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OBJECTIVES: This study aims to investigate the extent to which low job control and heavy physical workload in middle age explain educational differences in all-cause and ischemic heart disease (IHD) mortality while accounting for important confounding factors. METHODS: The study is based on a register-linked cohort of men who were conscripted into the Swedish military at around the age of 18 in 1969/1970 and were alive and registered in Sweden in 2005 (N=46 565). Cox proportional hazards regression models were built to estimate educational differences in all-cause and IHD mortality and the extent to which this was explained by physical workload and job control around age 55 by calculating the reduction in hazard ratio (HR) after adjustments. Indicators of health, health behavior, and other factors measured during conscription were accounted for. RESULTS: We found a clear educational gradient for all-cause and IHD mortality (HR 2.07 and 2.47, respectively, for the lowest compared to the highest education level). A substantial part was explained by the differential distribution of the confounding factors. However, work-related factors, especially high physical workload, also played important explanatory roles. CONCLUSION: Even after accounting for earlier life factors, low job control and especially high physical workload seem to be important mechanistic factors in explaining educational inequalities in all-cause and IHD mortality. It is therefore important to find ways to reduce physical workload and increase job control in order to decrease inequalities in mortality.

OBJECTIVES: While psychosocial working conditions have been associated with morbidity, their associations with mortality, especially cause-specific mortality, have been less studied. Additionally, few studies considered the time-varying aspect of exposures. We aimed to examine trajectories of job demand–control status in relation to all-cause and cause-specific mortality, including cardiovascular diseases (CVD), suicide, and alcohol-related mortality. METHODS: The study population consisted of around 4.5 million individuals aged 16-60 years in Sweden in 2005. Job control and demands were respectively measured using job exposure matrices (JEM). Trajectories of job control and demands throughout 2005–2009 were identified using group-based trajectory modelling, and job demand–control categories were subsequently classified. Deaths in 2010–2019 were recorded in the national cause of death register. Cox regression models were used. RESULTS: A total of 116 242 individuals died in 2010–2019. For both job control and demands, we identified four trajectories, which were parallel to each other and represented four levels of exposures. Low control and passive jobs were associated with higher all-cause, CVD, and suicide mortality among both men and women. High strain jobs were associated with higher all-cause and CVD mortality among men, while low control, passive jobs, and high strain jobs were associated with higher alcohol-related mortality among women. CONCLUSIONS: The trajectories identified may suggest stable levels of job control and demands over time. Poor psychosocial working conditions are related to all-cause and cause-specific mortality, and these patterns vary to some extent between men and women.

The effect of higher education on intelligence has been examined using longitudinal data. Typically, these studies reveal a positive effect, approximately 1 IQ point per year of higher education, particularly when pre-education intelligence is considered as a covariate in the analyses. However, such covariate adjustment is known to yield positively biased results if the covariate has measurement errors and is correlated with the predictor. Simultaneously, a negative bias may emerge if the intelligence measure after higher education has non-classical measurement errors as in data from the 1970 British Cohort Study that were used in a previous study of the effect of higher education. In response, we have devised an estimation method that used iterated simulations to account for both classical measurement errors in the covariate and non-classical errors in the dependent variable. Upon applying this method in a reanalysis of the data from the 1970 British Cohort Study, we find that the estimated effect of higher education diminishes to 0.4 IQ points per year. Additionally, our findings suggest that the impact of higher education is somewhat more pronounced in the initial 2 years of higher education, aligning with the notion of diminishing marginal cognitive benefits.

Purpose For many employees today, the work situation and work content differ from those of the industrial workers that were originally in mind when the well-known demand-control-support model was developed. The aim of this study was to gain a deeper understanding of the meaning of control, i.e., decision latitude, in post-industrial society, using night-working registered nurses as an example. Methods As an example of a modern human service occupation in a value-based organization we choose registered nurses. Twenty-nine registered nurses from 11 departments at three different hospitals participated in semi-structured interviews. The analysis used a thematic approach and was deductive, based on an operationalization of decision latitude. Results Findings indicate that the specific meaning of decision latitude is influenced by the specific work organization. Moreover, decision latitude appears to interact in a complex way with demands and support at work. Conclusions Decision latitude appears to be influenced by the specific work organization. Thus, when we address self-reported decision latitude, it can have different meanings and potentially different effects in different contexts. Moreover, the interface and interplay between the three constructs decision latitude, demand and support seems to be relevant and complex.

OBJECTIVE: This study aimed to examine if a change to an occupation with a lower physical workload reduces the risk of all-cause disability pension (DP) and musculoskeletal DP (MDP). METHODS: This study used a sample of 359 453 workers who were registered as living in Sweden in 2005 and aged 44–63 in 2010. Exposure to physical workload was measured from 2005–2010 by linking a mean value from a job exposure matrix to occupational codes. The mean values were then split into quartiles. All included participants had high exposure to physical workload (top quartile) from 2005–2007. A change in physical workload was measured as a change to (i) any lower quartile or (ii) medium-high or low quartiles from 2008–2010. DP cases were taken from register data from 2011–2016. Crude and multivariate Cox proportional-hazards regression models estimated sex-specific hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: Compared to workers with consistently high physical workload, a change to any lower quartile of physical workload was associated with a decreased risk of all-cause DP (men: HR 0.59, 95% CI 0.46–0.77, women: HR 0.63, 95% CI 0.52–0.76) and MDP (men: HR 0.52, 95% CI 0.31–0.89, women: HR 0.61, 95% CI 0.44–0.84). Older workers had the largest decreased risk for MDP. Generally, changing from high to low physical workload was associated with a greater reduced risk of DP than changing from high to medium-high physical workload. CONCLUSIONS: Changing to an occupation with lower exposure to physical workload was associated with reduced risks of DP and MDP among both sexes.

Abstract Background The present study aims to investigate the association between educational qualification and early labor market exit among men and to examine the contribution of labor market marginalization measured across the working life on this association. Method A register-linked cohort study was conducted including men who completed military service in 1969/70 (born between 1949 and 1951) and were alive at age 55 and not disability pension beneficiaries (n = 40 761). Information on the highest level of educational qualification and the outcome of early exit (disability pension, sickness absence, unemployment, and early old-age pension) was obtained from Swedish nationwide registers between the ages of 55 and 64 years. Labor market marginalization was defined as periods of long-term unemployment and sickness absence over the working life and up to follow-up. Cox regression analyses were used to obtain hazard ratios (HR) with 95% confidence intervals (CI). Results Low-educated men were more likely to leave the labor force early due to disability pension or sickness absence (HR: 2.48), unemployment (HR: 2.09), and early old-age pension with- (HR:1.25) and without -income (HR: 1.58). Labor market marginalization across the working life explained a large part of the association for the more involuntary early exit routes (disability pensions, sickness absence, unemployment) and explained very little with regards to the more voluntary early exit routes (early old-age pension with and without income). Conclusion Exposure to labor market marginalization across the working life was important in explaining educational differences in early labor market exit due to disability pension or sickness absence and unemployment. This study underscores the importance of identifying and implementing preventive measures in the workplace (e.g. adaptions) to prevent new spells of sickness absence and unemployment, especially among low educated individuals.

Abstract Background Some studies have suggested that teachers are particularly at risk for mental health problems but the research in this area has not been conclusive. This study aims to compare the risk of being diagnosed with depression for different types of teachers in Sweden, both with each other and with the rest of the population, using register data. Methods Just over 3 million individuals age 30-60 were included of which 256,166 were teachers. The exposure variable was the occupation held in 2005 and the outcome was any diagnosis of depression during the follow up period of 2006 to 2016. The data was analyzed using Cox proportional hazard regression. Results Around 5 % of women and 3 % of men developed depression during the follow up. For women, teachers had a decreased risk of developing depression compared to non-teachers, but this association was no longer present after adjusting for common covariates including education. For men, teachers had an increased risk of depression both before and after adjustment (HR 1.27 95% CI 1.22-1.32). When comparing different kinds of teachers to university teachers, several types of teachers including primary and special education teachers had an increased risk among men while primary and secondary teachers had a decreased risk among women. Conclusion The increased risk of depression in male teachers is a result that requires further exploration in terms of occupational differences between male and female teachers.