Stefania D’Angelo

Health and Employment after Fifty (HEAF): a new prospective cohort study

BackgroundDemographic trends in developed countries have prompted governmental policies aimed at extending working lives. However, working beyond the traditional retirement age may not be feasible for those with major health problems of ageing, and depending on occupational and personal circumstances, might be either good or bad for health. To address these uncertainties, we have initiated a new longitudinal study.Methods/designWe recruited some 8000 adults aged 50–64 years from 24 British general practices contributing to the Clinical Practice Research Datalink (CPRD). Participants have completed questionnaires about their work and home circumstances at baseline, and will do so regularly over follow-up, initially for a 5-year period. With their permission, we will access their primary care health records via the CPRD. The inter-relation of changes in employment (with reasons) and changes in health (e.g., major new illnesses, new treatments, mortality) will be examined.DiscussionCPRD linkage allows cost-effective frequent capture of detailed objective health data with which to examine the impact of health on work at older ages and of work on health. Findings will inform government policy and also the design of work for older people and the measures needed to support employment in later life, especially for those with health limitations.

0066 Problems of vision, hearing and balance and risks of workplace injury

Objectives To assess the role of sensory impairments and disorders of balance in occupational injury. Method The Clinical Practice Research Datalink records all medical consultations, referrals and diagnoses in primary care for 6% of the British population. Using this register we identified 1348 working-aged patients who had consulted medical services over a 20-year period for workplace injury (cases) and 6652 matched controls. Risks were assessed in relation to visual impairment, common eye diseases, hearing loss, perforated ear drum, non-acute otitis media, and disorders of balance, using conditional logistic regression. Results In all, 173 subjects had had an eye problem before the date of injury consultation (index date), 793 an ear problem (including 336 with impaired hearing and 482 with non-acute otitis media), and 266 a disorder of balance. No associations were found with specific eye diseases or perforation of the ear drum, but odds ratios (ORs) were moderately elevated for eye and ear problems more generally, and higher still in relation to blindness or partial sight (OR 1.90) and non-acute otitis media (OR 2.03). The OR for consulting with disorder of balance within the 12 months immediately preceding injury consultation was 1.81 (95% CI 1.03–3.17). Conclusions Problems of vision, impairments of hearing, and disorders of balance may all carry a moderately increased risk of occupational injury.

Job stress and post-retirement health in the Hertfordshire Cohort Study

Background Job demand-control (DC) and effort-reward imbalance (ERI) are two commonly used measures of work stress which are independently associated with health. Aims To test the hypothesis that DC and ERI have different and cumulative effects on health. Methods DC and ERI were assessed in the Hertfordshire Cohort Study. The characteristics and occupations of men and women reporting either or both work stresses were compared and the interaction of these with health status were explored. Results Complete data were available for 1021 men and 753 women, reporting on their most recent or current job. A total of 647 (63%) men and 444 (59%) women reported neither work stress, while 103 (10%) men and 78 (10%) women reported both. Patterns of ERI and DC, alone and in combination, were different by type of occupation and by gender. Men reporting both work stresses (as compared with neither) were more likely to be single. Reported ERI with DC in the most recent or current job was associated with: poorer SF-36 physical function scores (OR 2.3 [95% CI 1.5-3.7] for men; OR 2.0 [95% CI 1.2-3.6] for women) and mental health scores (OR 2.8 [95% CI 1.8-4.4] for men; OR 3.1 [95% CI 1.8-5.3] for women). Moreover, average grip strength was 1.7 kg (95% CI 0.2-3.3) lower among men who described both work stresses. Conclusion DC and ERI are two models of the psychosocial workplace environment which offer different but cumulative insight into the impacts of work on an individuals psychological and physical health, particularly in a population sample.

0274 The profile of informal carers in a cohort of 50–64 year-olds: results from the health and employment after fifty (heaf) study

Background With increases in the UK pensionable age, people are now expected to work to older ages, but they may also have caring responsibilities which constrain their capacity to work and could affect their health. To explore the extent of the problem, we assessed the profile of unpaid carers in the HEAF study. Methods 8134 men and women aged 50–64 were recruited from 24 English general practices. Socio-demographic, lifestyle and health characteristics were elicited by postal questionnaire, along with weekly hours giving personal care to someone in the home or family. Results 644 (17.4%) men and 1153 (26.0%) women had caring responsibilities; of these, 93 (14%) and 199 (17%) reported caring for ≥20 hours/week respectively. Participants with low levels of education or social class, non-homeowners, and those struggling to manage financially were more likely to be carers. Carers of both sexes were less likely to be working and, if working, more likely to be part-time or often working shifts. Carers, and particularly those caring for ≥20 hours/week, reported worse health (self-rated, depression and sleep problems). Prevalence of chronic musculoskeletal pain was 32% and 44% respectively among men and women who cared ≥20 hours/week, in comparison with 25% and 27% amongst non-carers. Conclusions The requirement to be a carer is common in the HEAF cohort. Those affected are less likely to be in full-time employment and more likely to be in worse health. There is a need for further research on how older workers with caring responsibilities can be better supported.

0047 Poor health, lifestyle, work-related factors and premature loss of employment in older workers – results from the health and employment after fifty (heaf) study

Background Populations of Western countries are ageing; in response to this, governments encourage longer working lives. However, many workers leave paid employment prematurely. We have examined the combined importance of poor health, lifestyle and work-related characteristics as risk factors for health-related job loss among older workers. Methods 8134 men and women aged 50–64 were recruited from 24 English general practices to the HEAF study. Participants provided information on their socio-demographic, lifestyle, health (self-rated health, depression, chronic disabling musculoskeletal pain, severe difficulties in daily activities), and employment characteristics. Those in paid employment at baseline were categorised at 1 year follow-up as: ‘still in work and didn’t change job on health grounds’ (n=4,232) versus ‘not in work due to health reasons (n=101)’. The remaining participants were excluded from this analysis. Multivariate Poisson regression with robust standard errors was used to analyse the data. Results All ill-health measures were strongly associated with health-related exit from the workplace (RR for poor self-rated health=4.5, (95%CI 3.1, 6.6)). Adjustment for smoking, leisure-time physical activity (LTPA) and job dissatisfaction attenuated these associations (RR for poor self-rated health=3.1, (95%CI 2.0, 4.8)). Smoking, lack of LTPA, and job dissatisfaction (RR=5.4; (95% CI 3.4, 8.5)) were associated with health-related job loss independently of health variables. Conclusions Poor self-rated health, depression, chronic disabling musculoskeletal pain and severe problems with daily activities significantly increased the risk of leaving employment on health grounds. Tackling unhealthy behaviours and improving job satisfaction could reduce the risk of exiting the workforce for older workers with poor health.

0315 Effect of multisite musculoskeletal pain on health related job loss: findings from the health and employment after fifty (heaf) study

Background Musculoskeletal pain (MSP) at multiple anatomical sites differs from single site pain both in its risk factors and prognosis. Multisite MSP is more likely to cause sickness absence from work, but knowledge about its effect on health-related job loss (HRJL) is limited. To explore this association we analysed longitudinal data from participants aged 50–64 recruited to the Health and Employment After Fifty (HEAF) study. Method Baseline information collected by postal questionnaire from 4333 employed participants included questions about MSP in the past year at three anatomical sites (spine, upper, and lower limb). Subsequent HRJL was ascertained through a follow-up questionnaire after one year. Associations between multisite MSP (pain at ≥2 anatomical sites) and HRJL were explored using Poisson regression with robust variance and summarised by prevalence rate ratios (PRRs). Results Among 437 participants with multisite MSP at baseline, 7% left their job due to ill health, compared to 3% in 547 with single-site pain and 2% in 3349 without MSP. After accounting for potential confounders, the risk of HRJL was higher among those with multisite MSP than in those with single-site MSP (fully-adjusted PRRs 1.9 (95%CI 1.1–3.2) and 1.6 (95%CI 0.9–2.7) compared with no MSP). The population attributable fraction for single-site pain was 7%, while that of multi-site pain was 15%. Conclusions This analysis suggests that multisite MSP carries a higher risk of HRJL than single-site pain. To develop future preventive strategies, efforts should focus on understanding the drivers of multisite MSP rather than concentrating on site-specific risk factors.

0270 Mortality from lung cancer in occupations with exposure to asbestos among men in england and wales (1979–2010)

Background Estimating national burdens of lung cancer from occupational exposure to asbestos is challenging because of the potential for confounding by smoking. Methods To generate a refined estimate, we analysed data on underlying cause of death and last full-time occupation for 3,688,916 deaths among men aged 20–74 years in England and Wales during 1979–2010, calculating proportional mortality ratios (PMRs) standardised for age and social class. We compared observed and expected deaths from lung cancer in 28 occupations with excess mortality from mesothelioma or asbestosis. To reduce the confounding effects of smoking, we adjusted the expected number of lung cancers in each occupation, according to its PMR for chronic obstructive pulmonary disease (COPD) in an analysis that excluded jobs with a known hazard of COPD. Results Adjusted PMRs for lung cancer were elevated in all but one of the 28 asbestos-exposed occupations, but did not correlate with those for cancer of the pleura (Spearman correlation coefficient=−0.3). The total excess of deaths from lung cancer across the 28 occupations over the 31 years of study was 9561 (as compared with 3164 when no adjustment was made). Conclusions Asbestos appeared to account for some 300 excess lung cancer deaths per year in England and Wales, which is approximately 70% of the annual number of deaths from mesothelioma. The lack of correlation between PMRs for the two diseases may reflect different exposure-response relationships.

O34-2 Insomnia and the older worker: findings from the health and employment after fifty (HEAF) study

Background Sleep disturbance is highly prevalent among people of working age, and has been linked with negative occupational outcomes including impaired productivity, absenteeism, risk of injuries, and health-related job loss. We aimed to describe the epidemiology of insomnia in HEAF, a cohort study of 50–64 year-olds from 24 English general practices, and to explore the relative importance of different occupational risk factors for insomnia. Methods Data came from the baseline questionnaire of the HEAF study. Participants reported on four problems with their sleep in the past 3 months, and insomnia was defined as having at least one severe problem. Socio-demographic variables, employment conditions and feelings about work were also ascertained. Analysis was restricted to those who answered the question on sleep disturbance (N = 8,067) and for the occupational analyses, to those in work (N = 5,470). Associations were assessed by logistic regression with adjustment for age and sex, and population attributable fractions (PAFs) were also computed. Results Insomnia was reported by 18.8% of the participants. It was more common among women, current smokers, manual social classes, and in those with lower educational level, living alone, experiencing financial hardship and who were obese. It was less prevalent among older people and those socialising with friends. Unemployed people tended to report more insomnia (OR = 3.1, 95% CI: 2.6–3.8), as did those in shift work (OR = 1.4, 95% CI: 1.2–1.7), dissatisfied with their job (OR = 3.9, 95% CI: 3.1–4.9), and rarely feeling appreciated (OR = 2.5, 95% CI: 2.1–3.1), or feeling unfairly criticised at work (OR = 4.2, 95% CI: 3.0–6.1). Population burden of insomnia was associated particularly with difficulties in coping with work demands, job insecurity and difficult colleagues (PAFs 17–33%). Conclusions Our data suggest that insomnia may be linked to several workplace elements that are potentially avoidable through better employment practices and policies.

OP05 Association between lifetime occupational physical activities and grip strength at retirement age: findings from the hertfordshire cohort study

Background Sarcopenia, the loss of skeletal muscle mass and function with age, is common among older people. Grip strength is a frequently-used, simple, reproducible clinical measure of muscle strength, and a marker of sarcopenia, which has been shown to be an independent predictor of disability and mortality in later life. Given its prognostic importance, it is crucial to understand its determinants. There is some evidence that leisure time physical activity is a positive determinant of grip strength, but little is known about the role of physical occupational activity. We aimed to investigate the role of lifetime occupational physical activity on grip strength measured at retirement age. Methods Data come from the Hertfordshire Cohort Study where information on lifetime exposure to three heavy physical workload measures (standing/walking ≥4 h/day; lifting ≥25 kg; and work sufficiently physical to induce sweating) was collected. Grip strength was measured three times on each hand and then the maximum value was used. Multivariable linear regression was used to investigate the cross-sectional associations between occupational activities and grip strength, controlling for age, body size measurements, social class, smoking, diet, and age upon leaving full time education. Results Analysis was restricted to 1,419 men with complete data who had worked at least 20 years. Among men who reported medium exposure to heavy lifting in their occupation, grip strength was significantly reduced compared with men reporting low levels of exposure, and this association persisted after full adjustment for confounders (β = –1.22; 95% CI = –2.21 to –0.24). Men who reported standing/walking ≥4 h/day for at least 36 years of working life (medium/high exposure), had significantly worse grip strength than men reporting low levels of this exposure, but after adjustment for potential confounders these associations were lost. Similarly, working at physical intensity enough to induce sweating was not significantly associated after adjustment for confounders. Conclusion Heavy occupational activities are negatively associated with grip strength at retirement age. We hypothesise that any potential beneficial effect of intensive physical work is offset by the negative impact of other socio-economic factors (diet/lifestyle/deprivation/education) that determine career opportunities.