Työkyvyttömyyseläkkeelle siirtymisen sosioekonomiset taustatekijät ja terveysvaikutukset

Socioeconomic factors are major predictors of disability retirement. Socioeconomic position and other socio-demographic factors also shape the retirement process, thereby modifying health outcomes after the transition. This study focuses on the socioeconomic differences in disability retirement and the influences of socio-demographic factors on mental health and mortality in relation to the transition. The study was based mainly on longitudinal register data on a representative sample of the Finnish population, but also included survey data on a municipal employee cohort linked to register data. Cox proportional hazard and linear regression models were used in the analyses. Low education and occupational social class were more strongly associated with disability retirement than a low level of income. Part of the effect of each of these three socioeconomic factors was explained by or mediated through the other two. Education, social class and income therefore have both independent and interdependent pathways to disability retirement. Social-class differences were particularly large in retirement due to musculoskeletal diseases. The association between social class and disability retirement was mediated largely through physical working conditions and partly also through job control. The contribution of health behaviours to the association was modest. Improvements in working conditions among those in lower social classes could reduce socioeconomic differences as well as the overall incidence of disability retirement in the population. Depressive morbidity measured via purchases of antidepressant medication decreased after disability retirement, following a pre-retirement increase. Such changes were more pronounced in retirement due to mental disorders, particularly depression. Compared to the general population, those who retired due to depression and other mental disorders had a high mortality risk, particularly from unnatural and alcohol-related causes. Socioeconomic position and family ties had only limited protective influence on mental ill-health and mortality after disability retirement. Among young adults disability retirement was particularly strongly associated with prolonged mental-health problems and a high risk of mortality, especially from unnatural causes. Particular attention should therefore be paid to younger adults in terms of mental ill health, work disability and other social problems.Työkyvyttömyyseläkkeelle siirtyminen aiheuttaa kansanterveydellisiä ja -taloudellisia haasteita, minkä vuoksi sen syiden ja seurausten ymmärtäminen on tärkeää. Matala sosioekonominen asema on yksi työkyvyttömyyseläkkeelle siirtymiseen johtava tekijä. Lisäksi monet sosiodemografiset tekijät vaikuttavat työkyvyttömyyseläkkeelle siirtymisen olosuhteisiin, minkä vuoksi myöhemmän terveydentilan kehitys saattaa vaihdella eri väestöryhmissä. Tässä tutkimuksessa tarkasteltiin työkyvyttömyyseläkkeelle siirtymisen sosioekonomisia taustatekijöitä sekä sosiodemografisia eroja mielenterveydessä ja kuolleisuudessa työkyvyttömyyseläkkeelle siirtymisen jälkeen. Tutkimuksessa käytettiin sekä rekisteri- että kyselytutkimusaineistoja. Analyysimenetelmänä käytettiin Coxin ja lineaarisen regression malleja. Matalissa sosioekonomisissa asemissa olevilla oli korkeampi todennäköisyys siirtyä työkyvyttömyyseläkkeelle, varsinkin kun asemaa mitattiin koulutuksella ja ammattiperusteisella sosiaaliryhmällä, mutta myös kun tätä mitattiin kotitalouden käytettävissä olevilla tuloilla. Sosiaaliryhmittäiset erot olivat erityisen suuret työkyvyttömyyseläkkeelle siirtymisessä, joka tapahtui tuki- ja liikuntaelinten sairauksien vuoksi. Työkyvyttömyyseläkkeelle siirtymisen yleisyys alemmissa sosiaaliryhmissä johtui suurelta osin raskaista fyysisistä työolosuhteista sekä osittain myös matalasta työn hallinnasta. Epäterveellisemmät elintavat taas selittivät yhteyttä vain vähän. Työolosuhteiden parantaminen matalissa sosiaaliryhmissä olevilla vähentäisi sosioekonomisia eroja sekä työkyvyttömyyseläkkeiden yleisyyttä koko väestön tasolla. Työkyvyttömyyseläkkeelle siirtymisen jälkeen masentuneisuus väheni kun tätä mitattiin masennuslääkeostoilla. Siirtymää kuitenkin edelsi masentuneisuuden voimakas lisääntyminen. Valtaväestöön verrattuna masennuksen ja muiden mielenterveyden häiriöiden vuoksi työkyvyttömyyseläkkeelle siirtyneillä oli korkeampi kuolleisuus varsinkin tapaturmiin, väkivaltaan ja alkoholiin liittyvistä syistä. Korkea sosioekonominen asema ja perhesiteet suojasivat mielenterveyden ongelmilta ja kuolleisuudelta vain rajoittuneessa määrin työkyvyttömyyseläkkeelle siirtymisen jälkeen. Nuoremmilla aikuisilla työkyvyttömyyseläkkeelle siirtyminen oli yhteydessä erityisen suuriin terveysongelmiin, jotka ilmenivät pitkittyneenä masentuneisuutena sekä suurena todennäköisyytenä kuolla varsinkin tapaturmiin ja väkivaltaan liittyvistä syistä. Nuorten aikuisten mielenterveyden ongelmiin, työkyvyttömyyteen, sekä muihin sosiaalisiin ongelmiin tulisi kiinnittää erityistä huomiota

Working life and retirement expectancies at age 50 by social class: period and cohort trends and projections for Finland

The balance between the amount of time spent in work and in retirement underlies the long-term sustainability of the social security system. We examined socioeconomic differences in how increasing longevity is distributed between labor market statuses in Finland

Trajectories of Antidepressant Medication before and after the Onset of Unemployment by Subsequent Employment Experience

Peer reviewe

Health as a predictor of early retirement before and after introduction of a flexible statutory pension age in Finland

Background: Little is known of how pension reforms affect the retirement decisions of people with different health statuses, although this is crucial for the understanding of the broader societal impact of pension policies and for future policy development. We assessed how the Finnish statutory pension age reform introduced in 2005 influenced the role of health as a predictor of retirement. Methods: We used register-based data and cox regression analysis to examine the association of health (measured by purchases of psychotropic medication, hospitalizations due to circulatory and musculoskeletal diseases, and the number of any prescription medications) with the risk of retirement at age 63-64 among those subject to the old pension system with fixed age limit at 65 (pre-reform group born in 1937-1941) and the new flexible system with 63 as the lower age limit (post-reform group born in 1941-1945) while controlling for socio-demographic factors. Results: Retirement at age 63-64 was more likely among the post- than the pre-reform group (HR = 1.50; 95% CI 1.43-1.57). This reform-related increase in retirement was more pronounced among those without a history of psychotropic medication or hospitalizations due to circulatory and musculoskeletal diseases, as well as among those with below median level medication use. As a result, poor health became a weaker predictor of retirement after the reform. Conclusion: Contrary to the expectations of the Finnish pension reform aimed at extending working lives, offering choice with respect to the timing of retirement may actually encourage healthy workers to choose earlier retirement regardless of the provided economic incentives for continuing in work. (C) 2016 The Authors. Published by Elsevier Ltd.Peer reviewe

Purchases of prescription drugs before an alcohol-related death : A ten-year follow-up study using linked routine data

Background: Physician's intention to prescribe drugs could potentially be used to improve targeting of alcohol interventions and enhanced disease management to patients with a high risk of severe alcohol-related harm within outpatient settings. Methods: Comparison of ten-year incidence trajectories of 13.8 million reimbursed purchases of prescription drugs among 303,057 Finnish men and women of whom 7490 ultimately died due to alcohol-related causes (Ale+), 14,954 died without alcohol involvement (Alc-), and 280,613 survived until the end of 2007. Results: 5-10 years before death, 88% of the persons with an Alc+ death had received prescription medication, and over two-thirds (69%) had at least one reimbursed purchase of drugs for the alimentary tract and metabolism, the cardiovascular system, or the nervous system. Among persons with an Alc+ death, the incidence rate (IR) for purchases of hypnotics, and sedatives was L38 times higher (95% confidence interval (C1):1.32,1.44) compared to those with an Alc death, and 4.07 times higher (95%C1:3.92,4.22) compared to survivors; and the IR for purchases of anxiolytics was 1.40 times higher (95%Ck1.34,1.47) compared to those with an Ale death, and 3.61 times higher (95%C1:3.48,3.78) compared to survivors. Conclusions: Using physician's intention to prescribe drugs affecting the alimentary tract and metabolism, cardiovascular system and nervous system could potentially be used to flag patients who might benefit from screening, targeted interventions or enhanced disease management. In particular, patients who are to be prescribed anxiolytics, hypnotics, and sedatives, and antidepressants may benefit from enhanced interventions targeted to problem drinking.Peer reviewe

Association between a history of clinical depression and dementia, and the role of sociodemographic factors: population-based cohort study

Background Depression is associated with an increased dementia risk, but the nature of the association in the long-term remains unresolved, and the role of sociodemographic factors mainly unexplored. Aims To assess whether a history of clinical depression is associated with dementia in later life, controlling for observed sociodemographic factors and unobserved factors shared by siblings, and to test whether gender, educational level and marital status modify the association. Method We conducted a national cohort study of 1 616 321 individuals aged 65 years or older between 2001 and 2018 using administrative healthcare data. A history of depression was ascertained from the national hospital register in the period 15-30 years prior to dementia follow-up. We used conventional and sibling fixed-effects Cox regression models to analyse the association between a history of depression, sociodemographic factors and dementia. Results A history of depression was related to an adjusted hazard ratio of 1.27 (95% CI 1.23-1.31) for dementia in the conventional Cox model and of 1.55 (95% CI 1.09-2.20) in the sibling fixed-effects model. Depression was related to an elevated dementia risk similarly across all levels of education (test for interaction, P = 0.84), but the association was weaker for the widowed than for the married (P = 0.003), and stronger for men than women (P = 0.006). The excess risk among men attenuated following covariate adjustment (P = 0.10). Discussion This study shows that a history of depression is consistently associated with later-life dementia risk. The results support the hypothesis that depression is an aetiological risk factor for dementia.Peer reviewe

Midlife socioeconomic position and old-age dementia mortality: a large prospective register-based study from Finland

Objectives To assess the association between multiple indicators of socioeconomic position and dementia-related death, and to estimate the contribution of dementia to socioeconomic differences in overall mortality at older ages. Design Prospective population-based register study. Setting Finland. Participants 11% random sample of the population aged 70-87 years resident in Finland at the end of year 2000 (n=54 964). Main outcome measure Incidence rates, Kaplan-Meier survival probabilities and Cox regression HRs of dementia mortality in 2001-2016 by midlife education, occupational social class and household income measured at ages 53-57 years. Results During the 528 387 person-years at risk, 11 395 individuals died from dementia (215.7 per 10 000 person-years). Lower midlife education, occupational social class and household income were associated with higher dementia mortality, and the differences persisted to the oldest old ages. Compared with mortality from all other causes, however, the socioeconomic differences emerged later. Dementia accounted for 28% of the difference between low and high education groups in overall mortality at age 70+ years, and for 21% of the difference between lowest and highest household income quintiles. All indicators of socioeconomic position were independently associated with dementia mortality, low household income being the strongest independent predictor (HR=1.24, 95% CI 1.16 to 1.32), followed by basic education (HR=1.14, 1.06 to 1.23). Manual occupational social class was related to a 6% higher hazard (HR=1.06, 1.01 to 1.11) compared with non-manual social class. Adjustment for midlife economic activity, baseline marital status and chronic health conditions attenuated the excess hazard of low midlife household income, although significant effects remained. Conclusion Several indicators of socioeconomic position predict dementia mortality independently and socioeconomic inequalities persist into the oldest old ages. The results demonstrate that dementia is among the most important contributors to socioeconomic inequalities in overall mortality at older ages.Peer reviewe

Changes in socioeconomic differences in hospital days with age: cumulative disadvantage, age-as-leveler, or both?

Objectives: Length of hospital stay is inversely associated with socioeconomic status (SES). It is less clear whether socioeconomic disparities in numbers of hospital days diverge or converge with age. Method: Longitudinal linked Finnish registry data (1988-2007) from 137,653 men and women aged 50-79 years at the end of 1987 were used. Trajectories of annual total hospital days by education, household income, and occupational class were estimated using negative binomial models. Results: Men and women with higher education, household income, and occupational class had fewer hospital days in 1988 than those with lower SES. Hospital days increased between 1988 and 2007. For some age groups, higher SES was associated with a faster annual rate of increase, resulting in narrowing rate ratios of hospital days between SES groups (relative differences); the rate ratios remained stable for other groups. Absolute SES differences in numbers of hospital days appeared to diverge with age among those aged 50-69 years at baseline, but converge among those aged 70-79 years at baseline. Discussion: The hypotheses that socioeconomic disparities in health diverge or converge with age may not be mutually exclusive; we demonstrated convergence/maintenance in relative differences for all age groups, but divergence or convergence in absolute differences depending on age

Changes in healthy and unhealthy working life expectancies among older working-age people in Finland, 2000-2017

Background Raising the statutory retirement age has been a common policy response to population ageing, but health problems may restrict labour force participation in older ages. We examined the development of healthy and unhealthy working life expectancies in Finland from 2000 to 2017 using different measures of health problems. Methods Healthy and unhealthy working life expectancies were calculated for the age range 50-65 years using the Sullivan method. The health measures were limiting long-standing illness, self-rated health, mental health problems and self-assessed work ability. Results Healthy working life expectancy was highest when health was measured by work ability. From 2000 to 2017, working years in full ability between the ages 50-65 increased from 6.2 (95% confidence interval 5.9-6.4) to 8.2 (8.0-8.5). Healthy working life expectancy increased also when measured by the other indicators. Unhealthy working years also increased, except when health problems were measured by limiting long-standing illness. The share of years in work increased both within the healthy and the unhealthy years, the increase being larger or equally large for the latter. Within the healthy and unhealthy years measured by the other three indicators, the share of working years increased irrespective of whether work ability was full or limited, but the increase was larger for limited work ability. Conclusions In Finland, healthy working life expectancy has increased irrespective of how health is measured but also working with health problems has become more prevalent. The estimates for healthy working years are highest when a direct measure of work ability is used.Peer reviewe