseases, preventive actions to reduce exposure to or mitigate the consequences of physically heavy work throughout the work career are needed.

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.

Controlling for Structural Changes in the Workforce Influenced Occupational Class Differences in Disability Retirement Trends.

We explored occupational class differences in disability retirement trends accounting for structural changes in the workforce induced by the recent economic crisis and the following economic stagnation. Using nationwide register data on the general Finnish population aged 30-59 years, we examined trends in disability retirement due to all causes, musculoskeletal diseases, and mental disorders in 2007, 2010, and 2013. Applying propensity score (PS) matching to control for bias induced by structural changes in the workforce over time, we obtained 885,807 matched triplets. In the original study population, all-cause and cause-specific disability retirement declined between 2007 and 2013 for most occupational classes. In the matched study population, the disability retirement among skilled and unskilled manual workers sharply increased in 2010 and then declined in 2013. PS matching considerably attenuated the decline in disability retirement, particularly between the years 2007 and 2010. In general, the differences in disability retirement between both skilled and unskilled manual workers and upper-level non-manual employees widened during the period of economic stagnation. In occupational epidemiology, structural changes in the workforce should be accounted for when analysing trends in ill-health. Controlling for these changes revealed widening occupational class differences in disability retirement during the period of economic stagnation.

The effectiveness of vocational rehabilitation on work participation: a propensity score matched analysis using nationwide register data.

Objective Research on the effectiveness of vocational rehabilitation has focused on small and selected groups, lacked proper controls, or not captured dynamic changes in work participation. Using rich nationwide data on vocational rehabilitees and matched controls, long-term changes in work participation before and after vocational rehabilitation were examined to assess its effectiveness. Methods Representative Finnish register data were used to examine 3199 recently employed individuals aged 30-55 years with histories of musculoskeletal- and mental-related work disability starting vocational rehabilitation in 2008-2010 (intervention group), and 3199 propensity score matched non-rehabilitees (control group). Sociodemographic and work-related factors and detailed 3-year work disability and other labor market history were used for matching. Generalized estimation equations were used to examine differences in the proportion of time spent at work between periods before and after rehabilitation among the intervention and control group and the difference in these differences (DID). Results Vocational rehabilitation resulted in gains in work participation, the total 1-, 2-, and 3-year DID being 11.8 [95% confidence interval (CI) 10.0-13.7], 8.9 (95% CI 7.6-10.2), and 7.2 (95% CI 6.1-8.3) percentage points, respectively. Contrary to this overall pattern, larger DID was observed over the long term for those whose rehabilitation lasted >10 months. The DID was lowest among women with musculoskeletal diseases. Conclusions Vocational rehabilitation after musculoskeletal- or mental-related work disability showed modest effectiveness on work participation. To promote sustained work participation after shorter rehabilitation (likely comprising workplace interventions) and faster work resumption after longer rehabilitation (likely comprising training), enhanced and complementary interventions should be considered.