Christopher McLeod

Income Inequality, Household Income, and Health Status in Canada: A Prospective Cohort Study

OBJECTIVES This study sought to determine whether income inequality, household income, and their interaction are associated with health status. METHODS Income inequality and area income measures were linked to data on household income and individual characteristics from the 1994 Canadian National Population Health Survey and to data on self-reported health status from the 1994, 1996, and 1998 survey waves. RESULTS Income inequality was not associated with health status. Low household income was consistently associated with poor health. The combination of low household income and residence in a metropolitan area with less income inequality was associated with poorer health status than was residence in an area with more income inequality. CONCLUSIONS Household income, but not income inequality, appears to explain some of the differences in health status among Canadians.

How Society Shapes the Health Gradient: Work-Related Health Inequalities in a Comparative Perspective

Analyses in comparative political economy have the potential to contribute to understanding health inequalities within and between societies. This article uses a varieties of capitalism approach that groups high-income countries into coordinated market economies (CME) and liberal market economies (LME) with different labor market institutions and degrees of employment and unemployment protection that may give rise to or mediate work-related health inequalities. We illustrate this approach by presenting two longitudinal comparative studies of unemployment and health in Germany and the United States, an archetypical CME and LME. We find large differences in the relationship between unemployment and health across labor-market and institutional contexts, and these also vary by educational status. Unemployed Americans, especially of low education or not in receipt of unemployment benefits, have the poorest health outcomes. We argue for the development of a broader comparative research agenda on work-related health inequalities that incorporates life course perspectives.

Unemployment and Mortality: A Comparative Study of Germany and the United States

OBJECTIVES We examined the relationship between unemployment and mortality in Germany, a coordinated market economy, and the United States, a liberal market economy. METHODS We followed 2 working-age cohorts from the German Socio-economic Panel and the US Panel Study of Income Dynamics from 1984 to 2005. We defined unemployment as unemployed at the time of survey. We used discrete-time survival analysis, adjusting for potential confounders. RESULTS There was an unemployment-mortality association among Americans (relative risk [RR]=2.4; 95% confidence interval [CI]=1.7, 3.4), but not among Germans (RR=1.4; 95% CI=1.0, 2.0). In education-stratified models, there was an association among minimum-skilled (RR=2.6; 95% CI=1.4, 4.7) and medium-skilled (RR=2.4; 95% CI=1.5, 3.8) Americans, but not among minimum- and medium-skilled Germans. There was no association among high-skilled Americans, but an association among high-skilled Germans (RR=3.0; 95% CI=1.3, 7.0), although this was limited to those educated in East Germany. Minimum- and medium-skilled unemployed Americans had the highest absolute risks of dying. CONCLUSIONS The higher risk of dying for minimum- and medium-skilled unemployed Americans, not found among Germans, suggests that the unemployment-mortality relationship may be mediated by the institutional and economic environment.

Descriptive Epidemiology of Serious Work-Related Injuries in British Columbia, Canada

Objective This study examined the rates and distribution of serious work-related injuries by demographic, work and injury characteristics in British Columbia, Canada from 2002–2008, using population-based data. Methods Claims for workers with a serious injury were extracted from workers’ compensation data. Serious injuries were defined by long duration, high cost, serious medical diagnosis, or fatality. Workforce estimates were used to calculate stratum-specific rates. Rate-ratios (RR) and 95% CIs were calculated using negative binomial regression for the comparison of rates, adjusting for gender, age and occupation. Results Women had a lower overall serious injury rate compared to men (RR: 0.93, 95% CI: 0.87–0.99). The 35–44 age group had the highest overall rate compared to the youngest age group. The rate for severe strains/sprains was similarly high for men and women in the 35–44 age group, although there was a differential pattern by gender for other injury types: the rate of fracture was similar across age groups for men, but increased with age for women (RR: 2.7, 95% CI: 2.2–3.3); and the rate of severe falls increased with age for men and women, with a larger three-fold increase for older women (men: RR: 1.8, 95% CI: 1.7–2.1; women: RR: 3.2, 95% CI: 2.7–3.7). Conclusions The risk of serious injuries is higher among specific age groups with different patterns emerging for men and women. Variations persisted within similar injury types and occupation groups in our adjusted models. These results provide evidence for the burden of serious injuries and a basis for future analytic research. Given projected demographic shifts and increasing workforce participation of older workers, intervention programs should be carefully implemented with consideration to demographic groups at risk for serious injuries in the workplace.

The Relationship between Age and Work Injury in British Columbia: Examining Differences across Time and Nature of Injury.

The Relationship between Age and Work Injury in British Columbia: Examining Differences across Time and Nature of Injury: Peter SMITH, et al. Institute for Work and Health, Canada—

Labor markets and health: An integrated life course perspective

Current work and health research is fragmented, focusing on jobs, exposures, specific worker groups, work organization, or employment contracts. An emphasis on the labor market in framing the work and health relationship conceptualizes work not only as an exposure that increases or lessens health risk but also as a life course experience that is dependent on place and time. The intention is to illustrate how the labor markets and health framework coupled with a life course perspective extends other epidemiological approaches to work and health to identify new research questions. Taking the changing nature of work and labor markets into account, this paper updates the labor markets and health framework. It then reviews, defines, and integrates key life course concepts. A model is developed that guides the understanding of how labor markets and health trajectories emerge from the consideration of the working life course in a social context. The application leads to new research questions investigating characteristics of labor markets and health trajectories that may lead to positive health outcomes over the life course.

Work injury risk by time of day in two population-based data sources.

Objective To estimate the rate of work injury over the 24 h clock in Ontario workers over 5 years (2004–2008). Methods A cross-sectional, observational study of work-related injury and illness was conducted for a population of occupationally active adults using two independent data sources (lost-time compensation claims and emergency department encounter records). Hours worked annually by the Ontario labour force by time of day, age, gender and occupation were estimated from population-based surveys. Results There was an approximately 40% higher incidence of emergency department visits for work-related conditions than of lost-time workers’ compensation claims (707 933 emergency department records and 457 141 lost-time claims). For men and women and across all age groups, there was an elevated risk of work-related injury or illness in the evening, night and early morning periods in both administrative data sources. This elevated risk was consistently observed across manual, mixed and non-manual occupational groups. The fraction of lost-time compensation claims that can be attributed to elevated risk of work injury in evening or night work schedules is 12.5% for women and 5.8% for men. Conclusions Despite the high prevalence of employment in non-daytime work schedules in developed economies, the work injury hazards associated with evening and night schedules remain relatively invisible. This study has demonstrated the feasibility of using administrative data sources to enhance capacity to conduct surveillance of work injury risk by time of day. More sophisticated aetiological research is needed to understand the specific mechanisms of hazards associated with non-regular work hours.

Population-based asbestosis surveillance in British Columbia

Objectives: To investigate the use of multiple health data sources for population-based asbestosis surveillance in British Columbia, Canada. Methods: Provincial health insurance registration records, workers’ compensation records, hospitalisation records, and outpatient medical service records were linked using individual-specific study identifiers. The study population was restricted to individuals ⩾15 years of age living in the province during 1992–2004. Results: 1170 new asbestosis cases were identified from 1992 to 2004 for an overall incidence rate of 2.82 (men: 5.48, women: 0.23) per 100 000 population; 96% of cases were male and average (SD) age was 69 (10) years. Although the annual number of new cases increased by 30% during the surveillance period (β = 2.36, p = 0.019), the observed increase in annual incidence rates was not significant (β = 0.02, p = 0.398). Workers’ compensation, hospitalisation and outpatient databases identified 23%, 48% and 50% of the total new cases, respectively. Of the new cases, 82% were identified through single data sources, 10% were only recorded in the workers’ compensation records, and 36% only in each of the hospitalisation and outpatient records. 84% of hospitalisation cases and 83% of outpatient cases were not included in the workers’ compensation records. The three data sources showed different temporal trends in the annual number of new cases and annual incidence rates. Conclusions: Single data sources were not sufficient to identify all new cases, thus leading to serious underestimations of the true burden of asbestosis. Integrating multiple health data sources could provide a more complete picture in population-based surveillance of asbestosis and other occupational diseases.

A Systematic Review of Retirement as a Risk Factor for Mortality

Aging, health, and retirement are closely related in modern industrialized societies such as the United States. Starting in the 1800s and continuing through the early 1900s, old age pensions, fixed age retirement, and government sponsored pension plans were introduced by Germany, France and England, which meant that persons no longer had to work until they died or to rely on friends and family for support in their old age (Streib and Schneider 1971). The aging population in the US is dramatically increasing. The U.S. Census Bureau (2006) estimated that 78.2 million people in the baby boomer generation, those born between 1946 and 1964, were alive, a total that represented 30 % of the U.S. population. In 2006, the oldest of this generation turned 60 years old. The Census also estimates that persons age 65 and older will total about 13 % of the U.S. population by 2010, and 19 % by 2025 (Campbell 1996). These changes could overwhelm the public and private social security and health care insurance and delivery systems (Gebbie et al. 2005).

The relationship between chronic conditions and absenteeism and associated costs in Canada

OBJECTIVES This study aimed to measure and compare the relationship between chronic diseases and the number of absent workdays due to health problems and the associated costs among working Canadians. METHODS The study sample included respondents to the 2010 Canadian Community Health Survey between aged 15-75 years who reported employment in the past three months. Respondents reported their number of absent workdays due to health problems and chronic conditions. A negative binomial regression was used to estimate the incremental absent workdays associated with having a particular chronic condition (of 16 conditions), conditional on other chronic conditions and confounders. For each condition, we calculated the incremental number of absent workdays, the incremental productivity loss attributed to absenteeism per employee, and the overall productivity loss in the population. RESULTS The final sample consisted of 28 678 respondents representing 15 468 788 employed Canadians. The average number of absent workdays due to health problems was 1.35 days over a 3-month period. The three conditions with the greatest association with absent workdays were mood disorders, heart disease, and bowel disorders. They were associated with 1.17, 0.81, and 0.80 additional absent workdays, respectively, compared to workers without this condition, holding other conditions and confounders at their means. At the national working population level, back problems (CAD