Heather Scott-Marshall

The impact of temporary employment and job tenure on work-related sickness absence

Objectives: To investigate the impact of temporary employment and job tenure on work-related sickness absence of 1 week or more. Methods: A longitudinal analysis was undertaken of the time to work-related sickness absence from the start of a job using the Canadian Survey of Labour and Income Dynamics. The sample consisted of 4777 individuals who experienced 7953 distinct job episodes and 167 absences. There were 114 488 person-job-month observational units. The major variables of interest in this study were a variable identifying whether the job was temporary or permanent, and tenure on the job. Results: Individuals in temporary jobs were as likely to have a work-related sickness absence as individuals in permanent jobs. Individuals with job tenure of 4–6 months were 64% less likely to have an absence than individuals with longer tenures. Individuals in a union were more likely to have an absence. Firm size was not associated with absence. Conclusions: Previous studies have suggested that temporary employment and job tenure are associated with work-related health risk exposures and the ability to take a sickness absence, but these studies have not considered the nature of the employment contract in a longitudinal framework. This analysis did not find temporary employment to be associated with differential absence rate after controlling for tenure, prior health status, and several other individual and job characteristics. Short tenure is negatively related to the probability of work-related sickness absence, union membership is positively related, and firm size is not related to this variable.

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—

Social protection and the employment contract: the impact on work absence.

OBJECTIVE This study investigates the impact of temporary employment on all-cause sickness absence of one week or more with a focus on how this relationship is moderated by factors related to social protection (job tenure, union membership and firm size). PARTICIPANTS A sample of 5,307 individuals who experienced 9,574 distinct job episodes was drawn from a longitudinal Canadian labour market survey (2000-2004). METHODS Duration analysis was undertaken to model the time from the start of a job to the first sickness absence. Specifically, a proportional hazard model was estimated using a complementary log-log function for continuous time processes. RESULTS Findings showed that temporary employment was associated with a lower rate of sickness absence after controlling for tenure, prior health status, and several other individual and job characteristics. CONCLUSIONS The results suggest that the lack of social protection in temporary jobs is a powerful determinant of absence taking, even in the case of serious health conditions that require an absence of one week or more.

Long-term mortality risk in individuals with permanent work-related impairment

OBJECTIVES: Recent estimates indicate that at least one in five activity-limiting injuries occurs at work. Of individuals who suffer these injuries approximately 10% experience some degree of functional impairment. We were interested in investigating long-term mortality risk in individuals with permanent impairment from work injury and to examine whether work disability is a significant explanatory factor.METHODS: We used a retrospective matched cohort methodology to examine differences in mortality rates between individuals with permanent impairment from a work injury and a group of non-injured controls over a 19-year period. We used a sample of impaired workers to investigate the impact of work disability on mortality risk using percentage of earnings recovery after injury as the key proxy measure. All analyses were stratified by sex.RESULTS: Permanent impairment from a work injury was predictive of premature mortality in both male and female claimants, though the risk was slightly higher among women. Work disability was a key explanatory factor in the rate of death among impaired workers, the effects being more pronounced in men. We also found that higher impairment level was associated with mortality in men but not in women.CONCLUSION: The study demonstrates the impact of permanent work-related impairment on longevity and identifies work disability as an important determinant of mortality risk. Given the disconnect between impairment ratings derived from standard diagnostic tools and labour-market activity after accident, more research is needed on the specific factors that contribute to work disability, particularly those related to psycho-social health and well-being.RésuméOBJECTIFS : Selon des estimations récentes, au moins un traumatisme sur cinq limitant les activités se produit au travail. Environ 10 % des personnes qui subissent ces traumatismes éprouvent une certaine incapacité fonctionnelle. Nous avons voulu étudier les risques de mortalité à long terme chez les personnes atteintes d’une incapacité permanente à la suite d’un accident du travail et déterminer si l’incapacité professionnelle en est un facteur explicatif important.MÉTHODE : À l’aide d’un modèle d’étude de cohorte rétrospective appariée, nous avons examiné sur une période de 19 ans les différences dans les taux de mortalité de sujets atteints d’une incapacité permanente à la suite d’un accident du travail et d’un groupe témoin n’ayant pas subi de traumatisme. Nous avons utilisé un échantillon de travailleurs ayant une incapacité pour étudier l’impact de l’incapacité professionnelle sur le risque de mortalité en utilisant le pourcentage de récupération des gains après le traumatisme comme variable substitutive clé. Toutes nos analyses ont été stratifiées selon le sexe.RÉSULTATS : Une incapacité permanente à la suite d’un accident du travail était une variable prédictive de mortalité prématurée tant chez les hommes que chez les femmes ayant présenté une demande d’indemnisation, bien que le risque ait été légèrement supérieur chez les femmes. L’incapacité professionnelle était un facteur explicatif clé du taux de décès des travailleurs ayant une incapacité, les effets étant plus prononcés chez les hommes. Nous avons aussi constaté qu’un niveau d’incapacité supérieur était associé à la mortalité chez les hommes, mais non chez les femmes.CONCLUSION : Cette étude montre l’impact d’une incapacité professionnelle permanente sur la longévité et identifie l’incapacité professionnelle comme étant un important déterminant du risque de mortalité. Étant donné le décalage entre les taux d’incapacité dérivés des outils de diagnostic standard et l’activité sur le marché du travail après un accident, il faudrait pousser la recherche sur les facteurs précis qui contribuent à l’incapacité professionnelle, surtout ceux qui sont liés à la santé et au bien-être sur le plan psychosocial.

How much do preexisting chronic conditions contribute to age differences in health care expenditures after a work-related musculoskeletal injury?

Objectives:To estimate the contribution of preexisting chronic conditions on age differences in health care expenditures for the management of work-related musculoskeletal injuries in British Columbia. Methods:A secondary analysis of workers’ compensation claims submitted over the 5-year period between January 1, 2002 and December 31, 2006 (N=55,827 claims among men and 32,141 claims among women). Path models examined the relationships between age and health care expenditures, and the extent to which age differences in health care expenditures were mediated by preexisting chronic conditions. Models were adjusted for individual, injury, occupational, and industrial covariates. Results:The relationship between age and health care expenditures differed for men and women, with a stronger age gradient observed among men. Preexisting osteoarthritis and coronary heart disease were associated with elevated health care expenditures among men and women. Diabetes was associated with elevated health care expenditures among men only, and depression was associated with elevated health care expenditures among women only. The percentage of the age effect on health care expenditures that was mediated through preexisting chronic conditions increased from 12.4% among 25–34-year-old men (compared with 15–24 y) to 26.6% among 55+-year-old men; and 14.6% among 25–34-year-old women to 35.9% among women 55 and older. Conclusions:The results of this study demonstrate that differences in preexisting chronic conditions have an impact on the relationship between older age and greater health care expenditures after a work-related musculoskeletal injury. The differing prevalence of preexisting osteoarthritis, coronary heart disease, and to a lesser extent diabetes (among men) and depression (among women) across age groups explain a nontrivial proportion of the age effect in health care expenditures after injury. However, approximately two thirds or more of the age effect in health care expenditures remains unexplained.

Labor market and health trajectories during periods of economic recession and expansion in the United States, 1988‒2011

Objectives We examined associations between labor market and health (LM-H) trajectories in the United States between 1988 and 2011 and whether associations differed across macroeconomic expansion/recession periods. Methods Working-age cohorts, derived from the US Panel Study of Income Dynamics, were followed over time to characterize LM-H trajectories. Poisson regression provided relative risks (RR) with robust 95% confidence intervals (CI) for the association between trajectories, adjusting for demographic and socioeconomic variables. Results LM trajectories ending in unemployment (RR 1.7‒2.5 across periods) or inactivity (RR 2.3-3.2) had a greater risk of worsening health trajectories, compared to stable employment. In contrast, RR for individuals returning to work following an intermediary period of unemployment/inactivity were attenuated across most periods. Stable-employed individuals had the highest probability of remaining in good health, whereas trajectories ending in unemployment or inactivity had the lowest probability. These overall relationships were consistent across macroeconomic periods. Conclusions We found strong and consistent relationships between LM-H trajectories across macroeconomic periods. The attenuated (but not eliminated) risk among individuals returning to work following a period of unemployment/inactivity suggests that health outcomes are not only dependent on the LM end-state, but also on the distinct pattern over time.

0466 Labour market and health trajectories during periods of economic recession and expansion in the united states, 1988–2011

Objectives Negative labour market experiences are associated with worse health outcomes, although little research has examined health effects of trajectories over time. This study examined associations between labour market and health (LMH) trajectories in the US between 1988 and 2011 and and whether associations differed across four macroeconomic periods defined by contraction or expansion. Methods Working-age cohorts were derived for each period using data from the Panel Study of Income Dynamics. Cohorts started from a baseline state of employment/good health, and were followed over time to characterise LMH trajectories. Modified Poisson regression provided relative risks (RR) with robust 95% CIs for the association between trajectories. Results LM trajectories ending in unemployment (RRs 1.7–2.5 across periods) or inactivity (RRs 2.3–3.2) had a greater risk of worse health trajectories, compared to stable employment. Individuals recovering into employment following a period of inactivity experienced a greater risk of worse health (RR s 1.6–2.1). There were persistent health-gradients across trajectories, with stable-employed individuals having the highest probability of remaining in good health, and ‘LM exit’ trajectories having the lowest probability. Overall relationships were consistent across the four periods. Conclusions The increased likelihood of having worse health among unemployed/inactive individuals, yet attenuated risk among those recovering into employment following these intermediary states, suggests that health outcomes are not only dependent on the LM end-state, but also on the distinct pattern over time. Findings suggest that the contextual economic period has limited impact on these overall relationships, although future research might incorporate methodological frameworks with direct measures of the social-economic context.