Ilmarinen, Juhani

Klockars, Matti

Nygård, Clas-Håkan

Rantanen, Taina

Seitsamo, Jorma

von, Bonsdorff Mikaela B

von, Bonsdorff Monika E

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   This document has been downloaded from  Tampub – The Institutional Repository of University of Tampere     Publisher's version   Authors: Seitsamo Jorma, von Bonsdorff Monika E, Ilmarinen Juhani, von Bonsdorff Mikaela B, Nygård Clas-Håkan, Rantanen Taina, Klockars Matti  Name of article: Work ability and later-life health : A 28-year longitudinal study among Finnish municipal workers  Name of work: Age Management during the Life Course : Proceeding on the 4th Symposium on Work Ability  Editors of work: Nygård Clas-Håkan, Savinainen Minna, Kirsi Tapio, Lumme-Sandt Kirsi  Year of publication: 2011 ISBN: 978-951-44-8392-9 Publisher: Tampere University Press Pages: 391-398  Discipline: Medical and Health sciences / Public health care science, environmental and occupational health Language: en School/Other Unit:  School of Health Sciences           All material supplied via TamPub is protected by copyright and other intellectual property rights, and duplication or sale of all part of any of the repository collections is not permitted, except that material may be duplicated by you for your research use or educational purposes in electronic or print form. You must obtain permission for any other use. Electronic or print copies may not be offered, whether for sale or otherwise to anyone who is not an authorized user.    |  391  |Work ability and later-life health: A 28-year longitudinal study among Finnish municipal workers Seitsamo J1, von Bonsdorff ME1, Ilmarinen J1, von Bonsdorff MB2, Nygård C-H3, Rantanen T2, Klockars M41. Finnish Institute of Occupational Health, Helsinki, Finland, 2. Finnish Gerontological Research Center, University of Jyväskylä, Jyväskylä, Finland, 3. School of Health Sciences, University of Tampere, Tampere, Finland, 4. University of Helsinki, Helsinki, FinlandAbstractWe examined longitudinally the associations between the work ability of middle-aged employees and their health over the retirement years. The study sample came from a follow-up questionnaire to Finnish municipal workers. General linear models with repeated measures were used to assess the effects of the Work Ability Index and other variables on health. The results showed that the Work Ability Index was a strong predictor of later-life health. If work ability was excellent, the odds of good health were over 3 times higher than for a person with poor work ability. Maintenance of good work ability throughout the occupationally active years has a strong impact on later-life health.Key terms: work ability index, longitudinal study, health  |  392  |IntroductionWork ability, measured by the Work Ability Index (WAI) has proved to be a reliable predictor of morbidity, early retirement, and disability in studies concerning ageing workers (1-3). Good work ability also predicts well-being and functional status far beyond the retirement transition (4). There is also some evidence that work ability may predict mortal-ity (5-6). Even though there is evidence that work ability is associated with a person’s own evaluations of his/her health (7-8) more studies are still needed to obtain information from the long-term effects of work ability on later-life health and well-being. The main objective of this study was to examine longitudinally the associations between work ability in midlife among occupationally active employees and their health in their retirement years.The specific study questions were:  1. Does the level of Work Ability Index (WAI) with the categories excellent, good, moderate, and poor have an impact on self-assessed health and morbidity 28 years later?2. Is WAI associated with health even if other factors are taken into account?Material and methodsThe study sampleThe study sample came from a follow-up questionnaire study of Finn-ish municipal workers which was conducted at the Finnish Institute of Occupational Health from 1981 to 2009 (6). In 1981, a questionnaire was mailed to 7,344 municipal workers in different areas of Finland. The respondents were born between 1923 and 1937 and the mean age was 50.5. A total of 6,257 persons responded to the first questionnaire (the response rate was 85.2%). In 2009, a total of 3,093 persons responded    |  393  |to the final questionnaire (the response rate was 74% of the surviving participants who responded to the first questionnaire). In 2009, the vital status and dates of death were added to the data. By then, 2,079 respondents had died. Study variablesThe measure of perceived health was constructed from two question-naire items: “Compared to your friends of the same age, is your health much better, slightly better, the same, slightly worse, or much worse?” and “To what extent do diseases hamper your everyday life:  not at all, relatively little, to some extent, rather much, or very much?” The responses to these questions were combined into four groups (good, moderate, poor, and very poor health). The construction of these groups has been reported elsewhere (9-10). The independent variables were work ability, measured by the Work Ability Index (WAI), categorized into excellent, good, moderate, and poor (11), physical function (coping with mainly physically demanding daily activities, for instance heavy cleaning work, lifting and carrying heavy weights, climbing three flights of stairs with-out needing to rest, walking about 2 km without a rest, running a short distance without a rest, sitting still for about 2 h, squatting down on one’s heels and getting up, bending over, bending down, lifting hands above the head, detailed movements of the arms and fingers), and lifestyle, including health behavior (i.e. alcohol consumption, smok-ing, physical exercise) and involvement in various activities (reading, studying, attending clubs and associations, and needlework, handi-crafts). For physical function and activity items, summary scores were created. Gender, marital status (unmarried, married, unmarried but co-habitating, separated, divorced, widow/widower), socio-economic group (blue-collar, lower-level white-collar, upper-level white-collar workers), age, and gender were also included in all analyses.Statistical analysisThe associations between health, physical function, lifestyle, and other background variables were assessed by general linear models with re-  |  394  |peated measurements. These likelihood based methods are valid under missing at random assumption when missing data might depend on observed data (12).  With this method it was possible to use all avail-able data from each time point and there was no need to be restricted to the follow-up data only. Statistical analyses were performed with the SAS statistical package (13).ResultsAt the baseline, there were some differences between the study partici-pants and those who had died during the 28-year follow-up or those who did not respond to all questionnaires (Table 1). Compared to non-respondents, the study participants belonged more often to the upper white-collar group; they were also younger, more active and had better physical function. About 60 per cent of the deceased were men or used to work in blue-collar occupations. In addition, work ability was better among the participants; the proportion of excellent work ability was 20% compared to 11% among non-respondents and 14% among the deceased.   |  395  |Table 1. Baseline characteristics of participants in the follow-up, deceased and other dropouts.Baseline characteristics   (range)Participants in the follow-up (n=3093)Deceased (n=2079)Non-respondents  (n=1085)% or Mean (Std) % or Mean (Std) % or Mean (Std)Gender                 Men 37% 61% 35%     Women 63% 39% 65%Socio-economic status    Upper white-collar work  25% 16% 14%    Lower white-collar work  38% 24% 36%    Blue-collar work  37% 60% 49%Activity level (0–5)   1.35  (1.1) 1.09 (1.0) 1.16 (1.1) Age  (45–58 years)  49.7  (3.4) 51.7 (3.6) 50.4 (3.6) Physical function (0–33)a 26.2  (5.9) 23.4 (7.2) 25.0 (6.5)  Morbidity (0–24 diseases)   1.69  (2.0) 2.26 (2.5) 1.82 (2.2)      Health      Good      Average      Poor      Very poor        9% 28% 49% 14%   7% 23% 47% 23%   7% 25% 51% 17%Work Ability Index      Excellent      Good      Moderate      Poor       20% 39% 31% 10% 14% 38% 34% 14% 11% 31% 37% 21%a from 1985The Work Ability Index was a strong predictor of later-life health (Table 2). When all the other independent factors were included in the analysis, the level of Work Ability Index was still a highly significant predictor of health. Besides good work ability, involvement in activities and good physical functioning further improved health at follow-up. Women reported better perceived health than men. Socio-economic status based on occupation was also a strong modifier of health. Upper white-collar work especially promoted health compared to blue-collar work.The adjusted odds ratios in Table 3 describe the relative differences between work ability groups. For instance, if a person had excellent-  |  396  |work ability in midlife the odds of having good health was 3.6 times compared to the odds of a person with poor work ability having good health during the retirement years. Even an increase from poor work ability to moderate almost doubled the odds of good health.Table 2. General linear model of health 1981-2009. Estimates and 95% confidence intervals (CI). N=3093Parameter Esti-mate StdE 95% CI Z Pr > |Z|Time    1981 -0.45 0.04 -0.53 -0.37 -10.9 <.0001    1992 -0.29 0.04 -0.36 -0.22 -8.13 <.0001    1997 -0.12 0.03 -0.18 -0.07 -4.58 <.0001    2009 0 .Gender    Women 0.35 0.05 0.25 0.44 7.22 <.0001    Men 0Age 0.04 0.01 0.02 0.05 6.14 <.0001Socio-economic status     Upper white-collar 0.17 0.06 0.06 0.28 3.05 < .01     Lower white-collar -0.02 0.05 -0.12 0.09 -0.30 n.s.     Blue-collar work 0Activity 0.09 0.02 0.05 0.12 4.97 <.0001Physical function 0.16 0.0 0.16 0.17 41.8 <.0001Work Ability Index     Excellent 1.27 0.09 1.10 1.46 13.5 <.0001     Good 1.11 0.06 0.98 1.23 17.1 <.0001     Moderate 0.61 0.06 0.50 0.72 10.9 <.0001     Poor 0Alcohol consumption     None  -0.34 0.04 -0.42 -0.25 -7.97 <.0001     Some 0Smoking     Does not smoke 0.13 0.06 0.02 0.25 2.25 < .05     Smokes 0   |  397  |Table 3. Relative differences between Work Ability Index groups explaining good health. Odds ratios (OR) and 95% confidence intervals (CL) Label Estimate SE CL Chi-sq Pr Excellent vs. poor 3.58 0.34 2.97 4.30 182.78 <.0001Excellent vs. moderate 1.98 0.16 1.66 2.29 64.83 <.0001Excellent vs. good 1.18 0.10 1.00 1.39 3.91 0.0480Good vs. poor 3.08 0.20 2.67 3.44 293.12 <.0001Good vs. moderate 1.65 0.08 1.50 1.82 105.20 <.0001Moderate vs. poor 1.83 0.10 1.64 2.05 118.55 <.0001DiscussionOur study suggests that promotion of good work ability over the oc-cupationally active years has a strong impact on later-life self-assessed health. It has also been shown that self-rated health predicts morbidity (14, 15), and consequently, if an aging employee could maintain his or her work ability over the occupationally active years it would enforce a healthier and disability-free third age. This may have strong implica-tions for social policy as populations in most industrialized countries are aging rapidly and the economic costs of this aging are expected to rise in the future. Acnowledgements:C-HN would like to thank the Gyllenberg Foundation for support in the preparation of this manuscript.  |  398  |References1. Ilmarinen J, Tuomi K. Past, present and future of work ability. People and Work Research Reports 2004; 65: 1–25. 2. Tuomi K, Ilmarinen J, Seitsamo J, Huuhtanen P, Martikainen R, Nygård C-H, Klockars M.. Summary of the Finnish research project (1981–1992) to promote the health and work ability of aging workers. Scand J Work Environ Health 1997; 23 suppl. 1: 66–71.3. Alavinia S, de Boer A, van Duivenbooden J, Frings-Dresen M, Burdorf A. Determinants of work ability and its predictive value for disability among Dutch construction workers. Occupational Medicine 2009; 59(1): 32–37.4. Tuomi K, Huuhtanen P. Promotion of work ability, the quality of work and retirement. Occupational Medicine 2001; 51: 318–324.5. Seitsamo J, Martikainen R. Work ability and all cause mortality: A 25-year longitudinal study among Finnish municipal workers. In M Kumashiro (ed.): Promotion of Work Ability towards Productive Ageing, Taylor & Francis, London 2009. p. 101–104.6. Tuomi K, Ilmarinen J, Klockars M, Nygård C-H, Seitsamo J, Huuhtanen P et al. Finnish research project on aging workers in 1981–1992. Scand J Work Environ Health 1997; 23 suppl 1: 7–11.7. Saarni SI, Saarni ES, Saarni H. Quality of life, work ability, and self employ-ment: a population survey of entrepreneurs, farmers, and salary earners. Occupational and Environmental Medicine 2008; 65: 98-103.8. Sörensen L, Pekkonen M, Männikkö K, Louhevaara V, Smolander J, Alèn M. Associations between work ability, health-related quality of life, physical activity and fitness among middle-aged men.” Applied Ergonomics 2008; 39: 786–791.9. Seitsamo J. Retirement transition and well-being – A 16-year longitudinal study. People and Work Research Reports 76, Helsinki 2007.10. Seitsamo J, Klockars M. Aging and changes in health. Scand J Work Environ Health 1997; 23 suppl 1: 27–35.11. Tuomi K, Ilmarinen J, Jahkola A, Katajarinne L, Tulkki A. Work Ability Index. Finnish Institute of Occupational Health. Helsinki 1998.12. Little R, Rubin D. Statistical analysis with missing data. Wiley, New York 1987.13. Littell R, Milliken G, Stroup W, Wolfinger R. SAS system for mixed models. SAS Institute. Cary, NC 1996. 14. Molarius A, Janson S. Self-rated health, chronic diseases, and symptoms among middle-aged men and women. Journal of Clinical Epidemiol-gy 2002; 55: 364–370.15. Vuorisalmi M, Lintonen T, Jylhä M.Global self-rated health data from a longitudinal study predicted mortality better than comparative self-rated health in old age. J Clin Epidemiol 2005; 58: 680–687.

Work ability and later-life health : A 28-year longitudinal study among Finnish municipal workers

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Work ability and later-life health : A 28-year longitudinal study among Finnish municipal workers

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