Work disability among young employees : Changes over time and socioeconomic differences

Work disability among young employees is a major risk for future employment and for extending working careers. Current sickness absence and disability retirement rates indicate a rising trend in reported ill health among young adults, but still they are considered a minority in health-related research and further details are lacking. Moreover, socioeconomic differences in work disability are widely recognised among older adults, but studies among younger cohorts are scarce. The aim of this study was to examine changes in sickness absence, and socioeconomic differences in sickness absence and disability retirement among young, 18-34-year-old female and male employees between 2002 and 2013. This research is register-based and is part of the Helsinki Health Study. The City of Helsinki s personnel and sickness absence registers were used to obtain socio-demographic characteristics and individual-level information on sickness absence. Information on education was obtained from Statistics Finland s register of completed education and degrees, and information on disability retirement was derived from the national register of the Finnish Centre for Pensions. Employees under the age of 35 were considered young. Those aged 35-54 comprised the reference group in two of the sub-studies. All appropriately aged members of staff permanently and temporarily employed by the City of Helsinki between 2002 and 2013 were included in the analyses. Annual sickness absence days, overall spells and spells of 1-3, 4-14 and 15+ days, as well as disability retirement events were used as outcome variables. Education was classified on four levels annually according to the highest qualification. Occupational class was assigned to one of four categories on the basis of the job title, and income quartiles were based on the monthly salary. Joinpoint regression modelling, quasi-likelihood Poisson regression, the relative index of inequality (RII) and Cox proportional hazard models were used for the statistical analyses. The results showed an initial increase and then a decrease in sickness-absence trends during the study period of 2002-2013. The turning points were predominantly between 2007 and 2010, depending on the groups under investigation and the length of the sickness absence. Young employees had more short and intermediate spells, but less long sickness absence, than older employees. Education turned out to be the strongest determinant of sickness absence among young employees, and followed a clear gradient. The occupational class differences in short sickness absence spells were not fully consistent in that routine non-manual workers had more than the lowest occupational class, in other words manual workers. Disability retirement due to any cause, and to mental and non-mental causes, followed a clear educational gradient, and mental disorders in particular led to disability retirement among young employees. These young employees had a considerable amount of sickness absence, although the bulk of it was taken in short and intermediate spells, and less in long spells: this distinguishes the younger employees from the older ones. Findings on socioeconomic differences in work disability among young employees mainly supported the previous knowledge received among older employees. The results showed that young employees should be taken into account in the design and implementation of measures for preventing work disability. Workplace and job demands should be better matched with employees work abilities. Young employees in lower socioeconomic positions are in particular need of such extra efforts. Changes in work disability among young employees should be studied and monitored more effectively, and the resulting information should be used to evaluate earlier preventive measures and to further develop efficient ways of reducing work disability.Nuorten työntekijöiden työkyvyttömyys muodostaa suuren riskin tulevaisuuden työnteolle ja työurien pidentämiselle. Sairauspoissaolo- ja työkyvyttömyyseläketilastot näyttävät, että sairastaminen on lisääntynyt nuorten aikuisten keskuudessa. Silti kyseinen ryhmä on vähemmistönä terveyteen liittyvissä tutkimuksissa. Työkyvyttömyyden sosioekonomiset erot ovat pitkälti tunnettuja vanhemman väestön keskuudessa, mutta huonosti tunnistettuja nuoremmilla aikuisilla. Tämän tutkimuksen tarkoituksena oli tutkia sairauspoissaolojen muutoksia sekä sairauspoissaolojen ja työkyvyttömyyseläkkeiden sosioekonomisia eroja nuorilla, 18-34 -vuotiailla nais- ja miespuolisilla työntekijöillä vuosina 2002 2013. Tutkimus on rekisteritutkimus ja osa Helsinki Health Studya. Helsingin kaupungin henkilöstö- ja sairauspoissaolorekistereistä saatiin tiedot sosiodemografisista tekijöistä sekä sairauspoissaoloista. Koulutustiedot saatiin Tilastokeskuksen tutkintorekisteristä. Tiedot työkyvyttömyyseläkkeistä saatiin Eläketurvakeskuksen ylläpitämästä rekisteristä. Alle 35 -vuotiaat katsottiin tässä tutkimuksessa nuoriksi, ja 35- 54 -vuotiaita käytettiin vertailuryhmänä kahdessa osatutkimuksessa. Kaikki tutkimuksen kannalta oikean ikäiset Helsingin kaupungin vakituiset ja määräaikaiset työntekijät vuosilta 2002-2013 otettiin mukaan analyyseihin. Vuosittaiset sairauspoissaolopäivät, yhteenlasketut sairauspoissaolojaksot sekä 1-3, 4-14, 15+ päivän pituiset sairauspoissaolojaksot ja työkyvyttömyyseläkkeet toimivat vastemuuttujina. Koulutustaso jaettiin neljään ryhmään korkeimman saavutetun tutkinnon perusteella. Ammattiasema jaettiin neljään ryhmään ammattinimikkeiden perusteella. Kuukausipalkka jaettiin kvartiileihin. Aineisto analysoitiin joinpoint regressiolla, Poissonin regressiolla, relatiivisella eriarvoisuusindeksillä ja Coxin suhteellisten riskien mallilla. Tulokset osoittavat, että sairauspoissaolotrendit ensin nousivat ja sitten laskivat aikavälillä 2002-2013. Trendien käännekohdat sijoittuivat enimmäkseen vuosiin 2007-2010 tarkastelun alla olevasta ryhmästä ja sairauspoissaolon pituudesta riippuen. Nuorilla työntekijöillä oli enemmän lyhyitä ja keskipitkiä sairauspoissaoloja, mutta vähemmän pitkiä sairauspoissaoloja, kuin vanhemmilla työntekijöillä. Koulutustaso osoittautui vahvimmaksi ja johdonmukaisimmaksi sairauspoissaolojen määrittäjäksi nuorilla työntekijöillä. Ammattiasemien väliset erot lyhyissä sairauspoissaoloissa olivat epäjohdonmukaisia, sillä alemmilla toimihenkilöillä oli enemmän lyhyitä sairauspoissaoloja kuin alimmalla ammattiasemaryhmällä, eli manuaalista työtä tekevillä. Kaikista syistä johtuvat, sekä mielenterveys- että muut kuin mielenterveyssyistä johtuvat työkyvyttömyyseläkkeet lisääntyivät johdonmukaisesti koulutustason laskiessa. Varsinkin mielenterveysongelmat aiheuttivat työkyvyttömyys-eläkkeitä nuorilla työntekijöillä. Nuorilla työntekijöillä on paljon sairauspoissaoloja, vaikkakin sairauspoissaolojen pituus on erilainen vanhempiin työntekijöihin verrattuna. Nuorilla painottuvat lyhyet ja keskipitkät ja vanhemmilla työntekijöillä pitkät sairauspoissaolot. Tulokset työkyvyttömyyden sosioekonomisia eroja koskien noudattavat pitkälti vanhempien työntekijöiden parissa tehtyjen tutkimusten tuloksia. Tämä tutkimus osoitti, että myös nuoret työntekijät tulisi huomioida kun työkyvyttömyyttä ennaltaehkäiseviä toimia suunnitellaan ja toteutetaan. Työolot ja työn vaatimukset pitäisi saada paremmin sovitettua työntekijöiden olemassa olevaan työkykyyn. Erityisesti matalan sosioekonomisen aseman omaavat nuoret työntekijät ovat erityistuen tarpeessa. Nuorten työkyvyttömyyden muutoksia tulisi jatkossa tutkia ja tarkkailla enemmän, koska kerätty tieto auttaa aikaisempien ennaltaehkäisevien toimien tehokkuuden arvioinnissa ja uusien työkyvyttömyyttä vähentävien toimien suunnittelussa

Patients Seeking Retreatment after Community Paramedic Assessment and Treatment: Piloting a Community Paramedic Unit Program in Southwest Finland

Community paramedic (CP) units are becoming more popular in enhancing a person’s access to the need for care assessment and treatment in acute but non-life-threatening health issues. Simultaneously CP units can reduce the strain on emergency departments (EDs) by treating patients effectively at home. The efficacy of CP units is proven in previous studies, but the details of conditions patients seek retreatment at the ED after a CP unit visit are largely unknown. This study aimed to categorize CP unit patients (n = 229) seeking retreatment after a CP unit visit and investigate links between CP unit actions and patients seeking retreatment. The study was based on a data set from a six-month CP unit pilot program in Finland. The main results show that 82% of the patients assessed and treated by the CP unit did not seek retreatment. Low back symptoms and nausea were the main problems patients presented to the ED within 96 h after the CP visit. On-call physician consultation (p = 0.335) or CP unit treatment time (p = 0.629) were not associated with the frequency of ED presentation. Further studies are needed in order to investigate which types of emergency medical missions are the most suitable for CP units. The findings of this study support the effectiveness of community paramedicine programs

Preparedness for Mass Gatherings: Factors to Consider According to the Rescue Authorities

Background: Mass gatherings cause a need for multi-authority preparedness in order to ensure the safety of the event participants and to minimize delays in response for emergencies. Rescue authorities are key players in the pre-planning phase; however, their own point of view regarding all aspects of preparedness for mass gatherings is not well known. The aim of this study was to investigate what factors, according to the rescue authorities, need to be considered when preparing for mass gatherings. Method: Semi-structured thematic interviews were carried out with the rescue authorities involved in the mass gathering planning process (n = 15). The transcribed material was analyzed using inductive content analysis. Results: Three main categories emerged from the interviews: (1) co-operation in the pre-planning phase, (2) factors to be noted in the emergency plan, and (3) actions during the event. These categories were divided into 11 generic categories, which were further divided into 42 sub-categories. Conclusion: Rescue authorities recognized various factors considering preparedness for mass gatherings. Knowledge considering the dispersion of operative workload during the event needs further investigation in order to facilitate the effective use of limited operative resources

Preparedness for Mass Gatherings: Factors to Consider According to the Rescue Authorities

Background: Mass gatherings cause a need for multi-authority preparedness in order to ensure the safety of the event participants and to minimize delays in response for emergencies. Rescue authorities are key players in the pre-planning phase; however, their own point of view regarding all aspects of preparedness for mass gatherings is not well known. The aim of this study was to investigate what factors, according to the rescue authorities, need to be considered when preparing for mass gatherings. Method: Semi-structured thematic interviews were carried out with the rescue authorities involved in the mass gathering planning process (n = 15). The transcribed material was analyzed using inductive content analysis. Results: Three main categories emerged from the interviews: (1) co-operation in the pre-planning phase, (2) factors to be noted in the emergency plan, and (3) actions during the event. These categories were divided into 11 generic categories, which were further divided into 42 sub-categories. Conclusion: Rescue authorities recognized various factors considering preparedness for mass gatherings. Knowledge considering the dispersion of operative workload during the event needs further investigation in order to facilitate the effective use of limited operative resources

Short sickness absence and subsequent sickness absence due to mental disorders - a follow-up study among municipal employees

Background: Mental disorders are common diagnostic causes for longer sickness absence and disability retirement in OECD-countries. Short sickness absence spells are also common, and neither trivial for health and work ability. We studied how prior short sickness absence spells and days are associated with subsequent longer sickness absence due to mental disorders in two age-groups of municipal employees during a 2-, 5- and 9-year follow-up. Methods: The analyses covered 20-34 and 35-49-year-old employees of the City of Helsinki in 2004. Those with prior >= 14 day sickness absence in 2002, 2003 or 2004 were excluded. Women and men were pooled together. Short, 1-13-day sickness absence spells and days were calculated per the actual time of employment during 2004. Logistic regression analysis was used to calculate odds ratios (OR) and their 95% confidence intervals (CI) for the subsequent long (>= 14 days) sickness absence due to mental disorders during three follow-ups. Results: The risk for long sickness absence due to mental disorders increased with increasing amount of short sickness absence spells and days. 3 or more short sickness absence spells and 8-14 sickness absence days from short spells in 2004 were strongly associated with subsequent long sickness absence in all three follow-ups. The associations were strongest for the 2-year follow-up; the younger employees tended to have higher risks than the older ones. Conclusions: Three spells or 8 days of short sickness absence per year constitutes a high risk for subsequent long sickness absence due to mental disorders and preventive measures should be considered.Peer reviewe

The Magnitude of Occupational Class Differences in Sickness Absence : 15-Year Trends among Young and Middle-Aged Municipal Employees

Background: Our aim was to examine the magnitude of relative occupational class differences in sickness absence (SA) days over a 15-year period among female and male municipal employees in two age-groups. Methods: 18-34 and 35-59-year-old employees of the City of Helsinki from 2002 to 2016 were included in our data (n = similar to 37,500 per year). Occupational class was classified into four groups. The magnitude of relative occupational class differences in SA was studied using the relative index of inequality (RII). Results: The relative occupational class differences were larger among older than younger employees; the largest differences were among 35-59-year-old men. Among women in both age-groups the relative class differences remained stable during 2002-2016. Among younger and older men, the differences were larger during the beginning of study period than in the end. Among women in both age-groups the RII values were between 2.19 (95% confidence intervals (CI) 1.98, 2.42) and 3.60 (95% CI 3.28, 3.95). The corresponding differences varied from 3.74 (95% CI 3.13, 4.48) to 1.68 (95% CI 1.44, 1.97) among younger and from 6.43 (95% CI 5.85, 7.06) to 3.31 (95% CI 2.98, 3.68) among older men. Conclusions: Relative occupational class differences were persistent among employees irrespective of age group and gender. Preventive measures should be started at young age.Peer reviewe

Association between socioeconomic position and occupational health service utilisation trajectories among young municipal employees in Finland

Objectives To identify groups of municipal employees between the ages of 20 and 34 years with distinct utilisation trajectories of primary care services provided by occupational health service (OHS), measured as the annual number of OHS visits, and to identify demographic and socioeconomic risk factors that distinguish employees in the high utilisation trajectory group(s). Methods The present study is a retrospective register-based cohort study. All municipal employees of the City of Helsinki, Finland, aged 20–34 in the Helsinki Health Study, recruited from 2004 to 2013, with follow-up data for 4 years were included in the study (n=9762). The outcome measure was group-based trajectories of OHS utilisation, identified with a group-based trajectory analysis. The demographic and socioeconomic variables used to predict the outcome were age, first language, educational level and occupational class. The analyses were stratified by gender. Results A large proportion of the young employees do not use OHS. Trajectory groups of ‘No visits’ (50%), ‘Low/increasing’ (18%), ‘Low/decreasing’ (22%) and ‘High/recurrent’ (10%) use were identified. We found occupational class differences in OHS utilisation patterns showing that lower occupational classes had a higher propensity for ‘High/recurrent’ OHS utilisation for both genders. Conclusions Preventive measures should be targeted particularly to the trajectory groups of ‘Low/increasing’ and ‘High/recurrent’ in order to intervene early. In addition, OHS utilisation should be closely monitored among the two lowest occupational classes. More research with longitudinal OHS data is needed.Peer reviewe

Diagnosis-Specific Sickness Absence and Subsequent Common Mental Disorders: A Register-Linkage Cohort Study among Finnish Public Sector Employees

Sickness absence is associated with poor health outcomes, but little is known about its consequences for general mental health. This study examined the associations between diagnosis-specific sickness absence and subsequent common mental disorders (CMD). Register data on medically certified all-cause sickness absence and sickness absence due to mental disorders and musculoskeletal diseases from 2004–2007 were linked to the Helsinki Health Study 2007 and 2012 survey data on City of Helsinki employees in Finland (N = 3560). Using logistic regression and multinomial logistic regression, we analysed the associations between the total number of reimbursed sickness absence days in 2004-7 and CMD General Health Questionnaire 12) in 2007 and 2012 and CMD changes. Sickness absence due to mental disorders (age- and sex-adjusted odds ratio (OR)range: 2.16 to 2.93), musculoskeletal diseases (OR range: 2.79 to 2.93) and all-cause sickness absence (OR range: 1.48 to 3.20) were associated with CMD in 2007. In 2012, associations with lower ORs were observed. Associations were also found with changing and especially repeated (OR range: 1.49 to 3.40) CMD. The associations remained after adjusting for work-related covariates and health behaviours. Diagnosis-specific sickness absence showed persistent associations with subsequent CMD and their changes. Attention should be paid to both the short- and long-term consequences of sickness absence for employee mental health

Diagnosis-Specific Sickness Absence and Subsequent Common Mental Disorders: A Register-Linkage Cohort Study among Finnish Public Sector Employees

Sickness absence is associated with poor health outcomes, but little is known about its consequences for general mental health. This study examined the associations between diagnosis-specific sickness absence and subsequent common mental disorders (CMD). Register data on medically certified all-cause sickness absence and sickness absence due to mental disorders and musculoskeletal diseases from 2004–2007 were linked to the Helsinki Health Study 2007 and 2012 survey data on City of Helsinki employees in Finland (N = 3560). Using logistic regression and multinomial logistic regression, we analysed the associations between the total number of reimbursed sickness absence days in 2004-7 and CMD General Health Questionnaire 12) in 2007 and 2012 and CMD changes. Sickness absence due to mental disorders (age- and sex-adjusted odds ratio (OR)range: 2.16 to 2.93), musculoskeletal diseases (OR range: 2.79 to 2.93) and all-cause sickness absence (OR range: 1.48 to 3.20) were associated with CMD in 2007. In 2012, associations with lower ORs were observed. Associations were also found with changing and especially repeated (OR range: 1.49 to 3.40) CMD. The associations remained after adjusting for work-related covariates and health behaviours. Diagnosis-specific sickness absence showed persistent associations with subsequent CMD and their changes. Attention should be paid to both the short- and long-term consequences of sickness absence for employee mental health