Gunnhild Åberge Vie

Health and unemployment: 14 years of follow-up on job loss in the Norwegian HUNT study

BACKGROUND Many studies have investigated how unemployment influences health, less attention has been paid to the reverse causal direction; how health may influence the risk of becoming unemployed. We prospectively investigated a wide range of health measures and subsequent risk of unemployment during 14 years of follow-up. METHODS Self-reported health data from 36 249 participants in the Norwegian HUNT2 Study (1995-1997) was linked by a personal identification number to the National Insurance Database (1992-2008). Exact dates of unemployment were available. Coxs proportional hazard models were used to estimate hazard ratios (HR) for the association of unemployment with several health measures. Adjustment variables were age, gender, education, marital status, occupation, lifestyle and previous unemployment. RESULTS Compared to reporting no conditions/symptoms, having ≥3 chronic somatic conditions (HR 1.78, 95% CI 1.46-2.17) or high symptom levels of anxiety and depression (HR 1.57, 95% CI 1.35-1.83) increased the risk of subsequent unemployment substantially. Poor self-rated health (HR 1.36, 95% CI 1.24-1.51), insomnia (HR 1.19, 95% CI 1.09-1.32), gastrointestinal symptoms (HR 1.17, 95% CI 1.08-1.26), high alcohol consumption (HR 1.17, 95% CI 0.95-1.44) and problematic use of alcohol measured by the CAGE questionnaire (HR 1.32, 95% CI 1.17-1.48) were also associated with increased risk of unemployment. CONCLUSION People with poor mental and physical health are at increased risk of job loss. This contributes to poor health amongst the unemployed and highlights the need for policy focus on the health and welfare of out of work individuals, including support preparing them for re-employment.

Leisure-time physical activity and disability pension: 9 years follow-up of the HUNT Study, Norway

The objective of this study was to prospectively examine the association between leisure‐time physical activity and risk of disability pension, as well as risk of disability pension because of musculoskeletal or mental disorders in a large population‐based cohort. Data on participants aged 20–65 years in the Norwegian Nord‐Trøndelag Health Study 1995–1997 (HUNT2) were linked to the National Insurance Database. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals for disability pension across physical activity categories. During a follow‐up of 9.3 years and 235 657 person‐years, 1266 of 13 823 men (9%) and 1734 of 14 531 women (12%) received disability pension. Compared with individuals in the inactive group, those in the highly active group had a 50% lower risk of receiving disability pension (HR for men: 0.50, 0.40–0.64; women: 0.50, 0.39–0.63). After comprehensive adjustment for potential confounders, the risk remained 32–35% lower (HR for men: 0.68, 0.53–0.86; women: 0.65, 0.51–0.83). The associations were stronger for disability pension due to musculoskeletal disorders than mental disorders. In summary, we observed strong inverse associations between leisure‐time physical activity and disability pension. Our findings strengthen the hypothesis that leisure‐time physical activity may be important for occupational health in reducing disability pension.

Cardiovascular mortality – Comparing risk factor associations within couples and in the total population – The HUNT Study

BACKGROUND To compare associations of conventional risk factors with cardiovascular death within couples and in the population as a whole. METHODS We analysed baseline data (1995-97) from the HUNT2 Study in Norway linked to the national Causes of Death Registry. We compared risk within couples using stratified Cox regression. RESULTS During 914776 person-years, 3964 cardiovascular deaths occurred, and 1658 of the deaths occurred among 1494 couples. There were consistently stronger associations of serum lipids and blood pressure with cardiovascular mortality within couples compared to the population as a whole. For instance, for systolic blood pressure (per 20mmHg), the hazard ratio (HR) within couples was 1.28 (95% confidence interval: 1.17, 1.40) compared to 1.16 (1.12, 1.20) in the total population, and for diastolic pressure (per 10mmHg), the corresponding HRs were 1.16 (1.07, 1.26) and 1.11 (1.08, 1.13). Anthropometric factors (BMI, waist circumference, waist-hip ratio) as well as diabetes, smoking, physical activity, and education, showed nearly identical positive associations within couples and in the total population. CONCLUSIONS Prospective population studies may tend to slightly underestimate associations of these factors with cardiovascular mortality.

Mortality and work disability in a cohort of Norwegian couples--the HUNT study.

BACKGROUND Poor health is clustered in families, and partners might influence each other. We studied possible consequences of living with a spouse with poor health or unhealthy lifestyle on mortality and work disability. METHODS In total, 18 943 couples from the HUNT2 Study (1995-97) were linked to national registries and followed until December 2007, identifying deaths and disability pension retirements. Couples mean exposures were included together with the individuals deviation from the couple mean in discrete time multilevel logistic regression. RESULTS There was weak evidence of associations between partners health and risk of dying. Associations between couples slightly exceeded associations within couples for smoking [odds ratio (OR) within 1.57 (95% confidence interval (CI): 1.38-1.78); OR between 1.88 (95% CI: 1.70-2.08), P value for difference 0.027] and education [OR within 1.07 (95% CI: 0.99-1.15); OR between 1.17 (1.11-1.23), P value for difference 0.065]. Indicators of partners health, such as self-rated health [OR within 3.17 (95% CI: 2.80-3.58); OR between 3.92 (95% CI: 3.50-4.40), P value for difference 0.014], insomnia [OR within 1.39 (95% CI: 1.18-1.64); OR between 2.11 (95% CI: 1.86-2.53), P value for difference <0.001] and symptoms of depression [OR within 1.45 (95% CI: 1.22-1.71); OR between 1.98 (95% CI: 1.69-2.31) P value for difference 0.009] were, however, associated with risk of work disability. Self-rated health and symptoms displayed stronger associations with work disability among partners than reported somatic diseases. CONCLUSIONS This study did not indicate strong consequences of living with a spouse with poor health or unhealthy lifestyle on mortality. It did, however, indicate associations of partners health with work disability.

The Health Hazards of Marriage. A cohort study of work related disability within 12,500 Norwegian couples – the HUNT Study:

Aims: Work disability and sickness absence increase following partner’s retirement, which similarities in spouses’ health could explain. We therefore studied the risk of work disability within couples, taking account of baseline health, lifestyle and socioeconomic factors. Methods: A cohort of 12,511 couples from the HUNT Study (aged 20–67 years in HUNT2, 1995–1997) was linked to national registries, identifying all new cases of disability pension up until December 2007. Data were analysed with discrete time multilevel logistic regression and Cox regression models. Partners’ disability pension was included as a time-varying covariate. Follow-up time was split to examine the association dependent of time. Analyses were adjusted for age only, adjusted for health, and for lifestyle and education along with health. Results: About 15% of an individual’s propensity to receive a disability pension could be attributed couple similarity. There was an increased risk of work disability following the spouse’s disability retirement [HR (hazard ratio) 1.43 (95% confidence interval 1.20–1.71) for men, HR 1.49 (95% confidence interval 1.28–1.74) for women]. The association was somewhat attenuated after adjustments for health, lifestyle and education. Conclusion: There was a substantial clustering of disability pensions within couples, which cannot be explained by similarities in health, lifestyle and education. This suggests partners influence each other’s work ability. From a clinical perspective, the family situation needs to be taken into account when addressing health promotion and work participation.

Evidence of a common causal relationship between body mass index and inflammatory skin disease: a Mendelian Randomization study

Objective Psoriasis and eczema are common inflammatory skin diseases that have been reported to be associated with obesity. However, causality has not yet been established. We aimed to investigate the possible causal relationship between body mass index (BMI) and psoriasis or eczema. Methods Following a review of published epidemiological evidence of the association between obesity and either psoriasis or eczema, Mendelian Randomization (MR) was used to test for a causal relationship between BMI and these inflammatory skin conditions. We used a genetic instrument comprising 97 single nucleotide polymorphisms (SNPs) associated with BMI. One-sample MR was conducted using individual-level data (401,508 individuals) from the UK Biobank and the Nord-Trøndelag Health Study (HUNT), Norway. Two-sample MR was performed with summary-level data (731,021 individuals) from published BMI, psoriasis and eczema GWAS. The one-sample and two-sample MR estimates were meta-analysed using a fixed effect model. To explore the reverse causal direction, MR analysis with genetic instruments comprising variants from recent genome-wide analyses for psoriasis and eczema were used to test if inflammatory skin disease has a causal effect on BMI. Results Published observational data show an association of greater BMI with both psoriasis and eczema case status. The observational associations were confirmed in UK Biobank and HUNT datasets. MR analyses provide evidence that higher BMI causally increases the odds of psoriasis (by 53% per 5 units higher BMI; OR= 1.09 (1.06 to 1.12) per 1 kg/m2; P=4.67×10-9) and eczema (by 8% per 5 units higher BMI; OR=1.02 (1.00 to 1.03) per 1 kg/m2; P=0.09). When investigating causality in the opposite direction, MR estimates provide little evidence for an effect of either psoriasis or eczema influencing BMI. Conclusion Our study, using genetic variants as instrumental variables for BMI, shows that higher BMI leads to a higher risk of inflammatory skin disease. The causal relationship was stronger for psoriasis than eczema. Therapies and life-style interventions aimed at controlling BMI or targeting the mechanisms linking obesity with skin inflammation may offer an opportunity for the prevention or treatment of these common skin diseases.

Occupational and leisure-time physical activity and risk of disability pension: Prospective data from the HUNT study, Norway

Objectives To prospectively investigate the association between occupational physical activity (OPA) and disability pension due to musculoskeletal cause, mental cause or any cause. We also examined the combined association of OPA and leisure-time physical activity (LTPA) with disability pension. Methods A population-based cohort study in Norway on 32 362 persons aged 20–65 years with questionnaire data on OPA and LTPA that were followed up for incident disability pension through the National Insurance Database. We used Cox regression to estimate adjusted HRs with 95% CIs. Results During a follow-up of 9.3 years, 3837 (12%) received disability pension. Compared with people with mostly sedentary work, those who performed much walking, much walking and lifting, and heavy physical work had HRs of 1.26 (95% CI 1.16 to 1.38), 1.44 (95% CI 1.32 to 1.58) and 1.48 (95% CI 1.33 to 1.70), respectively. These associations were stronger for disability pension due to musculoskeletal disorders, whereas there was no clear association between OPA and risk of disability pension due to mental disorders. People with high OPA and low LTPA had a HR of 1.77 (95% CI 1.58 to 1.98) for overall disability pension and HR of 2.56 (95% CI 2.10 to 3.11) for disability pension due to musculoskeletal disorders, versus low OPA and high LTPA. Conclusions We observed a positive association between OPA and risk of disability pension due to all causes and musculoskeletal disorders, but not for mental disorders. Physical activity during leisure time reduced some, but not all of the unfavourable effect of physically demanding work on risk of disability pension.

The causal role of smoking on the risk of headache. A Mendelian randomization analysis in the HUNT study

Headache has been associated with various lifestyle and psychosocial factors, one of which is smoking. The aim of the present study was to investigate whether the association between smoking intensity and headache is likely to be causal.

Reply to Letter to the editor “Comments on cardiovascular mortality – Comparing risk factor associations within couples and in the total population – The HUNT Study”

a Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway b Forensic Department, Research Centre Bröset, St. Olavs University Hospital Trondheim, Trondheim, Norway c HUNT Research Center, Norwegian University of Science and Technology, Levanger, Norway d Regional Center for Health Care Improvement, St Olav Hospital, Trondheim, Norway

Temporal changes in health within 5 years before and after disability pension-the HUNT Study

Background Health status has been reported to change before, during and after disability pension receipt. These associations might be subject to temporal changes according to changes in policy, incidence of disability pensions and other contextual factors. We compared the perceived health around time of disability retirement among persons receiving disability pension in the 1990 s and 2000 s in Norway. Methods We linked data from two consecutive cross-sectional population based Norwegian health surveys, HUNT2 (1995-97) and HUNT3 (2006-08), to national registries, identifying those who received disability pension within 5 years before or after participation in the survey (HUNT2: n = 5362, HUNT3: n = 4649). We used logistic regression to assess associations of time from receiving a disability pension with self-rated health, insomnia, depression and anxiety symptoms and subsequently estimated adjusted prevalence over time. Results Prevalence of poor self-rated health peaked around time of receiving disability pension in both decades. For those aged 50+, prevalence the year before disability pension was slightly lower in 2006-08 (74%, 95% CI 70-79%) than in 1995-97 (83%, 95% CI 79-87%), whereas peak prevalence was similar between surveys for those younger than 50. Depression symptoms peaked more pronouncedly in 1995-97 than in 2006-08, whereas prevalence of anxiety symptoms was similar at time of receiving disability pension between surveys. Conclusions We found no strong evidence of differences in health selection to disability pension in the 2000 s compared to the 1990 s. However, we found indication of less depression symptoms around time of disability pension in the 2000 s compared to the 1990 s.