The objective was to provide a systematic literature review on associations between poor health and exit from paid employment through disability pension, unemployment and early retirement, and to ...estimate the magnitude of these associations using meta-analyses. Medline and Embase databases were searched for longitudinal studies on the relationship between health measures and exit from paid employment. Random-effects models were used to estimate the pooled effects. In total, 29 studies were included. Self-perceived poor health was a risk factor for transition into disability pension (relative risk (RR) 3.61; 95% CI 2.44 to 5.35), unemployment (RR 1.44; 95% CI 1.26 to 1.65) and early retirement (RR 1.27; 95% CI 1.17 to 1.38). Workers with mental health problems had an increased likelihood for transition into disability pension (RR 1.80; 95% CI 1.41 to 2.31) or unemployment (RR 1.61; 95% CI 1.29 to 2.01). Chronic disease was a risk factor for transition into disability pension (RR 2.11; 95% CI 1.90 to 2.33) or unemployment (RR 1.31; 95% CI 1.14 to 1.50), but not for early retirement. This meta-analysis showed that poor health, particularly self-perceived health, is a risk factor for exit from paid employment through disability pension, unemployment and, to a lesser extent, early retirement. To increase sustained employability it should be considered to implement workplace interventions that promote good health.
In most occupational populations common chronic diseases, such as chronic obstructive pulmonary disease, asthma, depression, and low-back pain and other musculoskeletal disorders, contribute ...substantially to the work-related burden of disease (1). These common health problems often have an episodic nature with strong fluctuations in severity of complaints, expressed by recurrent episodes interspersed with periods free from complaints. Longitudinal studies among nurses and construction workers with annual follow-up measurements have documented a high prevalence of low-back pain, but also high annual recurrence and recovery rates (2, 3). These studies illustrate the dynamic patterns of musculoskeletal diseases in occupational populations, whereby some workers have persistent pain and other workers have incidental complaints or remain completely free from health problems during prolonged periods. Similar patterns have also been observed for other chronic diseases, such as respiratory disorders and depressive symptoms (4, 5). There is an abundance of longitudinal studies on the effects of work-related factors on various diseases and their consequences for sustained employability. Typically, independent variables are collected at enrolment of workers into the study and are used to estimate their relative contribution to the incidence of health problems, sickness absence, or disability during the follow-up period. Such an analysis seldom addresses the time-varying patterns of working conditions and disease responses. A dynamic pattern of disease over time will prompt different questions, such as: “when does work trigger the onset of an episode of disease?”; “do the same work-related factors that determine onset of disease also play a role in aggravation of this disease?”; “when will an episode of disease cause sickness absence?”; and “how will chronic diseases and repeated sickness absence influence the capacity of workers to maintain their work ability and participation in the workforce?”. There is rapidly emerging evidence that, for many diseases, the interplay of work, disease, and work capacity has a dynamic pattern during the life course of a worker. This dynamic pattern has important implications for our understanding of how strenuous working conditions contribute to the occurrence of disease and consequent sickness absence and disability. For musculoskeletal disorders, there are strong indications that work-related factors play a different role in different stages of disease and consequences for work performance. For example, a recent study showed that mechanical load predicted the persistence of knee pain over a 12-year period (6), whereas another study on shoulder and neck complaints suggested that awkward postures were more important for onset than recurrence of complaints (7). A study among predominantly female industrial workers reported that work-related physical and psychosocial factors were associated with low-back pain but not with sickness absence (8). In contrast, a study among mostly female personnel in healthcare showed that, among those workers with substantial back and neck pain, heavy physical work was an important predictor for long-term sickness absence (9). These contradictory findings can partly be explained by the inability of classical analytical methods to capture the dynamics of time-varying health states, since each adverse health event is regarded as completely independent from previous episodes of that event. The importance of this problem was recently demonstrated by Navarro and colleagues (10) through a survival analysis with repeated measurements in a cohort of hospital workers with an 8-year follow-up. The hazard rates of recurrent episodes of sickness absence for musculoskeletal, respiratory, and mental and behavioral disorders were substantially higher than the hazard rates of initial sickness absences, suggesting that different factors play a role in onset and aggravation of these diseases. When repeated observations over time are available, newly developed strategies allow us to study how and when work-related factors influence patterns of change in an individual’s health. Two strategies have become increasingly popular to address the dynamic pattern of the interplay of determinants, health, and consequences over time: (i) the life-course approach with latent and pathways models that focus on estimating trajectories over time and determinants of trajectory shapes and trajectory group membership, and (ii) multi-state models for changes in health states over time that provide probabilities of transition among health states and explain differences among individuals during the course of a disease. The usefulness of the life-course approach with trajectory analysis has been demonstrated in recent studies. In a longitudinal study among Finnish municipal employees with 5 measurements during 28 years of follow-up, group-based trajectory modeling was used to identify 5 distinct trajectories of development of work ability over time, partly influenced by mental and physical workload during midlife (11). The same technique was used on six repeated measurements during a two-year follow-up of workers with a traumatic limb injury and distinguished three return-to-work trajectories with different patterns of individual and work-related characteristics (12). An exemplary study with exceptional use of register-based information demonstrated convincingly through growth-curve trajectories that mental health improved after disability retirement, especially for workers with mental disorders, but no change was observed among old-age pensioners (13). Multi-state models for changes in health states over time have been very useful to demonstrate the impact of exposure at work over a complete working career on disease and associated disability, for example for mechanical load and low-back pain among healthcare workers (14) and flour dust and occupational asthma among bakers (15). Another interesting application of multi-state models is the description of the course of disease using probabilities for transitions from being healthy to becoming disabled via sickness absence during a specified period of time. This approach is especially of interest in situations with recurrent events, such as sickness absence, and competing risks, for example becoming unemployed or disabled. In this issue of the Journal, Pedersen and colleagues (16) present a fine example of a multi-state model on sickness absence, unemployment, and disability in the Danish workforce. A large register for sickness absence and social benefits covering 52 months provided detailed information on the dynamic pattern between 4 possible states: sickness absence, dutiful employment, unemployment, and disability pension. The use of a Cox proportional hazards model with multi-states enabled the researchers to provide a comprehensive description of the different transitions among the four distinguished states and to analyze the factors that influenced these transitions. A traditional survival analysis would be limited to the risks of sickness absence, unemployment, and disability, without addressing the opposite routes of returning to work and re-entering paid employment and the particular role of sickness absence in the pathways of displacement from the workforce. The study of Pedersen and colleagues is unique in the sense that multiple routes of (temporary) displacement from the workforce are quantified. Among men and women, the presence of a chronic disease is an important risk factor for sickness absence hazard ratios (HR) of 4.11 and 4.18, respectively and disability pension (HR of 3.76 and 4.79, respectively), but not for unemployment (HR of 0.62 and 0.56, respectively). This striking difference between unemployment and disability implies that both routes of displacement act to some extent as communicating vessels, whereby some workers with a chronic disease who face unemployment are eligible for a disability pension. In most European countries, the presence of a chronic disease is a risk factor for exit from paid employment through disability as well as unemployment (17). Another interesting finding of the Pedersen et al study is that chronic disease is not a barrier for re-entering paid employment among unemployed women (HR 0.99), whereas unemployed men with a chronic disease have an even higher probability to find a paid job again (HR 1.15). A longitudinal study in 11 European countries showed that a chronic health problem was a relevant barrier with odds ratios varying between 0.3 (Belgium) and 0.9 (Germany, Portugal) (18). Pedersen and colleagues (16) point out that the Danish flexicurity model aims to include persons with a chronic disease in the labor market. This particular feature of the Danish welfare state seems also responsible for a comparable health status between workers in precarious jobs and those with permanent positions, whereas in other welfare regimes precarious employment is an important determinant of health inequalities (19). However, it remains an intriguing observation that the presence of a chronic disease plays a different role for men and women in re-entering the labor market, which may suggest differential opportunities. Recent studies in the Scandinavian Journal of Work, Environment & Health have applied novel analytical methods for longitudinal studies to determine how and when work-related factors influence patterns of change in an individual’s health. The results of these studies present valuable new insights into the mechanisms of sustainable employability. This knowledge will certainly contribute to interventions, programs, and national regulations to support workers to continue working longer in good health.
Objectives This study aimed to investigate the influence of chronic diseases and multimorbidity on entering paid employment among unemployed persons. A secondary objective was to estimate the ...proportion of persons not entering paid employment that can be attributed to specific chronic diseases across different age groups. Methods Data linkage of longitudinal nationwide registries on employment status, medication use and socio-demographic characteristics was applied. Unemployed Dutch persons (N=619 968) were selected for a three-year prospective study. Cox proportional hazards analyses with hazard ratios (HR) were used to investigate the influence of six common chronic diseases on entering paid employment, stratified by age. The population attributable fraction (PAF) was calculated as the proportion of all persons who did not enter paid employment that can be attributed to a chronic disease. Results Persons with chronic diseases were less likely to enter paid employment among all age groups. The impact of a chronic disease on maintaining unemployment at population level was largest for common mental disorders (PAF 0.20), due to a high prevalence of common mental disorders (6%), and for psychotic disorders (PAF 0.19), due to a high likelihood of not entering paid employment (HR 0.21), among persons aged 45-55 years. Multimorbidity increased with age, and the impact of having multiple chronic diseases on remaining unemployed increased especially among persons aged ≥45 years. Conclusion Chronic diseases and multimorbidity are important factors that reduce employment chances among all age groups. Our results provide directions for policy measures to target specific age and disease groups of unemployed persons in order to improve employment opportunities.
Objectives This study aimed to assess the influence of chronic health problems on work ability and productivity at work among older employees using different methodological approaches in the analysis ...of longitudinal studies. Methods Data from employees, aged 45-64, of the longitudinal Study on Transitions in Employment, Ability and Motivation was used (N=8411). Using three annual online questionnaires, we assessed the presence of seven chronic health problems, work ability (scale 0-10), and productivity at work (scale 0-10). Three linear regression generalized estimating equations were used. The time-lag model analyzed the relation of health problems with work ability and productivity at work after one year; the autoregressive model adjusted for work ability and productivity in the preceding year; and the third model assessed the relation of incidence and recovery with changes in work ability and productivity at work within the same year. Results Workers with health problems had lower work ability at one-year follow-up than workers without these health problems, varying from a 2.0% reduction with diabetes mellitus to a 9.5% reduction with psychological health problems relative to the overall mean (time-lag). Work ability of persons with health problems decreased slightly more during one-year follow-up than that of persons without these health problems, ranging from 1.4% with circulatory to 5.9% with psychological health problems (autoregressive). Incidence related to larger decreases in work ability, from 0.6% with diabetes mellitus to 19.0% with psychological health problems, than recovery related to changes in work ability, from a 1.8% decrease with circulatory to an 8.5% increase with psychological health problems (incidence-recovery). Only workers with musculoskeletal and psychological health problems had lower productivity at work at one-year follow-up than workers without those health problems (1.2% and 5.6%, respectively, time-lag). Conclusions All methodological approaches indicated that chronic health problems were associated with decreased work ability and, to a much lesser extent, lower productivity at work. The choice for a particular methodological approach considerably influenced the strength of the associations, with the incidence of health problems resulting in the largest decreases in work ability and productivity at work.
In a recent editorial, British researchers concluded that, due to heterogeneity of shift working in longitudinal studies, it is too difficult to draw a firm conclusion about the risk of breast ...cancer, let alone about an exposure threshold for night shift work (2). Recently, a large-scale RCT found no effect of vitamin D intake on reduced risk of depression (8), despite numerous observational studies suggesting such an effect (9). ...there are good reasons to treat results from observational studies with caution. The recommendation to stop asbestos production, which rather came too late than too early, was not based on RCT but observational studies on the multiple health-hazardous effects of asbestos (11). ...when considering the evidence, researchers should not only consider the best evidence based on available data and their causal inference, but also the potential consequences of continuing current practice. Regarding single observational studies, VanderWeele lists eight considerations that increase confidence in the estimate, including longitudinal design; the quality of the assessment of exposure, outcome and confounders; flexible statistical modeling examining robustness to modelling decisions; and attempts to address unmeasured confounding.
Heavy industry emits many potentially hazardous pollutants into the air which can affect health. However, the effects of air pollution from heavy industry on lung function and respiratory symptoms ...have been investigated scarcely. Our aim was to investigate the associations of long-term air pollution from heavy industry with lung function and respiratory symptoms in school children.
A cross-sectional lung function study was conducted among school children (7-13 years) in the vicinity of an area with heavy industry. Lung function measurements were conducted during school hours. Parents of the children were asked to complete a questionnaire about the health of their children. A dispersion model was used to characterize the additional individual-level exposures to air pollutants from the industry in the area. Associations between PM
and NO
exposure with lung function and presence of respiratory symptoms were investigated by linear and/or logistic regression analysis.
Participation in the lung function measurements and questionnaires was 84% (665/787) and 77% (603/787), respectively. The range of the elevated PM
and NO
five years average concentrations (2008-2012) due to heavy industry were 0.04-1.59 μg/m
and 0.74-11.33 μg/m
respectively. After adjustment for confounders higher exposure to PM
and NO
(per interquartile range of 0.56 and 7.43 μg/m
respectively) was associated with lower percent predicted peak expiratory flow (PEF) (B -2.80%, 95%CI -5.05% to - 0.55% and B -3.67%, 95%CI -6.93% to - 0.42% respectively). Higher exposure to NO
(per interquartile range of 7.43 μg/m
) was also associated with lower percent forced vital capacity (FVC) and percent predicted forced expiration volume in 1 s (FEV1) (B -2.30, 95% CI -4.55 to - 0.05 and B -2.73, 95%CI -5.21 to - 0.25 respectively). No significant associations were found between the additional exposure to PM
or NO
and respiratory symptoms except for PM
and dry cough (OR 1.40, 95%CI 1.00 to 1.94).
Exposure to PM
and NO
from industry was associated with decreased lung function. Exposure to PM
was also associated with parents' reports of dry cough among their children.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective
To identify risk factors for low back pain (LBP) and lumbar radicular pain and to assess whether obesity and exposure to workload factors modify the effect of leisure‐time physical activity ...on LBP and lumbar radicular pain.
Methods
The population of this 11‐year longitudinal study consists of a nationally representative sample of Finns ages ≥30 years (n = 3,505). The outcomes of the study were LBP and lumbar radicular pain for >7 days or for >30 days in the past 12 months at follow‐up.
Results
LBP and lumbar radicular pain were more common in women than in men. LBP slightly declined with increasing age, while lumbar radicular pain increased with age. Abdominal obesity (defined by waist circumference) increased the risk of LBP (adjusted odds ratio OR 1.40 95% confidence interval (95% CI) 1.16–1.68 for LBP >7 days and adjusted OR 1.41 95% CI 1.13–1.76 for LBP >30 days) and general obesity (defined by body mass index) increased the risk of lumbar radicular pain (adjusted OR 1.44 95% CI 1.12–1.85 for pain >7 days and adjusted OR 1.62 95% CI 1.16–2.26 for pain >30 days). Smoking and strenuous physical work increased the risk of both LBP and lumbar radicular pain. Walking or cycling to work reduced the risk of LBP, particularly LBP for >30 days (adjusted OR 0.75 95% CI 0.59–0.95), with the largest reductions among nonabdominally obese individuals and among those not exposed to physical workload factors. Using vibrating tools increased the risk of lumbar radicular pain.
Conclusion
Lifestyle and physical workload factors increase the risk of LBP and lumbar radicular pain. Walking and cycling may have preventive potential for LBP.
Unlike other major journals in occupational health and safety, SJWEH is published not by a large commercial publishing house but by a not-for-profit organization: the Nordic Association of ...Occupational Safety and Health (NOROSH) (4). ...the journal is not published to make a financial profit, and we operate on a relatively small budget with the constant challenge to balance income and expenses. The five most often cited articles in 2019 among those published in SJWEH in 2018 were all open access articles (11-15). ...OA also benefits authors. Key terms: editorial; open access; open science This article in PubMed: www.ncbi.nlm.nih.gov/pubmed/32852043 Reiner Rugulies, PhD, Editor-in-Chief National Research Centre for the Working Environment, Copenhagen, Denmark e-mail: rer@nfa.dk Alex Burdorf, PhD, Editor-in-Chief Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands e-mail: a.burdorf@erasmuscmc.nl References 1.
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