Hans-Tore Hansen

Disability pension by occupational class - the impact of work-related factors: The Hordaland Health Study Cohort

BackgroundThe social gradient in disability pension is well recognized, however mechanisms accounting for the gradient are largely unknown. The aim of this study was to examine the association between occupational class and subsequent disability pension among middle-aged men and women, and to what extent work-related factors accounted for the association.MethodsA subsample (N = 7031) of the population-based Hordaland Health Study (HUSK) conducted in 1997-99, provided self-reported information on health and work-related factors, and were grouped in four strata by Erikson, Goldthorpe and Portocareros occupational class scheme. The authors obtained follow-up data on disability pension by linking the health survey to national registries of benefit (FD-trygd). They employed Cox regression analysis and adjusted for gender, health (medical conditions, mental health, self-perceived health, somatic symptoms) and work-related factors (working hours, years in current occupation, physical demands, job demands, job control).ResultsA strong gradient in disability pension by occupational class was found. In the fully adjusted model the risk (hazard ratio) ranged from 1.41 (95% CI 0.84 to 2.33) in the routine non-manual class, 1.87 (95% CI 1.07 to 3.27) in the skilled manual class and 2.12 (95% CI 1.14 to 3.95) in the unskilled manual class, employing the administrator and professional class as reference. In the gender and health-adjusted model work-related factors mediated the impact of occupational class on subsequent disability pension with 5% in the routine non-manual class, 26% in the skilled manual class and 24% in the unskilled manual class. The impact of job control and physical demands was modest, and mainly seen among skilled and unskilled manual workers.ConclusionsWorkers in the skilled and unskilled manual classes had a substantial unexplained risk of disability pension. Work-related factors only had a moderate impact on the disability risk. Literature indicates an accumulation of hazards in the manual classes. This should be taken into account when interpreting the gradient in disability pension.

The ecological effect of unemployment on the incidence of very low birthweight in Norway and Sweden.

Little attention has been paid to the ecological effects of unemployment, despite strong theory suggesting that being socially or economically connected to unemployed persons can induce illness. Theory suggests, for example, that the labor market experience of adult males should affect maternal and infant health. We advance this line of inquiry by testing the hypothesis that quarterly increases in unemployment among Norwegian and Swedish males were associated with increased incidence of very low weight births from 1973 through 1995. Results support the hypothesis. We estimate that approximately 188 very low weight births could have been averted in Norway, and about 329 in Sweden, if quarterly increases in male unemployment had been constrained to the median over the 23-year period. Our findings imply that the social cost of unemployment may be underestimated by focusing on unemployment as an individual risk factor.

Social Class and Sickness Absence in Norway

In this article we study class differences, as measured by the Erikson, Goldthorpe and Portocarero (EGP) class scheme, in long-term sickness absence, and, using data from three years of the Norwegian Level of Living Survey, we investigate the possible explanatory mechanisms for these differences in Norway. Our results show that there are class differences in sickness absence especially among men, but also among women. The two main underlying factors are education and physical work environment. The results suggest that selection mechanisms and material conditions are important, and prompt the question whether psychosocial work environment explains the marked class differences in sickness absence.

Sickness Absence among Immigrants in Norway, 1992—2003

Utilizing register panel data (1992—2003), in this article we study long-term sickness absence among immigrants and ethnic Norwegians (n = 200,022). The data contain detailed information on socio-economic background, labour market participation and social insurance benefits for all individuals aged between 16 and 67 years residing in Norway. We present four main findings: (1) There is no difference in sickness absence between ethnic Norwegians and immigrants from the other Nordic countries, Western and Eastern Europe after controlling for demographic, socio-economic and labour market factors; (2) the sickness absence rates are higher among individuals from Asia (men and women) and Africa (men), and lower among men from North America and Oceania compared with ethnic Norwegians; (3) second-generation immigrants share the same level of sickness absence as ethnic Norwegians; (4) residence time has a curve-linear effect (reversed U-shape) on sickness absence for most immigrant groups. We discuss the findings in relation to the reason for emigrating, health risks related to immigration, social exclusion and norms towards sickness absence.

General practitioner characteristics and sickness absence—a register-based study of 348 054 employed Norwegians

Abstract Background: Sickness certification is currently of increased interest in general practice research. Sickness absence certification is a key medical task for general practitioners (GPs), but the knowledge of GPs’ certification practices and the GPs’ role in sickness absence is limited and partly contradictory. Objective: The objective of this study was to analyse whether rates of sickness absence vary in relation to characteristics of the GP and their list-population. Methods: The data set consisted of matched GP–patient data, including 627 GPs and 348 054 people in employment in the two largest cities in Norway in 2006. Sickness absence rates (total annual days) were estimated using descriptive statistics and analysis of variation. Results: Of the population at risk of sick leave, 23.3% of the women had at least one sickness episode in 2006, compared with 12.7% of the men. Mean total annual days of sick leave was 12.1 for the women and 6.4 for the men. Characteristics of the GPs’ list population, especially the socio-economic status of those on the list, were associated with variations in sickness absence rates. GP gender and age showed association only in one subgroup of list patients. Conclusion: Our findings support previous studies concluding that individual patient factors are the most important variables explaining with sickness absence patterns. The study also showed that some GP-factors, and especially factors linked to the composition of the list population, are associated with variations in sickness absence rates and thus important when studying certification practices.

Using time-series analyses to detect the health effects of medical care reforms: : a Norwegian example

Reforms of health care financing are controversial because, among other reasons, they might adversely affect public health. Social scientists are expert on many of the mechanisms that could connect these reforms to health. Yet there have been remarkably few attempts by social scientists to contribute to the debate over the health effects of medical care reforms. We suspect that the reasons for this gap include the lack of agreement on a method for such research. We suggest one method and demonstrate its application by testing the hypothesis that the incidence of very low birthweight increased when the financing of health care was changed in four Norwegian communities.