Peppiina Saastamoinen

Register-based study among employees showed small nonparticipation bias in health surveys and check-ups

OBJECTIVES To examine nonparticipation to a questionnaire survey and occupational health check-ups by sociodemographic variables and health status, measured by medically confirmed sickness absence, and whether the associations between other study variables and participation were affected by health status. STUDY DESIGN AND SETTING Questionnaire surveys and health check-ups were conducted among the City of Helsinki employees. Sample information was derived from the employers personnel register and analyzed by participation and giving consent to link the data to external administrative registers. RESULTS Participation to the questionnaire survey was more common among the older, higher occupational classes, those with higher income, permanent employment, and those with no absence due to medically confirmed sickness. Among women in particular, the differences were small. Consent giving followed generally similar patterns than survey response. Nonparticipation to health check-ups was related to low income and temporary employment contract. In both questionnaire survey and health check-ups, associations between other study variables and participation were not affected by health status. CONCLUSIONS Questionnaire surveys and health check-ups were broadly representative of the target population. Associations between other study variables and participation did not differ by health status. This suggests that even when the data are not fully representative associations between the study variables need not to be biased.

Socio-economic differences in the prevalence of acute, chronic and disabling chronic pain among ageing employees

&NA; Pain is a strong predictor of reduced work ability and well‐being, but there is little information on the prevalence of and socio‐economic differences in acute, chronic and disabling chronic pain among employees. A questionnaire survey conducted in 2000–2002 among employees aged 40, 45, 50, 55 and 60 of the City of Helsinki (N=8970, response rate 67%) included socio‐demographic and socio‐economic factors and measures of current pain, pain duration and pain‐related disability. Pain was acute when lasting a maximum of 3 months and chronic when persisting for more than 3 months. Disabling chronic pain was determined using the disability subscale of Von Korffs Chronic Pain Grade questionnaire. Acute pain was reported by 15% of women, chronic pain by 29% and disabling chronic pain by 7%. The corresponding figures for men were 12, 24 and 5%. Chronic and disabling chronic pain were more common in older age groups among both genders. Among women, those with secondary or basic education were more likely to report chronic or disabling chronic pain than those with higher education, and semi‐professionals, routine non‐manual employees and manual workers were more likely to report disabling chronic pain than managers. Among men, separated/divorced or widowed men were more likely to report acute pain than married men, and manual workers were more likely to report chronic pain than managers. Chronic pain was relatively common in this population, and those with older age, lower education and occupational class appear to be at excess risk for chronic pain, especially for disabling chronic pain.

Cohort Profile: The Helsinki Health Study

The Helsinki Health Study cohort was set up to enable longitudinal studies on the social and work related determinants of health and well-being, making use of self-reported as well as objective register data. The target population is the staff of the City of Helsinki, Finland. Baseline data for the cohort were derived from questionnaire surveys conducted in 2000, 2001 and 2002 among employees reaching 40, 45, 50, 55 or 60 years of age in each year. The number of responders at baseline was 8960 (80% women, response rate 67%). Additional age-based health examination data were available. A follow up survey was conducted in 2007 yielding 7332 responders (response rate 83%). Measures of health include health behaviours, self-rated health, common mental disorders, functioning, pain, sleep problems, angina symptoms and major diseases. Social determinants include socio-demographics, socio-economic circumstances, working conditions, social support, and work-family interface. Further register linkages include sickness absence, hospital discharge, prescribed drugs, and retirement updated at the end of 2010. The cohort allows comparisons with the Whitehall II study, London, UK, and the Japanese Civil Servants Study from western Japan. The cohort data are available for collaborative research at Hjelt Institute, Department of Public Health, University of Helsinki, Finland.

Working conditions as risk factors for disability retirement: a longitudinal register linkage study

BackgroundEarly retirement due to disability is a public health and work environment problem that shortens working careers. Transition to disability retirement is based on ill-health, but working conditions are also of relevance. We examined the contributions of work arrangements, physical working conditions and psychosocial working conditions to subsequent disability retirement.MethodsThe data were derived from the Helsinki Health Study cohort on employees of the City of Helsinki, Finland. Information on working conditions was obtained from the baseline surveys conducted in 2000, 2001 and 2002. These data were linked with register data on disability retirement and their main diagnoses obtained from the Finnish Centre for Pensions. Follow up by the end of 2008 yielded 525 disability retirement events. The analysed data included 6525 participants and 525 disability retirement events. Hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated from Cox regression analysis.ResultsSeveral working conditions showed own associations with disability retirement before adjustment. After adjustment for all working conditions, the primary risk factors for all-cause disability retirement were physical workload among women (HR 2.02, 95% CI 1.57-2.59) and men (HR 2.00, 95% CI 1.18-3.38), and low job control among women (HR 1.60, 95% CI 1.29-1.99). In addition, for disability retirement due to musculoskeletal causes, the risk factors were physical workload and low job control. For disability retirement due to mental causes the risk factors were computer work and low job control. Furthermore, occupational class was a risk factor for disability retirement due to all causes and musculoskeletal diseases.ConclusionsAmong various working conditions, those that are physically demanding and those that imply low job control are potential risk factors for disability retirement. Improving the physical working environment and enhancing control over one’s job is likely to help prevent early retirement due to disability.

Pain and health related functioning among employees

Study objective: Although employees report high rates of pain, little is known about the effects of pain on health related functioning among them. This study examined the effects of pain on employees’ health related functioning by bodily locations of pain, number of painful locations, and whether pain was acute or chronic. Design: Cross sectional questionnaire survey. Data on pain and health related functioning as measured with the eight subscales of the short form 36 health survey (SF-36) were obtained in the years 2001 and 2002. Setting: Municipal employees of the City of Helsinki, Finland. Participants: All employees who reached the age of 40, 45, 50, 55, and 60 years during each study year. Response rate was 66% (n = 5829). Main results: Compared with those reporting no pain, those with pain had considerably poorer functioning on all SF-36 subscales. The lowest scores for health related functioning were seen in the physical domain of health, whereas the mental domain was less affected. The association of pain with functioning was practically independent of the bodily location of pain. Whether pain was acute or chronic had only a modest effect on functioning. Widest variation in functioning was found by the number of painful locations. Conclusions: Among employees pain complaints, irrespective of the location, are associated with a decreased level of functioning. The number of painful locations is likely to be the most useful measure to identify employees with a high risk of poor functioning.

Psychosocial risk factors of pain among employees

The study of psychosocial risk factors of pain among employees has typically focused on Karaseks job‐demand‐control model. The aim of the study was to examine the own and independent associations of job strain, organizational justice, workplace bullying, and work–home interface with pain.

Workplace bullying and common mental disorders: a follow-up study

Background Workplace bullying has been associated with mental health, but longitudinal studies confirming the association are lacking. This study examined the associations of workplace bullying with subsequent common mental disorders 5–7 years later, taking account of baseline common mental disorders and several covariates. Methods Baseline questionnaire survey data were collected in 2000–2002 among municipal employees, aged 40–60 years (n=8960; 80% women; response rate 67%). Follow-up data were collected in 2007 (response rate 83%). The final data amounted to 6830 respondents. Workplace bullying was measured at baseline using an instructed question about being bullied currently, previously or never. Common mental disorders were measured at baseline and at follow-up using the 12-item version of the General Health Questionnaire. Those scoring 3–12 were classified as having common mental disorders. Covariates included bullying in childhood, occupational and employment position, work stress, obesity and limiting longstanding illness. Logistic regression analysis was used. Results After adjusting for age, being currently bullied at baseline was associated with common mental disorders at follow-up among women (OR 2.34, CI 1.81 to 3.02) and men (OR 3.64, CI 2.13 to 6.24). The association for the previously bullied was weaker. Adjusting for baseline common mental disorders, the association attenuated but remained. Adjusting for further covariates did not substantially alter the studied association. Conclusion The study confirms that workplace bullying is likely to contribute to subsequent common mental disorders. Measures against bullying are needed at workplaces to prevent mental disorders.

The association of employment status and family status with health among women and men in four Nordic countries.

Aims: The Nordic countries have relatively equal employment participation between men and women, but some differences between countries exist in labour market participation. The aim was to examine the association between employment status and health among women and men in Denmark, Finland, Norway, and Sweden, and analyse whether this association is modified by marital status and parental status. Methods: The data come from nationally representative cross-sectional surveys carried out in Denmark (n=2,209), Finland (n=4,604), Norway (n=1,844) and Sweden (n=5,360) in 1994—95. Women and men aged 25—49 were included. Employment status was categorized into full-time employed, part-time employed, unemployed, and housewives among women and into employed and unemployed among men. Health was measured by perceived health and limiting longstanding illness. Logistic regression analysis was used, adjusting for age and education. Marital status and parental status were analysed as modifying factors. Results: The non-employed were more likely to report perceived health as below good and limiting longstanding illness than the employed among both women and men. The association between employment status and perceived health remained unchanged when marital status and parental status were adjusted for among all men and Finnish women, but the association was slightly strengthened among Danish and Swedish women, with the housewives becoming more likely to report ill health than employed women. The association between employment status and limiting longstanding illness was slightly strengthened among women, and slightly weakened among Norwegian men when marital and parental status were adjusted for. Conclusions: Non-employment was associated with poorer health in all countries, although there are differences in the employment patterns between the countries. Among women marital status and parental status showed a modest or no influence on the association between employment status and health. Among men there was no such influence.

Pain and disability retirement: A prospective cohort study

Summary Chronic pain is strongly associated with subsequent disability retirement. Abstract This study examined the association of pain with subsequent disability retirement due to all causes as well as musculoskeletal diseases, mental disorders, and a heterogeneous group of other diseases and to study whether pain has an effect of its own after taking into account long‐standing illness, physician‐diagnosed diseases, working conditions, and occupational class, which are the key factors affecting disability retirement. The data consisted of the Helsinki Health Study baseline survey linked to national pension register data (n = 6258). Mean follow‐up time was 8.1 years. The data included 594 disability retirement events. Pain (acute or chronic) was stratified by long‐standing illness (yes/no). Cox regression analysis was performed. Chronic pain without and with co‐occurring long‐standing illness was strongly associated with all types of disability retirement outcomes, but the associations were particularly strong for disability retirement due to musculoskeletal diseases. The associations remained even when further adjusted for physician diagnosed chronic conditions and diseases, psychosocial and physical working conditions, and occupational class. Associations for acute pain were also found, but they were clearly weaker than those of chronic pain. Chronic pain contributes to disability retirement. Prevention and effective treatment of chronic pain may help prevent early retirement due to disability.

The effect of pain on sickness absence among middle-aged municipal employees

Objectives: To study the effects of pain on sickness absence, taking into account physical and psychosocial work load and socio-economic position. Methods: Data consisted of City of Helsinki personnel register data on sickness absence and a cross-sectional questionnaire survey which was carried out among employees of the City of Helsinki who reached the age of 40, 45, 50, 55 or 60 years during the years 2000–2002 (n = 8960, response rate 67%). Data sets were combined for those who gave permission for such linkage (78%). The main statistical method was negative binomial regression analysis. Results: The burden of pain on sickness absence was dependent on the duration of absence: the longer the duration, the higher the burden. Self-certified absence was equally predicted by acute and chronic pain, but medically certified absence was more clearly predicted by chronic pain. Adjustments for a range of work load factors and socio-economic position showed that pain was a relatively independent determinant of subsequent sickness absence, but in particular physical work load and socio-economic position explained a small proportion of the association. Overall, pain accounted for 13% of self-certified absence among women and 8% among men. Corresponding figures were 23% and 25% for medically certified 4–14-day sickness absence and 37% and 30% for absence of over 2 weeks. Conclusions: The burden of pain on medically certified sickness absence is considerable. Prevention of pain problems is vital for reducing sickness absence rates.