Social capital and work participation among people with mobility disability and overweight

People with disabilities or who are overweight/obese may have fewer opportunities and experience more barriers to a social participation and working life than people without disabilities or overweight/obesity. Even less is known about the social and working life participation of people who are burdened with both mobility disability (MD) and obesity. This relatively large group of people may not be given equal opportunities to social inclusion and work as people without MD and/or overweight/obesity. This thesis focuses on Swedish people between 19 and 64 years of age who have participated in population-based surveys of health and living conditions. Specific questions on weight (kg), height (m), and MD were used to identify the study populations. People with a BMI ≥ 18.5 kg/m2 and/or MD (six study groups in total) were compared with a reference group of people without MD and of normal weight, and also with people who had only one of these conditions. Outcomes investigated between the study groups were social capital (reflecting broader aspects of social participation), work environment, disability pension, and unemployment. The results showed that when compared with the reference group, people with MD and obesity did not differ in structural social capital over time, but had lower cognitive social capital over time. They were also more exposed to demanding work environments, over which they had little or no control. It was also found that people with MD and obesity were at much higher risk of being prematurely excluded from the working life through disability pension, and were more likely to be unemployed, with more unemployment days on average per year. The results also showed that people with MD and obesity did not differ on most study outcomes compared with other people with MD only. It thus seemed that MD has a greater impact on social and work participation than overweight/obesity. In conclusion, people with MD (with or without overweight/obesity) had difficulties in participating in several important domains of social life, which remains a great challenge for public health practitioners, policy makers, and politicians in Swede

The association of mobility disability and obesity with risk of unemployment in two cohorts from Sweden.

Background People with mobility disability (MD) or obesity often have more health problems and are less able to participate in work than individuals without these conditions. This study investigated whether people burdened with MD and obesity have a greater risk of unemployment than people with either one (MD only or obesity only) or none of these conditions. Methods The study included two Swedish population-based cohorts, a national cohort (n = 39,947) and a regional cohort (n = 40,088). Six exposure groups were created using baseline self-reported data on MD and body mass index from participants aged 19 to 64 years. The MD definition differed between the cohorts. Various sources of socio-demographic factors were used to address confounding. Participants’ risks of unemployment were assessed longitudinally in a nationwide register with objective data and with almost no loss of follow-up (< 1%). Cox regression was used to analyse associations of MD and/or obesity (BMI ≥ 30) with risk of any (≥1 day) and long-term unemployment (≥90 days during two consecutive years). Quantile regression was used to estimate participants’ unemployment risks as average days of unemployment. Normal-weight people without MD were used as a reference group. The Wald test was applied for specific group comparisons other than to the reference group. Results In summary, the groups with MD and the obese group without MD had a higher risk of becoming unemployed than the reference group (regional survey adjusted hazard ratio range: 1.30–1.59; 95% CI range: 1.06–1.90, national survey adjusted hazard ratio range: 1.11–1.34; 95% CI range: 0.88–1.81). The obese group with MD did not differ from the groups with MD only or obesity only in terms of unemployment risk. Conclusions People with MD and/or obesity are vulnerable groups at risk of prolonged unemployment during their working life in a country with a highly developed welfare system

The association of mobility disability and obesity with risk of unemployment in two cohorts from Sweden.

Background People with mobility disability (MD) or obesity often have more health problems and are less able to participate in work than individuals without these conditions. This study investigated whether people burdened with MD and obesity have a greater risk of unemployment than people with either one (MD only or obesity only) or none of these conditions. Methods The study included two Swedish population-based cohorts, a national cohort (n = 39,947) and a regional cohort (n = 40,088). Six exposure groups were created using baseline self-reported data on MD and body mass index from participants aged 19 to 64 years. The MD definition differed between the cohorts. Various sources of socio-demographic factors were used to address confounding. Participants’ risks of unemployment were assessed longitudinally in a nationwide register with objective data and with almost no loss of follow-up (< 1%). Cox regression was used to analyse associations of MD and/or obesity (BMI ≥ 30) with risk of any (≥1 day) and long-term unemployment (≥90 days during two consecutive years). Quantile regression was used to estimate participants’ unemployment risks as average days of unemployment. Normal-weight people without MD were used as a reference group. The Wald test was applied for specific group comparisons other than to the reference group. Results In summary, the groups with MD and the obese group without MD had a higher risk of becoming unemployed than the reference group (regional survey adjusted hazard ratio range: 1.30–1.59; 95% CI range: 1.06–1.90, national survey adjusted hazard ratio range: 1.11–1.34; 95% CI range: 0.88–1.81). The obese group with MD did not differ from the groups with MD only or obesity only in terms of unemployment risk. Conclusions People with MD and/or obesity are vulnerable groups at risk of prolonged unemployment during their working life in a country with a highly developed welfare system

Earnings and work loss from 5 years before to 5 years after bariatric surgery: A cohort study.

BackgroundThe personal economic impact of bariatric surgery is not well-described.ObjectivesTo examine earnings and work loss from 5 years before to 5 years after bariatric surgery compared with the general population.SettingNationwide matched cohort study in the Swedish health care system.MethodsPatients undergoing primary bariatric surgery (n = 15,828) and an equal number of comparators from the Swedish general population were identified and matched on age, sex, place of residence, and educational level. Annual taxable earnings (primary outcome) and annual work loss (secondary outcome combining months with sick leave and disability pension) were retrieved from Statistics Sweden. Participants were included in the analysis until the year of study end, emigration or death.ResultsFrom 5 years before to 5 years after bariatric surgery, earnings increased for patients overall and in subgroups defined by education level and sex, while work loss remained relatively constant. Bariatric patients and matched comparators from the general population increased their earnings in a near parallel fashion, from 5 years before (mean difference -$3,489 [95$4,164 [-4,709 to -3,619]). Work loss was relatively stable within both groups but with large absolute differences both at 5 years before (1.09 months, [95%CI 1.01 to 1.17]) and 5 years after surgery (1.25 months, [1.11 to 1.40]).ConclusionsFive years after treatment, bariatric surgery had not reduced the gap in earnings and work loss between surgery patients and matched comparators from the general population

The association of mobility disability and weight status with risk of disability pension : A prospective cohort study

BACKGROUND/AIMS: Mobility disability (MD) and obesity are conditions which have been associated with weaker labour market attachment. This study investigates whether the combined burden of MD and obesity increase the risk of disability pension compared with having only one of these conditions (the reference group).METHODS: A nationwide cohort study, based on national surveys made between 1996 and 2011, was conducted including 50,015 individuals aged 19-64 years who were followed-up in a large database in terms of attainment of disability pension until 31 December 2012 (at the latest). Proportional hazards regression models were used to analyse the risk of all-cause and diagnosis-specific disability pension with six exposure groups, established by mobility and weight status (BMI) obtained through self-reports.RESULTS: A total of 2296 participants had received disability pension after a mean follow-up period of 7.2 years (SD 4.6). People with MD, regardless of weight, had 4-8 times higher risk of disability pension (for any reason) compared with the reference group (individuals with normal weight and no MD).CONCLUSIONS: No evidence of a double burden of MD and obesity with disability pension was observed in this study. MD seemed to contribute more to the risk of disability pension than weight status. In a long-term perspective, society and also people at risk of these disabling conditions would benefit from reallocation of resources from disability pensions to health-promoting and preventive policies, not least targeting MD

The impact on social capital of mobility disability and weight status: The Stockholm Public Health Cohort.

People with mobility disability are more often overweight or obese and have lower social capital than people without mobility disability. It is unclear whether having a combination of mobility disability and overweight or obesity furthers negative development of social capital over time

The association of mobility disability, weight status and job strain : A cross-sectional study

Aims: The study investigated whether people with mobility disability (MD) and/or obesity had higher job strain than people without it, and whether social support at work modifies this association. Methods: The study included 35,160 individuals (25-64 years of age) from the Stockholm Public Health Surveys of 2006 and 2010. Data on MD and obesity (BMI ≥ 3/4 30 kg/m2 calculated from weight (kg) and height (m)) were self-reported. According to the Demand-Control-Support theory job strain, collective strain, and isolated strain were calculated for six groups of people based on the presence of MD and obesity, using the subtraction approach (demand minus control). Differences in job strain mean scores were estimated by multivariate linear regression. Social support at work was analyzed as a potential effect modifier (high/low). Results: Obese people with MD had the highest job strain (β = 0.92, 95% CI 0.64-1.19), compared to normal weight people without MD (reference group). We found that social support at work significantly (