Xavier Duran

Labour market trajectories and early retirement due to permanent disability: a study based on 14 972 new cases in Spain

BACKGROUND To analyse the impact of labour market trajectory indicators on early retirement, measured by age at onset of permanent disability (PD). METHODS Four labour market trajectory indicators were reconstructed in 14 972 new cases of PD recognized between 2004 and 2010: (1) number of employment contracts, (2) number of unemployment periods, (3) number of periods without social security affiliation and (4) percentage of time spent in inactivity. The outcome was measured as the age at onset of PD. Median differences and 95% confidence intervals (95%CI) were compared using a median regression. Analyses were stratified by sex and adjusted for occupational category and total time elapsed between the beginning of working life and the age at onset of PD: separately for each labour market indicator, and adjusted for each other. RESULTS In men, the age at the onset of PD for workers with 15 or more employment contracts decreased by 4.8 years; and for workers with five or more periods without affiliation it decreased by 4.6 years. In women, the corresponding decreases were 5.8 years for 15 or more contracts and 7.2 years for five or more unaffiliated periods. The results for four indicators slightly changed when they were mutually adjusted. CONCLUSIONS Poor employment conditions, such as having a high number of periods without affiliation, a high number of contracts (in men) and a higher percentage of inactive time (in women) are associated with early retirement due to PD.

Occupational factors associated with the potential years of working life lost due to a non-work related permanent disability

OBJECTIVE To analyze the association between occupational factors (number of contracts and occupational category) and potential years of working life lost (PYWLL) due to non-work related permanent disability (PD). PARTICIPANTS The study design was a retrospective cohort of 11,812 workers affiliated with the Social Security System in Spain that began a non-work related PD between 2004 and 2009. METHODS The PYWLL was defined as the time in years between the age at which a worker initiates a PD and age 65 or the age of reinstatement to a job. The PYWLL was analyzed by calculating the quartiles and using an approach based on a median regression. RESULTS The difference in medians of PYWLL between men and women was 2.49 years (95% CI: 2.01-2.97); between skilled non-manual and unskilled manual workers was 1.88 years (95% CI: 1.08-2.69); between workers with three or more contracts and workers with a single contract in the period was 3.78 years (95% CI: 3.28-4.29). CONCLUSION Women, non-skilled workers and employees that have had more contracts within the period of study are those with greatest loss of PYWLL. This suggests that individuals with poorer working and employment conditions could have more PYWLL.

Estimación de la carga de enfermedad por incapacidad laboral permanente en España durante el período 2009-2012

Fundamentos: La incapacidad laboral permanente (IP) supone una importante carga social y economica. El objetivo de este estudio fue estimar la carga de enfermedad debida a la IP en Espana. Metodos: A partir de la Muestra Continua de Vidas Laborales (MCVL) se imputo como diagnostico de la IP (2009-2012) el de la incapacidad temporal (IT) iniciada en 2009 en los individuos que cumplieron dos criterios: larga duracion de la IT y corta duracion del periodo entre la IT y la IP. Para los casos con diagnostico imputado se calculo la carga de enfermedad por IP a partir de los anos potenciales de vida laboral perdidos (APVLP), definidos como la diferencia entre la edad de jubilacion (65 anos) y la edad de inicio de la IP. Resultados: Segun la MCVL, 163.135 (13,6%) personas sufrieron de IT en 2009, de las cuales a 4.738 (0,39%) se le reconocio una IP entre 2009-2012. Se pudo establecer el diagnostico de IP en 3.073 (64,9%) casos. Las causas mas frecuentes de IP fueron los trastornos musculo-esqueleticos (27,4%) y mentales (11,6%) que, asimismo, produjeron mayor cantidad de APVLP por IP: 11.086 (26,5%) y 7.052 (16,9%), respectivamente. Los trastornos mentales destacaron por producir IP a edades mas jovenes (mediana=49 anos). Conclusiones: Los trastornos mentales y los musculo-esqueleticos representaron la mayor carga de enfermedad en individuos en situacion de IP.

La utilidad del uso de datos administrativos en la investigación de salud pública: la Muestra continua de vidas laborales

The use of administrative data is common practice in public health research. The present field note describes the Continuous Working Life Sample (CWLS) and its use in health research. The CWLS is built on records generated by all contacts with the social security system (work contracts, disability, etc.), plus tax data (monetary gains, income, etc.) and census data (level of education, country of birth, etc.), but does not allow individuals to be identified. The CWLS was started in 2004 with 4% (1.1 million persons) of the total population who were either contributors to or beneficiaries of the social security system. The information on the individuals in the CWLS is updated annually and lost individuals are replaced. This continuous design allows the construction of a cohort with information on working life and financial status and evaluation of their relationship with work disability. Future connection with clinical records would enable analysis of other health-related outcomes.

Incidencia de incapacidad permanente en una cohorte de trabajadores afiliados a la Seguridad Social, 2004-2007

OBJECTIVE To describe the incidence of permanent disability, both work-related and non-work-related, by several socioeconomic and geographical variables. METHODS We performed a retrospective study of a cohort of 768,454 workers covered by the General Social Security Regimen, followed-up from 2004 to 2007. This study was based on the Continuous Working Life Survey. In the 4 years of follow-up, 7,749 cases in 1,937,921 workers-years were identified. Incidence rates and crude and adjusted rate ratios were estimated by Poisson regression models. RESULTS The incidence of non-work-related permanent disability was 10 times greater than that of work-related disability (36.3 versus 3.7 per 10,000 workers-years). The incidences for both non-work-related and work-related disability were higher in men and increased with age and lower education level. For non-work-related permanent disability, the region with the highest incidence was Asturias and that with the lowest was Madrid (56.7 vs. 23.3). For work-related permanent disability, the highest incidence was found in Asturias and the lowest in Navarre (7.8 vs. 1.4). This differential was maintained for work-related and non-work-related permanent disability for Asturias, after adjustment was made by sex, age, educational level, company size and economic activity. CONCLUSIONS In this study, we observed substantial differences in the incidences of permanent disability by demographic, social and geographical characteristics, which should be analyzed in greater depth, especially the differences observed by regions.

Cohort profile: the Spanish WORKing life Social Security (WORKss) cohort study.

Purpose The global economy is changing the labour market and social protection systems in Europe. The effect of both changes on health needs to be monitored in view of an ageing population and the resulting increase in prevalence of chronic health conditions. The Spanish WORKing life Social Security (WORKss) cohort study provides unique longitudinal data to study the impact of labour trajectories and employment conditions on health, in terms of sickness absence, permanent disability and death. Participants The WORKss cohort originated from the Continuous Working Life Sample (CWLS) generated by the General Directorate for the Organization of the Social Security in Spain. The CWLS contains a 4% representative sample of all individuals in contact with the Social Security system. The WORKss cohort exclusively includes individuals with a labour trajectory from 1981 or later. In 2004, the cohort was initiated with 1 022 779 Social Security members: 840 770 (82.2%) contributors and 182 009 (17.8%) beneficiaries aged 16 and older. Findings to date The WORKss cohort includes demographic characteristics, chronological data about employment history, retirement, permanent disability and death. These data make possible the measurement of incidence of permanent disability, the number of potential years of working life lost, and the number of contracts and inactive periods with the Social Security system. The WORKss cohort was linked to temporary sickness absence registries to study medical diagnoses that lead to permanent disability and consequently to an earlier exit from the labour market in unhealthy conditions. Future plans Thanks to its administrative source, the WORKss cohort study will continue follow-up in the coming years, keeping the representativeness of the Spanish population affiliated to the Social Security system. The linkage between the WORKss cohort and temporary sickness absence registries is envisioned to continue. Future plans include the linkage of the cohort with mortality registries.

GCAT|Genomes for life: a prospective cohort study of the genomes of Catalonia

Purpose The prevalence of chronic non-communicable diseases (NCDs) is increasing worldwide. NCDs are the leading cause of both morbidity and mortality, and it is estimated that by 2030, they will be responsible for 80% of deaths across the world. The Genomes for Life (GCAT) project is a long-term prospective cohort study that was designed to integrate and assess the role of epidemiological, genomic and epigenomic factors in the development of major chronic diseases in Catalonia, a north-east region of Spain. Participants At the end of 2017, the GCAT Study will have recruited 20 000 participants aged 40–65 years. Participants who agreed to take part in the study completed a self-administered computer-driven questionnaire, and underwent blood pressure, cardiac frequency and anthropometry measurements. For each participant, blood plasma, blood serum and white blood cells are collected at baseline. The GCAT Study has access to the electronic health records of the Catalan Public Healthcare System. Participants will be followed biannually at least 20 years after recruitment. Findings to date Among all GCAT participants, 59.2% are women and 83.3% of the cohort identified themselves as Caucasian/white. More than half of the participants have higher education levels, 72.2% are current workers and 42.1% are classified as overweight (body mass index ≥25 and <30 kg/m2). We have genotyped 5459 participants, of which 5000 have metabolome data. Further, the whole genome of 808 participants will be sequenced by the end of 2017. Future plans The first follow-up study started in December 2017 and will end by March 2018. Residences of all subjects will be geocoded during the following year. Several genomic analyses are ongoing, and metabolomic and genomic integrations will be performed to identify underlying genetic variants, as well as environmental factors that influence metabolites.

Tendencia temporal de la incapacidad laboral permanente en España (1992-2010)

Fundamentos: La incapacidad permanente (IP) es un problema de salud laboral en el que intervienen factores laborales, sanitarios o legales, los cuales han variado en Espana a lo largo de los ultimos anos. El objetivo del presente estudio es describir la tendencia temporal de la IP en Espana desde 1992 a 2010 por gravedad de la incapacidad y diferentes variables sociodemograficas y de afiliacion a la seguridad social. Metodos: A partir de los datos de la Seguridad Soci al sobre afiliacion y altas de IP en Espana se describio la tendencia temporal de la incidencia anual de la IP en el periodo comprendido entre 1992 y 2010. Para valorar las tendencias se estimo el porcentaje de cambio anual (PCA) y el intervalo de confianza al 95% mediante un modelo de regresion binomial negativa. Resultados: La tendencia de la incidencia de IP se subdividio en tres periodos. El primero (1992 a 1997) presento una incidencia aproximadamente constante de 75 casos por 10.000 trabajadores (PCA1= -0,1; IC 95%:-1,6 a 1,4). Seguidamente las tasas descendieron durante un periodo de tres anos (PCA2:-12,1%; IC 95%:-13,9 a -10,4), situandose alrededor de 50 nuevos casos por 10.000 trabajadores en el ano 2000. A partir de este ano la incidencia de IP se mantuvo aproximadamente constante hasta el ano 2010 (PCA3=0,4; IC 95%:-0,2 a 1,0). Conclusiones: A pesar del incremento de trabajadores afiliados a la seguridad social en el periodo estudiado, la incidencia de IP se mantiene bastante estable, con un descenso entre 1997 y 2000 que se podria atribuir a las medidas de evaluacion y seguimiento de las IP adoptados en 1995.

Social security status and mortality in Belgian and Spanish male workers

OBJECTIVE To assess differences in mortality rates between social security statuses in two independent samples of Belgian and Spanish male workers. METHODS Study of two retrospective cohorts (Belgium, n=23,607; Spain, n=44,385) of 50-60 year old male employees with 4 years of follow-up. Mortality rate ratios (MRR) were estimated using Poisson regression models. RESULTS Mortality for subjects with permanent disability was higher than for the employed, for both Belgium [MRR=4.56 (95% CI: 2.88-7.21)] and Spain [MRR=7.15 (95% CI: 5.37-9.51)]. For the unemployed/early retirees, mortality was higher in Spain [MRR=1.64 (95% CI: 1.24-2.17)] than in Belgium [MRR=0.88 (95% CI: 0.46-1.71)]. CONCLUSION MRR differences between Belgium and Spain for unemployed workers could be partly explained because of differences between the two social security systems. Future studies should further explore mortality differences between countries with different social security systems.