RESUMO
BACKGROUND: Work-family conflicts (WFC) have been associated with poor mental health, poor self-rated health and sickness absence. However, studies on short sickness absence are lacking and more information is needed also about long sickness absence regarding the direction of WFC, and potential explaining factors particularly among young and early middle-aged employees. METHODS: The Helsinki Health Study baseline survey (2017) among 19- to 39-year-old municipal employees (N = 3683, 80% women, response rate 51.5%) was linked to employer's sickness absence data. The associations of work-to-family conflicts (WTFC) and family-to-work conflicts (FTWC) with short (1-7 days) and long (over 7 days) sickness absence were analyzed using negative binomial regression analysis. Covariates were age, gender, family-related factors and work-related factors. Stratified analyses by occupational class were performed. The results are presented as rate ratios and their 95% confidence intervals. RESULTS: High WTFC were associated with short (1.25, 1.12-1.40) and long (1.37, 1.11-1.70) sickness absence. High FTWC were also associated with short (1.12, 1.03-1.22) and long (1.24, 1.06-1.45) sickness absence. Adjustment for family-related factors strengthened the associations, whereas adjustment for work-related factors abolished the associations between WTFC and sickness absence. Associations between WFC and sickness absence were observed among two lowest occupational classes only. CONCLUSION: WFC are associated with both short and long sickness absence. Work-related factors including the quality of supervisory work and shift work play a role in the association. Intervention studies could determine if improvements in combining work and family life lead to a reduction in sickness absence.
Assuntos
Conflito Familiar , Relações Familiares , Pessoa de Meia-Idade , Humanos , Feminino , Adulto Jovem , Adulto , Masculino , Estudos de Coortes , Inquéritos e Questionários , Inquéritos Epidemiológicos , Licença Médica , FinlândiaRESUMO
AIMS: Parental education and childhood adversities are associated with long-term work disability but their contribution to sickness absence is largely unknown. We aimed to examine the associations between parental education, childhood adversities and self-certified and medically-certified sickness absence among midlife employees. METHODS: The Helsinki Health Study baseline survey data (2000-2002) of 40-to-60-year-old municipal employees were linked with sickness absence data from the employer's register. Self-certified (1-3 days) and medically-certified (>3 days) sickness absence spells were followed from 2003 until the end of 2008. The study included 5728 employees. The analyses were made by Poisson regression and the results are presented as rate ratios (RRs) and their 95% confidence intervals (CIs). RESULTS: Low maternal education was associated with self-certified sickness absence (RR 1.32, 95% CI 1.13-1.55) among women only whereas both low maternal (1.49, 1.26-1.77) and low paternal education (1.48, 1.32-1.67) were associated with medically-certified sickness absence. Adjustment for own occupational class mainly abolished these associations. Having experienced any childhood adversity was associated with self-certified (1.18, 1.12-1.25) and medically-certified (1.22, 1.15-1.30) sickness absence. In addition, childhood economic difficulties, childhood illness, parental divorce, parental mental illness, parental alcohol problems and bullying were each associated both with self-certified and with medically-certified sickness absence. The associations mainly remained after adjustments for occupational class, marital status, working condition, body mass index and health behaviours. CONCLUSIONS: Low parental education and childhood adversities contributed to midlife sickness absence. Promoting well-being of families with children might help sustain adult work ability and prevent sickness absence still in midlife.
Assuntos
Pais , Setor Público , Adulto , Criança , Humanos , Feminino , Pessoa de Meia-Idade , Escolaridade , Índice de Massa Corporal , Divórcio , Licença Médica , FinlândiaRESUMO
AIMS: We examined the development of research articles published in the Scandinavian Journal of Public Health and its predecessors Acta Socio-Medica Scandinavica and the Scandinavian Journal of Social Medicine from 1969 until 2020 to be able to identify the place of international comparisons of socioeconomic inequalities in health in the journal. METHODS: Altogether 3237 research articles were screened to yield 126 comparative research articles. Examining full texts of the comparative articles led to 13 articles reporting comparisons of health inequalities. RESULTS: The first one came out in 1972, but the rest only after the mid-1990s. The most common socioeconomic indicator was education, but also occupational class and income was used. The most common health indicator was self-rated health. The articles compared Nordic countries with each other, but also with non-Nordic countries. Although the number of comparative studies on health inequalities was relatively small, there were examples of well-designed studies using advanced methodology. We examined only published journal articles over the past five decades, not submitted but rejected papers. CONCLUSIONS: In the Scandinavian Journal of Public Health and its predecessors, comparisons of health inequalities were few and emerged relatively late, that is, during the past two decades.
Assuntos
Disparidades nos Níveis de Saúde , Saúde Pública , Escolaridade , Humanos , Renda , Fatores SocioeconômicosRESUMO
Aims: Chronic pain is a notable burden on public health, with past and present factors contributing to it. This study aimed to examine the associations between childhood adversities and chronic pain. Methods: Data on seven childhood adversities, chronic pain and disabling pain were derived from questionnaire surveys conducted in 2000, 2001 and 2002 among 40- to 60-year-old employees (response rate of 67%) of the City of Helsinki, Finland. The study included 8140 employees (80% women). Logistic regression was used in the analyses, and the results are presented as odds ratios (OR) and their 95% confidence intervals (CI). Age, sex, the father's education, the participant's education, marital status, working conditions, sleep problems and common mental disorders were included as covariates. Results: In the age-adjusted models, childhood economic difficulties (OR=1.60, 95% CI 1.41-1.81), childhood illness (OR=1.74, 95% CI 1.45-2.08), parental divorce (OR=1.26, 95% CI 1.07-1.48), parental alcohol problems (OR=1.34, 95% CI 1.18-1.52) and bullying at school or among peers (OR=1.59, 95% CI 1.37-1.89) were associated with chronic pain. Working conditions, sleep problems and common mental disorders each slightly attenuated the associations between childhood adversities and chronic pain. Childhood economic difficulties among women (OR=1.72, 95% CI 1.40-2.10), childhood illness (OR=1.40, 95% CI 1.07-1.82) and bullying at school or by peers (OR=1.91 95% CI 1.48-2.46) were also associated with disabling pain. Conclusions: Childhood adversities were associated with chronic pain in mid-life, and the associations mainly remained after adjustments. Investing in the well-being of children might prevent pain and promote well-being in mid-life.
Assuntos
Dor Crônica , Transtornos do Sono-Vigília , Adulto , Criança , Dor Crônica/epidemiologia , Divórcio , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Disadvantageous socioeconomic circumstances and minor mental health problems have both been associated with mental disorders, such as depression, but their joint contribution remains unknown. METHODS: The Helsinki Health Study baseline survey (2000-02) of 40- to 60-year-old employees was linked with antidepressant medication data from registers of the Social Insurance Institution of Finland. The analyses were made using logistic regression with first prescribed antidepressant medication purchase during a 10-year follow-up as the outcome. Minor mental health problems were measured by the emotional well-being scale of the RAND-36. Odds ratios were calculated for joint association of the lowest quartile of the emotional well-being scale of the RAND-36 and socioeconomic circumstances. Childhood (parental education and childhood economic difficulties), conventional (education, occupational class and income) and material (housing tenure and current economic difficulties) socioeconomic circumstances were examined. This study included 5450 participants. RESULTS: Minor mental health problems dominated the joint associations. Minor mental health problems were associated with antidepressant medication irrespective of socioeconomic circumstances whereas only low income, current economic difficulties and living in rented housing showed an association without minor mental health problems at baseline. Marital status, working conditions and BMI and health behaviours had only minimal contributions to the associations. CONCLUSIONS: Minor mental health problems were consistently and strongly associated with antidepressant medication and dominated the joint associations with socioeconomic circumstances. Paying attention to minor mental health problems might help prevent mental disorders such as depression.
Assuntos
Transtornos Mentais , Saúde Mental , Adulto , Antidepressivos/uso terapêutico , Criança , Escolaridade , Finlândia/epidemiologia , Humanos , Renda , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Pobreza , Fatores SocioeconômicosRESUMO
Aims: The aim was to examine whether the contribution of physical work exposures to the risk of sickness absence (SA) is different between those with and without common mental disorders (CMD). Methods: We used questionnaire data on four work exposures and CMD from 6159 participants of the Helsinki Health Study cohort with 12,458 observations from three surveys (2000-2002, 2007 and 2012). We formed combination exposures for the work exposures (hazardous exposures, physical workload, computer and shift work) with CMD. Associations with SA of different length were examined with negative binomial regression models. Results: We observed stronger associations for CMD with SA than for the individual work exposures. The strength of the associations for hazardous exposures and physical workload increased with length of SA, especially when the participant also had CMD. The strongest associations for the combined exposures were observed for SA ⩾15 days, the rate ratios being 2.63 (95% CI 2.27-3.05) among those with hazardous exposure and CMD, and 3.37 (95% CI 2.93-3.88) among those with heavy physical workload and CMD. Conclusions: Employees with hazardous exposures or physical workload combined with CMD were at the highest risk of SA compared with those without these exposures or with only one exposure.
Assuntos
Absenteísmo , Transtornos Mentais/epidemiologia , Licença Médica/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , Fatores de TempoRESUMO
Aims: Obesity and weight change are associated with sickness absence; however, less is known about the diagnoses for sickness absence. We examined the association between stable and changing weight by body mass index groups with sickness absence due to any, musculoskeletal and mental diagnoses among midlife female and male employees. Methods: The Finnish Helsinki Health Study phase 1 survey took place in 2000-2002 (response rate 67%) and phase 2 in 2007 (response rate 83%). Based on self-reported body mass index, we calculated the weight change between phases 1 and 2 (body mass index change ⩾5%). The data were linked with registers of the Social Insurance Institution of Finland, including information on diagnoses (ICD-10) for sickness absence >9 days. We used a negative binom ial model to examine the association with sickness absence among 3140 women and 755 men during the follow-up (2007-2013). Results are presented as rate ratios. Covariates were age, sociodemographic factors, workload, health behaviors and prior sickness absence. Results: Weight-gain (rate ratio range=1.27-2.29), overweight (rate ratio range=1.77-2.02) and obesity (rate ratio range=2.16-2.29) among women were associated with a higher rate of sickness absence due to musculoskeletal diseases, compared to weight-maintaining normal-weight women. Similarly, obesity among men was associated with sickness absence due to musculoskeletal diseases (rate ratio range=1.55-3.45). Obesity among women (rate ratio range=1.54-1.72) and weight gain among overweight men (rate ratio=3.67; confidence interval=1.72-7.87) were associated with sickness absence due to mental disorders. Conclusions: Obesity and weight gain were associated with a higher rate of sickness absence, especially due to musculoskeletal diseases among women. Preventing obesity and weight gain likely helps prevent sickness absence.
Assuntos
Peso Corporal Ideal , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Licença Médica/estatística & dados numéricos , Aumento de Peso , Adulto , Índice de Massa Corporal , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Sistema de Registros , AutorrelatoRESUMO
PURPOSE: Physical work exposures and common mental disorders (CMD) have been linked to increased risk of work disability, but their joint associations with disability retirement due to any cause, mental disorders or musculoskeletal diseases have not been examined. METHODS: The data for exposures and covariates were from the Finnish Helsinki Health Study occupational cohort surveys in 2000-2002, 2007 and 2012. We used 12,458 observations from 6159 employees, who were 40-60 years old at baseline. CMD were measured by the General Health Questionnaire (GHQ-12, cut-off point 3+). Four self-reported work exposures (hazardous exposures, physical workload, computer and shift work) were combined with CMD and categorized as "neither", "work exposure only", "CMD only", and "both". Associations with register-based disability retirement were assessed with Cox proportional hazards models for sample survey data adjusting for confounders over 5-year follow-up. Additionally, synergy indices were calculated for the combined effects. RESULTS: Those reporting CMD and high physical workload had a greater risk of disability retirement due to any cause (HR 4.26, 95% CI 3.60-5.03), mental disorders (HR 5.41, 95% CI 3.87-7.56), and musculoskeletal diseases (HR 4.46, 95% CI 3.49-5.71) when compared to those with neither. Synergy indices indicated that these associations were synergistic. Similar associations were observed for CMD and hazardous exposures, but not for combined exposures to CMD and computer or shift work. CONCLUSIONS: Identification of mental health problems among employees in physically demanding jobs is important to support work ability and reduce the risk of premature exit from work due to disability.
Assuntos
Pessoas com Deficiência , Transtornos Mentais , Doenças Musculoesqueléticas , Adulto , Finlândia/epidemiologia , Humanos , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Aposentadoria , Fatores de RiscoRESUMO
OBJECTIVE: This study examined the associations between changes in common mental disorders (CMD) and subsequent diagnosis-specific sickness absence (SA) among midlife and ageing municipal employees. METHODS: Data from the Helsinki Health Study phase I (2000-2002) and phase II (2007) surveys among employees of the City of Helsinki, Finland, were linked with prospective register data from the Social Insurance Institution of Finland on diagnosis-specific (mental, musculoskeletal, other causes) SA (n=3890). Associations between change in CMD (General Health Questionnaire 12) from phase I to phase II and the first SA event in 2007-2014 were analysed using Cox regression modelling. Sociodemographic, work and health-related covariates from phase I, and SA from the year preceding phase I were controlled for. RESULTS: Having CMD at one or two time points, that is, favourable and unfavourable change in CMD and repeated CMD, were all associated with a higher risk of SA due to mental, musculoskeletal and other diagnoses compared with women and men with no CMD. Favourable change in CMD reduced the risk of SA when compared with repeated CMD. The strongest associations were observed for repeated CMD (HR range: 1.44 to 5.05), and for SA due to mental diagnoses (HR range: 1.15 to 5.05). The associations remained after adjusting for the covariates. CONCLUSIONS: Changing and repeated CMD increased the risk of SA due to mental, musculoskeletal and other diagnoses. CMD should be tackled to prevent SA and promote work-ability among ageing employees.
Assuntos
Absenteísmo , Empregados do Governo/psicologia , Transtornos Mentais/classificação , Adulto , Feminino , Finlândia , Seguimentos , Empregados do Governo/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Prior analyses of class differences in health trajectories among employees have often omitted women and transitions to retirement. We examined social class trajectories in physical functioning among Finnish female employees from midlife to retirement age, and whether transitions to retirement modified these trajectories. METHODS: Data were derived from mail surveys at Phases 1-3 (2000-2012) among employees of the City of Helsinki, Finland, aged 40-60 at baseline (n = 8960, 80% women, response rates 69-83%). We included respondents to any of the Phases 1-3 aged 40-72 (n = 6976). We distinguished higher and lower social classes, and employment statuses, i.e. employed, mandatorily retired and disability-retired. Short Form 36 physical component summary was used to measure physical functioning. Mixed-effect growth curve models were used to assess the association of social class and employment status with functioning over age. RESULTS: For employed women, physical functioning deteriorated faster in the lower than in the higher class, with class trajectories widening in ages 40-65. After mandatory retirement, functioning deteriorated in both classes, whereas after disability retirement, functioning improved. Across employment statuses, functioning converged at older ages, and the disability-retired caught up with the better functioning of the employed and mandatorily retired. Employment status modified the trajectories, as among the continuously employed and mandatorily retired women functioning deteriorated, but among the disability-retired, trajectories improved and reached a similar level with employed and mandatorily retired women. Social class inequalities remained in all employment status groups. CONCLUSIONS: Overall, our results suggest evidence for the cumulative disadvantage model, with accumulating work exposures among lower classes potentially contributing to their trajectories of ill health.
Assuntos
Emprego , Nível de Saúde , Desempenho Físico Funcional , Classe Social , Adulto , Fatores Etários , Idoso , Pessoas com Deficiência , Feminino , Finlândia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Aposentadoria , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , TrabalhoRESUMO
PURPOSE: We developed a job exposure matrix (JEM) to study the association between long-term exposure to heavy physical effort or heavy lifting and carrying at work with disability pension due to musculoskeletal disorders and premature all-cause mortality. METHODS: Exposure to heavy physical effort at work during 1996-2005 was estimated with JEM developed for this study population, where the exposure was based on occupational titles of the participants. We included all employees of the City of Helsinki, Finland, who had annual data of exposure for 8-10 years (1996-2005, n = 18387). The outcome variables were register-based, and the follow-up was from 2006 until 2015. The risk estimates were evaluated using competing risk survival analysis. RESULTS: There were 530 (3%) disability pension events due to musculoskeletal disorders during the 10-year follow-up. After adjustment for sex, age, education and chronic diseases, employees in the second (SHR = 1.46, 95% CI 1.05-2.05), third (SHR = 2.73, 95% CI 2.00-2.29), and the highest exposure quartile (SHR = 2.56, 95% CI 1.88-3.50) had a higher risk of musculoskeletal disability pension than employees in the lowest quartile. A total of 110 (4%) men and 266 (2%) women died during the follow-up. Men in the third quartile (SHR = 2.29, 95% CI 1.23-4.24), and women in the highest exposure quartile (SHR = 1.54, 95% CI 0.99-2.41) had a higher risk of premature mortality than those in the lowest quartile. CONCLUSIONS: Eight to ten years of exposure to heavy physical effort at work is strongly associated with disability pension due to musculoskeletal disorders. This exposure also increases the risk of premature mortality, particularly among men.
Assuntos
Mortalidade , Doenças Musculoesqueléticas/epidemiologia , Exposição Ocupacional/estatística & dados numéricos , Pensões/estatística & dados numéricos , Adulto , Estudos de Coortes , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Seguimentos , Empregados do Governo/estatística & dados numéricos , Humanos , Remoção , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Esforço Físico , Carga de TrabalhoRESUMO
BACKGROUND: Early exit from paid employment is a notable public health and societal challenge. Previous research has largely focused on the relationships among variables instead of the relationships among individuals with different work participation history. Person-oriented methods enable to identify latent groups of individuals who are likely to follow similar development in their work participation over time. We thus aimed to identify work participation trajectories during early and midlife careers and their social determinants using large nationally representative data comprising over 1 million initially employed individuals and a 10-year follow-up for their work participation. A further aim was to determine the cumulative incidence of sickness absence due to key diagnostic groups, mental disorders and musculoskeletal diseases within the trajectories. METHODS: Young (25-38 years at baseline, n = 495,663) and midlife (39-52 years at baseline, n = 603,085) Finnish people, all working in 2004, were followed up through 2013, with registers of the Social Insurance Institution, and the Statistics Finland. The registers provided data for work participation and its determinants, as well as for computing the cumulative incidence of sickness absence. Latent class growth analysis was used to identify trajectories. RESULTS: Three distinctive trajectories were identified: temporary exit, permanent exit, and continuously employed people. As compared to the other trajectories, those belonging to the permanent exit trajectory were more likely men, manual workers and had a lower income. The cumulative incidence of sickness absence due to mental disorders was highest in the permanent exit trajectory group. For musculoskeletal diseases, the cumulative incidence of sickness absence increased in the permanent exit trajectory mainly in the older age groups. CONCLUSION: Distinct group-based trajectories of early work exit can be identified in a representative cohort of initially employed people. Focusing on the determinants of premature exit and early intervention to tackle increasing sickness absence may promote work participation particularly in the most vulnerable groups.
Assuntos
Absenteísmo , Emprego , Renda , Transtornos Mentais/epidemiologia , Doenças Musculoesqueléticas/epidemiologia , Ocupações , Licença Médica , Fatores Etários , Idoso , Estudos de Coortes , Emprego/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ocupações/estatística & dados numéricos , Fatores Sexuais , Licença Médica/estatística & dados numéricos , DesempregoRESUMO
BACKGROUND: Heavy physical effort at work has been linked with disability pension, but the contribution of other ergonomic job exposures is less studied. We studied the independent and joint contributions of long-term exposure to (i) rotation of the back and (ii) repetitive movements to disability pension, particularly due to musculoskeletal disorders. METHODS: Exposures were measured with the Helsinki Health Study Job Exposure Matrix during 1996-2005 and linked to register data on employees of the City of Helsinki, Finland (n = 18 585). Outcomes were followed up during 2006-2015. Competing risk survival analyses were performed and synergy indices computed, adjusting for sociodemographic factors. RESULTS: Long-term exposure to rotation of the back was associated with disability pension due to any cause [age and sex-adjusted subhazard ratio (SHR) 2.39, 95% confidence interval (CI) 1.73-3.30], and specifically disability pension due to musculoskeletal disorders (SHR = 3.39, 95% CI 1.52-7.56) when compared to employees exposed to neither of the two exposures. Repetitive movements alone did not increase the risk of disability pension (all-cause SHR = 1.08, 95% CI 0.84-1.38, musculoskeletal SHR = 1.65, 95% CI 0.91-2.97). Employees with exposure to both rotation of the back and repetitive movements had the highest risk of disability pension due to musculoskeletal disorders (SHR = 5.98, 95% CI 3.85-9.28), but the interaction between exposures was additive rather than synergistic. Adjustment for education diluted the associations by 42-108%. CONCLUSION: Long-term exposure to awkward work postures increased the risk of disability pension. Educational inequalities largely account for differences in occupational exposures.
Assuntos
Lesões nas Costas/epidemiologia , Lesões nas Costas/etiologia , Transtornos Traumáticos Cumulativos/complicações , Transtornos Traumáticos Cumulativos/epidemiologia , Pessoas com Deficiência , Exposição Ocupacional/efeitos adversos , Rotação/efeitos adversos , Ergonomia , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologiaRESUMO
OBJECTIVES: Those in lower occupational classes have an increased risk of sickness absence due to musculoskeletal diseases (MSDs), but studies examining the associations simultaneously across specified diagnostic groups within MSDs are lacking. We examined occupational class differences in the occurrence and length of long-term sickness absence due to different musculoskeletal diagnoses. METHODS: A 70% random sample of employed Finns aged 25-64 years old at the end of 2013 was linked to data on sickness absence of over 10 working days obtained from The Social Insurance Institution of Finland and occupational class from Statistics Finland. Sickness absences due to MSDs initiated in 2014 were followed until the end of each episode for female (n=675 636) and male (n=604 715) upper non-manuals, lower non-manuals and manual workers. Negative binomial hurdle models were used to analyse the associations. RESULTS: Within the studied MSDs, the most common causes of absence were back disorders, particularly back pain, and shoulder disorders. Osteoarthritis, disc disorders and rheumatoid arthritis induced the longest episodes of absence. Clear hierarchical class differences were found throughout, but the magnitude of the differences varied across the diagnostic causes. The largest class differences in the occurrence were detected in shoulder disorders and back pain. The class differences in length were greatest in rheumatoid arthritis, disc disorders and, among men, also in hip osteoarthritis. CONCLUSIONS: Hierarchical occupational class differences were found across different MSDs, with large differences in back and shoulder disorders. Occupational class and diagnosis should be considered when attempting to reduce sickness absence due to MSDs.
Assuntos
Doenças Musculoesqueléticas/epidemiologia , Doenças Profissionais/epidemiologia , Licença Médica/estatística & dados numéricos , Adulto , Dor nas Costas/epidemiologia , Dor nas Costas/etiologia , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/etiologia , Doenças Profissionais/etiologia , Sistema de Registros , Fatores de Risco , Dor de Ombro/epidemiologia , Dor de Ombro/etiologiaRESUMO
AIMS: This study aimed to investigate whether hospitalisation is associated with increased risk of disability retirement differently across four occupational classes. METHODS: 170,510 employees of the City of Helsinki, Finland were followed from 1990 to 2013 using national registers for hospitalisations and disability retirement. Increases in the risk of disability retirement after hospitalisation for any cause, cardiovascular diseases, musculoskeletal disorders, mental disorders, malignant neoplasms, respiratory diseases and injuries were assessed across four occupational classes: professional, semi-professional, routine non-manual and manual, using competing risks models. RESULTS: In general, hospitalisation showed a slightly more increased risk of disability retirement in the lower ranking occupational classes. Hospitalisation among women for mental disorders showed a more increased risk in the professional class (hazard ratio 14.73, 95% confidence interval 12.67 to 17.12) compared to the routine manual class (hazard ratio 7.27, 95% confidence interval 6.60 to 8.02). Occupational class differences were similar for men and women. The risk of disability retirement among women increased most in the routine non-manual class after hospitalisation for musculoskeletal disorders and injuries, and most in the professional class after hospitalisation for cardiovascular diseases. The corresponding risks among men increased most in the two lowest ranking classes after hospitalisation for injuries. CONCLUSIONS: Ill-health as measured by hospitalisation affected disability retirement in four occupational classes differently, and the effects also varied by the diagnostic group of hospitalisation. Interventions that tackle work disability should consider the impact of ill-health on functioning while taking into account working conditions in each occupational class.
Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Hospitalização/estatística & dados numéricos , Ocupações/classificação , Aposentadoria/estatística & dados numéricos , Adolescente , Adulto , Feminino , Finlândia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Medição de Risco , Adulto JovemRESUMO
Background: Changes in health functioning over different retirement transitions are poorly understood. This study aimed to examine associations between transition into statutory, disability and part-time retirement, and changes in health functioning. Methods: Survey data were collected among ageing employees of the City of Helsinki, Finland, at three phases: (i) (2000-02), (ii) (2007) and (iii) (2012). Physical and mental health functioning were measured using the Short-Form 36 questionnaire at each phase. Retirees between phases 1 and 3 were identified from the national registers of the Finnish Centre for Pensions: full-time statutory retirement (n = 1464), part-time retirement (n = 404), and disability retirement (n = 462). Generalized estimating equations were used to examine the associations. Results: Disability retirees had poorer pre- and post-retirement health functioning compared to statutory and part-time retirees. Statutory and part-time retirement were associated with no or only small changes in physical health functioning during retirement transition (ß 0.1, 95% CI -0.3 to 0.5 and -1.0, -1.8 to -0.1, respectively), whereas a clear decline in functioning was observed among disability retirees (-4.3, -5.4 to -3.2). Mental health functioning improved during the retirement transition among statutory and part-time retirees (1.9, 1.4-2.4 and 2.0, 1.0-3.0, respectively), whereas no change was observed for disability retirees. Conclusions: Transition to disability retirement led to a decrease in physical health functioning, and statutory retirement to a slight improvement in mental health functioning. Evidence on changes in physical and mental health functioning during retirement transition process may provide useful information for interventions to promote healthy ageing.
Assuntos
Emprego/psicologia , Nível de Saúde , Atividades de Lazer/psicologia , Aposentadoria/psicologia , Aposentadoria/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Finlândia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The prevalence of obesity increased dramatically in many European countries in the past decades. Whether the increase occurred to the same extent in all socioeconomic groups is less known. We systematically assessed and compared the trends in educational inequalities in obesity in 15 different European countries between 1990 and 2010. METHODS: Nationally representative survey data from 15 European countries were harmonized and used in a meta-regression of trends in prevalence and educational inequalities in obesity between 1990 and 2010. Educational inequalities were estimated by means of absolute rate differences and relative rate ratios in men and women aged 30-64 years. RESULTS: A statistically significant increase in the prevalence of obesity was found for all countries, except for Ireland (among men) and for France, Hungary, Italy and Poland (among women). Meta-regressions showed a statistically significant overall increase in absolute inequalities of 0.11% points [95% CI 0.03, 0.20] per year among men and 0.12% points [95% CI 0.04, 0.20] per year among women. Relative inequalities did not significantly change over time in most countries. A significant reduction of relative inequalities was found among Austrian and Italian women. CONCLUSION: The increase in the overall prevalence aligned with a widening of absolute but not of relative inequalities in obesity in many European countries over the past two decades. Our findings urge for a further understanding of the drivers of the increase in obesity in lower education groups particularly, and an equity perspective in population-based obesity prevention strategies.
Assuntos
Escolaridade , Disparidades nos Níveis de Saúde , Obesidade/epidemiologia , Adulto , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores SocioeconômicosRESUMO
BACKGROUND: It is uncertain whether tobacco control policies have contributed to a narrowing or widening of socioeconomic inequalities in smoking in European countries during the past two decades. This paper aims to investigate the impact of price and non-price related population-wide tobacco control policies on smoking by socioeconomic group in nine European countries between 1990 and 2007. METHODS: Individual-level education, occupation and smoking status were obtained from nationally representative surveys. Country-level price-related tobacco control policies were measured by the relative price of cheapest cigarettes and of cigarettes in the most popular price category. Country-level non-price policies were measured by a summary score covering four policy domains: smoking bans or restrictions in public places and workplaces, bans on advertising and promotion, health warning labels, and cessation services. The associations between policies and smoking were explored using logistic regressions, stratified by education and occupation, and adjusted for age, Gross Domestic Product, period and country fixed effects. RESULTS: The price of popular cigarettes and non-price policies were negatively associated with smoking among men. The price of the cheapest cigarettes was negatively associated with smoking among women. While these favorable effects were generally in the same direction for all socioeconomic groups, they were larger and statistically significant in lower socioeconomic groups only. CONCLUSIONS: Tobacco control policies as implemented in nine European countries, have probably helped to reduce the prevalence of smoking in the total population, particularly in lower socioeconomic groups. Widening inequalities in smoking may be explained by other factors. Policies with larger effects on lower socioeconomic groups are needed to reverse this trend. IMPLICATIONS: Socioeconomic inequalities in smoking widened between the 1990s and the 2000s in Europe. During the same period, there were intensified tobacco control policies in many European countries. It is uncertain whether tobacco control policies have contributed to a narrowing or widening of socioeconomic inequalities in smoking in European countries. This study shows that tobacco control policies as implemented in the available European countries have helped to reduce the prevalence of smoking in the total population, particularly in lower socioeconomic groups. Widening inequalities in smoking may be explained by other factors.
Assuntos
Prevenção do Hábito de Fumar/economia , Prevenção do Hábito de Fumar/legislação & jurisprudência , Fumar/economia , Fumar/legislação & jurisprudência , Classe Social , Fatores Socioeconômicos , Adulto , Idoso , Comércio/economia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ocupações/economia , Fumar/epidemiologia , Abandono do Hábito de Fumar/economia , Abandono do Hábito de Fumar/legislação & jurisprudência , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/métodos , Produtos do Tabaco/economia , Fumar Tabaco/economia , Fumar Tabaco/terapiaRESUMO
BACKGROUND: Musculoskeletal diseases and mental disorders are major causes of long-term sickness absence in Western countries. Although sickness absence is generally more common in lower occupational classes, little is known about class differences in diagnostic-specific absence over time. Focusing on Finland during 2005-2014, we therefore set out to examine the magnitude of and changes in absolute and relative occupational class differences in long-term sickness absence due to major diagnostic causes. METHODS: A 70-per-cent random sample of Finns aged 25-64 linked to register data on medically certified sickness absence (of over 10 working days) in 2005-2014 was retrieved from the Social Insurance Institution of Finland. Information on occupational class was obtained from Statistics Finland and linked to the data. The study focused on female (n = 658,148-694,142) and male (n = 604,715-642,922) upper and lower non-manual employees and manual workers. The age-standardised prevalence, the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were calculated for each study year to facilitate examination of the class differences. RESULTS: The prevalence of each diagnostic cause of sickness absence declined during the study period, the most common causes being musculoskeletal diseases, mental disorders and injuries. The prevalence of other causes under scrutiny was less than 1 % annually. By far the largest absolute and relative differences were in musculoskeletal diseases among both women and men. Moreover, the absolute differences in both genders (p < 0.0001) and the relative differences in men (p < 0.0001) narrowed over time as the prevalence declined most among manual workers. Both genders showed modest and stable occupational class differences in mental disorders. In the case of injuries, no major changes occurred in absolute differences but relative differences narrowed over time in men (p < 0.0001) due to a strong decline in prevalence among manual workers. Class differences in the other studied diagnostic causes under scrutiny appeared negligible. CONCLUSIONS: By far the largest occupational class differences in long-term sickness absence concerned musculoskeletal diseases, followed by injuries. The results highlight potential targets for preventive measures aimed at reducing sickness absence and narrowing class differences in the future.
Assuntos
Transtornos Mentais/diagnóstico , Doenças Musculoesqueléticas/diagnóstico , Doenças Profissionais/diagnóstico , Traumatismos Ocupacionais/diagnóstico , Ocupações/classificação , Licença Médica/estatística & dados numéricos , Adulto , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Doenças Profissionais/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Prevalência , Sistema de RegistrosRESUMO
BACKGROUND: Mental disorders are common diagnostic causes for longer sickness absence and disability retirement in OECD-countries. Short sickness absence spells are also common, and neither trivial for health and work ability. We studied how prior short sickness absence spells and days are associated with subsequent longer sickness absence due to mental disorders in two age-groups of municipal employees during a 2-, 5- and 9-year follow-up. METHODS: The analyses covered 20-34 and 35-49-year-old employees of the City of Helsinki in 2004. Those with prior ≥14 day sickness absence in 2002, 2003 or 2004 were excluded. Women and men were pooled together. Short, 1-13-day sickness absence spells and days were calculated per the actual time of employment during 2004. Logistic regression analysis was used to calculate odds ratios (OR) and their 95% confidence intervals (CI) for the subsequent long (≥14 days) sickness absence due to mental disorders during three follow-ups. RESULTS: The risk for long sickness absence due to mental disorders increased with increasing amount of short sickness absence spells and days. 3 or more short sickness absence spells and 8-14 sickness absence days from short spells in 2004 were strongly associated with subsequent long sickness absence in all three follow-ups. The associations were strongest for the 2-year follow-up; the younger employees tended to have higher risks than the older ones. CONCLUSIONS: Three spells or 8 days of short sickness absence per year constitutes a high risk for subsequent long sickness absence due to mental disorders and preventive measures should be considered.