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Background: Simple and efficient survey measures to predict staying in or leaving work are needed. We examined the association of single-item self-rated work ability (SRWA) with disability retirement in two large population-based samples and compared the association of SRWA to two other scales, work ability score (WAS) and self-rated health (SRH), used earlier in studies., Methods: The study population comprised 6034 participants aged 35-58 from the population-based Health 2000 and FinHealth 2017 cohort studies, pooled together. SRWA, WAS and SRH were all classified in three categories: poor, limited and good. A 36-month follow-up for disability retirement via linkage to electronic records was included in the analysis., Results: Of the participants, 195 retired during the follow-up. All three measures strongly predicted disability retirement. Hazard ratio (HR) for poor SRWA (vs. good) was 8.48 [95% confidence interval (CI) 5.41-13.28], WAS 7.99 (95% CI 5.62-11.37) and SRH 5.96 (95% CI 4.17-8.51). HR for limited SRWA (vs. good) was 4.35 (95% CI 3.21-5.91), WAS 3.54 (95% CI 2.49-5.04) and SRH 2.27 (95% CI 1.59-3.23). Taking into account gender, age, education and mental health narrowed the gap between poor and limited vs. good work ability as predictors of disability retirement, but the differences remained clear., Conclusions: Limited or poor self-rated work ability or health are strong predictors of disability retirement. The SRWA measure is a useful survey-measure of work ability in community-based surveys., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Public Health Association.)

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., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association.)

Background: Health status is a principal determinant of labour market participation. In this study, we examined whether excess weight is associated with withdrawal from the labour market owing to premature retirement., Methods: The analyses were based on nationally representative data from Finland over the period 2001-15 (N ∼ 2500). The longitudinal data included objective measures of body weight (i.e. body mass index and waist circumference) linked to register-based information on actual retirement age. The association between the body weight measures and premature retirement was modelled using cubic b-splines via logistic regression. The models accounted for other possible risk factors and potential confounders, such as smoking and education., Results: Excess weight was associated with an increased risk of premature retirement for both men and women. A closer examination revealed that the probability of retirement varied across the weight distribution and the results differed between sexes and weight measures., Conclusion: Body weight outside a recommended range elevates the risk of premature retirement., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association.)

Background: The aim was to identify specific manual occupations with high mortality and to examine whether there are differences in the role of alcohol in explaining the excess mortality among manual occupations with high all-cause mortality., Methods: A register-based study of employees aged 30-64 years, followed for mortality 2001-15. Age standardized mortality ratios (SMRs) were calculated to compare the mortality rates of manual occupations. The contribution of alcohol-related mortality to excess mortality was obtained by comparing the excess mortality in all deaths and deaths not related to alcohol., Results: Men had 31 and women 11 manual occupations with SMR statistically significantly over 120 compared with all employees. Mortality rates were highest among building construction labourers (SMR 180) among men and building caretakers (SMR 155) among women. With few exceptions, high mortality was a combination of high alcohol-related and high non-alcohol-related mortality. Among men, the contribution of alcohol-related mortality to the excess all-cause mortality compared with all employees was over 10% in half of the high-mortality occupations. The contribution was highest among welders and flame cutters (50%) and lowest among farmer's locums (-50%). Among women the contribution was highest among building caretakers (15%)., Conclusions: High-mortality occupations had high mortality even without alcohol-related deaths. However, alcohol-related mortality was generally higher than mortality for other causes; therefore, alcohol-related mortality increased further the excess mortality. Diminishing the alcohol-related mortality would level excess mortality of these occupations but not eliminate it., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: This study looks at how previous disability retirement is associated with economic difficulties in covering the costs of everyday basic necessities in old age, and the extent to which the differences in economic difficulties between old-age pensioners with previous disability pension and other old-age pensioners are mediated by health, income and life satisfaction., Methods: The survey data includes 2227 retirees aged 63-85 who were receiving old-age pension in 2017. A quarter of them had received a disability pension before their old-age pension. Economic difficulties were measured through a subjective assessment of how difficult it was to cover the following necessities: food, housing, medication, health services, transport, phone and internet use. The odds ratios and their 95%-confidence intervals were analyzed with ordered logistic regression models., Results: Old-age pensioners with previous disability retirement experienced more economic difficulties in covering cost of necessities than other old-age pensioners. The differences were especially large among those with a mental diagnosis. Health, pension income and life satisfaction attenuated the differences slightly. The fully adjusted odds ratio for having economic difficulties in covering the cost of medicine and health care among old-age pensioners with previous disability retirement due to mental disorders was 2.15 (95% CI 1.44-3.22) compared to other old-age pensioners without previous disability retirement., Conclusions: Preventing disability retirement among working-age people diminishes the risk of economic difficulties in old age. More attention should be focussed especially on those with a high risk of disability retirement due to mental disorders., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Retirement has been associated with improved mental health, but it is unclear how much this is due to the removal of work-related stressors. We examined rates of psychotropic medication use before and after the transition to disability retirement due to mental, musculoskeletal and other causes by pre-retirement levels of perceived work stress (effort-reward imbalance, ERI)., Methods: Register-based date and diagnosis of disability retirement of 2766 participants of the Finnish Public Sector study cohort were linked to survey data on ERI, social- and health-related covariates, and to national records on prescribed reimbursed psychotropic medication, measured as defined daily doses (DDDs). Follow-up for DDDs was 2-5 years before and after disability retirement. We assessed differences in the levels of DDDs before and after retirement among those with high vs. low level of pre-retirement ERI with repeated measures regression., Results: Those with high (vs. low) levels of ERI used slightly more psychotropic medication before disability retirement due to mental disorders [rate ratio (RR) 1.14, 95% confidence intervals (CI) 0.94-1.37], but after retirement this difference attenuated (RR 0.94, 95% CI 0.80-1.10, P for interaction 0.02). Such a change was not observed for the other causes of disability retirement., Conclusions: The level of psychotropic medication use over the transition to disability retirement due to mental, but not musculoskeletal or other, causes was modified by pre-retirement perceived work-related stress. This suggests that among people retiring due to mental disorders those who had stressful jobs benefit from retirement more than those with low levels of work-related stress., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: We examined whether the risk for disability retirement varies between companies over and above the individual-level characteristics of their employees and which company-level characteristics are associated with the risk for any, full or partial disability retirement., Methods: A 30% random sample of Finnish private sector companies with at least 10 employees was used (5567 companies and 301 313 employees). The risk for disability retirement over 6 years was analyzed using multilevel logistic regression. Company size and industry, as well as gender, age, education and social class measured both at the individual- and the company-level were used as explanatory variables., Results: 3.8% of the variance in the risk for disability retirement was attributed to the company level after controlling for individual-level characteristics of the employees. Company-level variance was much larger in partial (11.7%) than in full (4.2%) disability retirement. After controlling for all individual- and company-level characteristics, those working in health and social work activities had increased risk for both full and partial disability retirement. The risk for full disability retirement increased by decreasing educational level of the company. The risk for partial disability retirement increased by increasing company size and was elevated in companies with the highest proportion of women., Conclusions: After controlling for the individual-level characteristics, variation in the risk for disability retirement between companies was modest. The more substantial variation in partial disability pension suggests that companies have a marked role in advancing working with partial disabilities., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Objectives: Women have higher sickness absence rate than men, but less is known of changes in this difference over time. We examined gender differences in sickness absence trends focusing on gender segregation in the labour market., Methods: We used large nationwide register data on Finnish wage earners aged 25-59 and generalized estimation equations based on repeated logistic regression to estimate the annual risk of sickness absence lasting at least 2 weeks., Results: Between 2005 and 2013, the age-adjusted proportion (%) of employees with all-cause sickness absence decreased from the initial levels of 10.6 among men and 15.1 among women by 16.7 and 13.6%, respectively. Among both genders, the largest decrease in sickness absence coincided with the peak of the economic recession in 2009. In sickness absence due to all causes and musculoskeletal diseases, also the excess decrease among men mainly occurred in 2009, and in sickness absence due to mental disorders 2 years later. In sickness absence due to all causes and musculoskeletal diseases, the increasing gender difference was mainly attributable to a larger decrease in sickness absence at the time of the recession in male-dominated groups, such as in manual and manufacturing work, than in other sectors and occupational classes. In mental disorders, the increasing gender difference was partly attributable to a later smaller decrease in sickness absence among female-dominated lower non-manual and lower income employment groups. The increasing gender differences did not result from differential distributional changes in employment or sociodemographic factors among the employed male and female populations. In fact, widening of the gender gap in sickness absence due to all causes and musculoskeletal diseases would have been even larger without faster increase among women in the educational level and in non-manual employment., Conclusions: Sickness absence decreased especially in male-dominated employment groups, resulting in a larger decrease in absences among men compared with women. More research is needed to ascertain whether these differential changes are attributable, for example, to reduced willingness to seek medical advice or increased presenteeism in male-dominated groups, or to increased work pressures in female-dominated groups. Selection mechanisms, i.e. men's increased ill-health-related exit from work through other routes than sickness absence, also cannot be ruled out.

Objectives: To identify subgroups of disability retirees with different pre-retirement sickness allowance histories and to examine whether the diagnosis of disability pension and socio-demographic variables discriminate these subgroups., Methods: The data included all Finnish residents aged 30-64 years who were granted a full disability pension in 2011 (N = 17 208). Sickness allowance trajectories during the preceding 10 years were searched using latent trajectory analysis. Multinomial logistic regression analysis was used to explore determinants of the trajectories., Results: Six distinct sickness allowance trajectories were identified. Four large subgroups with a long sickness allowance period during the final pre-retirement year were found, characterized by increasing (29% of retirees), early high (21%), stable low (24%) or stable high (16%) sickness allowance histories. In addition, two small subgroups (6 and 4%) with only a little sickness allowance during the final year were identified. The diagnosis of disability pension strongly influenced assignment to the trajectory groups. Women were more likely to have followed the stable high or the early high sickness allowance trajectory. Older age strongly increased but being a lower non-manual employee or self-employed decreased the probability of belonging to the two small trajectory groups. Long-term unemployment slightly increased belonging to the stable low trajectory and was strongly associated with the small subgroups with little or no sickness allowance during the final year preceding retirement., Conclusions: Different pre-retirement sickness allowance trajectories can be found. Assignment to the trajectories differed by the diagnosis of disability pension but associations with socio-demographic variables were weak., (© The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Self-rated health (SRH) has been found to predict sickness absence (SA). The present study investigated the effect of replacing single-item SRH by a multi-item health measure on SA predictions., Methods: Longitudinal study of 2059 Norwegian nurses with assessments in three waves each separated by 1 year. Health was measured by single-item SRH and multi-item SF-12 in waves 1 and 2. SA was self-reported in all three waves and high SA was defined as more than or equal to 31 SA days within the last 12 months. Predictions of high SA by a model including age, prior SA and single-item SRH were compared with predictions by a model including age, prior SA and multi-item SF-12. Both models were bootstrapped to correct for over-optimism and prospectively validated for their predictions in a new time frame., Results: 1253 nurses (61%) had complete data for analysis. The SF-12 model predicted the risk of high SA more accurately (χ(2) = 4.294; df = 8) and was more stable over time than the SRH model (model χ(2) = 14.495; df = 8). Both prediction models correctly discriminated between high-risk and low-risk individuals in 73% of the cases at wave 2 and in 71% of the cases at wave 3., Conclusions: The accuracy of predictions increased when single-item SRH was replaced by multi-item SF-12, but the discriminative ability did not improve. Single-item SRH suffices to identify employees at increased risk of high SA., (© The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Obesity is associated with an increased risk of work disability, but studies concerning weight change are few. We examined the associations of weight change with subsequent sickness absence., Methods: Weight status data of 4164 (83% women) employees of the City of Helsinki were gathered from the Helsinki Health Study baseline survey in 2000-2002 and follow-up survey in 2007. Data were linked prospectively with the employer's sickness absence registers. Employees were categorized according to their baseline Body Mass Index (normal weight, overweight, obese) as well as weight change (weight gainer, weight loser, weight maintainer) between the two surveys. The association of weight change with sickness absence spells was analysed with Poisson regression., Results: Among women, those who maintained normal weight had the lowest risk for sickness absence. Weight loss, weight gain and stable obesity increased the risk for sickness absence spells of all lengths. Adjustments for covariates attenuated the association only slightly. Among men, the achieved results were mostly not statistically significant., Conclusions: Preventing obesity and weight gain is important for employee well-being and work ability. Early support measures in occupational health care could benefit obese employees and those with weight gain to maintain work ability. The association between weight loss and sickness absence should be corroborated in further studies., (© The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Events and conditions during childhood have been found to affect health and mortality at later stages in life. We studied whether childhood conditions explain the observed all-cause and cause-specific mortality disparity between income groups in adulthood., Methods: We used a 10% register linked sample of Finnish households in the 1950 census identifying 51 647 children aged 0-14 with at least one sibling of the same sex and followed them for mortality from the age 35 until ages 57-72. Using Cox regression with sibling design, we estimated hazard ratios (HRs) for quintiles of personal income at the age 35. We controlled for observed childhood family sociodemographic characteristics and allowed different baseline hazard functions for each group of siblings in order to control for all shared unobserved characteristics within families., Results: Accounting for the observed childhood characteristics did not attenuate the income disparity in mortality, whereas adjusting for the sociodemographic characteristics in adulthood reduced the difference of the lowest quintiles by ∼70% among men and 30-40% among women. Controlling for the unobserved childhood characteristics in the sibling design did not provide any further explanation to the income differentials in mortality. This applied also for cause-specific mortality among men. HR to the cardiovascular diseases was 38% higher and 73% higher in alcohol, accidental and violent causes in the lowest quintile even after adjusting for all observed and unobserved characteristics., Conclusions: The excess mortality in the lowest income quintiles persists even after shared childhood family conditions among siblings are accounted for., (© The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Objectives: In addition to individual-level characteristics also contextual factors may contribute to the large regional variation seen in disability retirement. We examined the associations of municipality-level characteristics and disability retirement due to all causes, musculoskeletal diseases, mental disorders and other diseases., Methods: A register-based study was conducted with a 20% random sample of the Finnish population aged 25-62 years. Municipalities were separately divided into quintiles by their proportion of manual workers, unemployed and industrial employees. Multilevel Poisson regression analysis was applied to examine associations between the three municipality characteristics and disability retirement during a 5-year follow-up., Results: All three municipality-level indicators were associated with disability retirement, but the association between the proportion of industrial workers and disability retirement disappeared after adjustment for age, gender, marital status, socioeconomic position, unemployment and industrial employee status at the individual level. The associations were particularly strong for disability retirement due to musculoskeletal diseases: in the municipalities with the highest proportion of manual workers, the risk for disability retirement due to musculoskeletal diseases was 2.5 times higher than in the municipalities with least manual workers. After adjustment for the individual-level factors, the risk was 1.5 times higher. Cross-level interactions showed that the risk of disability retirement increased with the increasing proportion of unemployment in the municipality only among those who had not experienced unemployment themselves., Conclusions: Municipality-level characteristics made an independent contribution to the probability of disability retirement in particular due to musculoskeletal diseases. Also, area-level characteristics should be considered when targeting disability retirement.

Background: Measures of socio-economic position, such as education, occupational class and income, are well-known determinants of ill-health, injury and sickness absence. The aim was to analyse socio-economic and occupational determinants of work injury absence and their contribution to overall socio-economic inequalities in all-cause sickness absence., Methods: A register-based follow-up study included municipal employees of the City of Helsinki aged 25-59 years in 2004. The number of participants was 16,471 women and 5033 men. The mean follow-up time was 3.0 years. Education, occupational class and individual income were used as measures of socio-economic position. The main outcome was medically confirmed work injury and all-cause sickness absence of ≥4 days. Inequality indices were calculated using Poisson regression analysis., Results: High education, occupational class and individual income were consistently associated with lower work injury absence among both women and men. The inequalities in work injury absence were larger than in all-cause sickness absence, especially among men, but the contribution to overall socio-economic inequalities was limited. Among women, bus drivers, cooks and hospital attendants had the highest rates of work injuries. Among men, youth mentors, firemen and janitors had the highest rates., Conclusions: Our results indicate that relative socio-economic inequalities in work injury absence are larger than in all-cause sickness absence. Prevention of work injuries provides a source of reducing socio-economic inequalities in health, but their effect is not very large. Prevention of work injuries should be targeted to lower white-collar and manual workers and vulnerable occupations.

The Helsinki Health Study cohort was set up to enable longitudinal studies on the social and work related determinants of health and well-being, making use of self-reported as well as objective register data. The target population is the staff of the City of Helsinki, Finland. Baseline data for the cohort were derived from questionnaire surveys conducted in 2000, 2001 and 2002 among employees reaching 40, 45, 50, 55 or 60 years of age in each year. The number of responders at baseline was 8960 (80% women, response rate 67%). Additional age-based health examination data were available. A follow up survey was conducted in 2007 yielding 7332 responders (response rate 83%). Measures of health include health behaviours, self-rated health, common mental disorders, functioning, pain, sleep problems, angina symptoms and major diseases. Social determinants include socio-demographics, socio-economic circumstances, working conditions, social support, and work-family interface. Further register linkages include sickness absence, hospital discharge, prescribed drugs, and retirement updated at the end of 2010. The cohort allows comparisons with the Whitehall II study, London, UK, and the Japanese Civil Servants Study from western Japan. The cohort data are available for collaborative research at Hjelt Institute, Department of Public Health, University of Helsinki, Finland.

Background: Socio-economic position measures, such as education, occupational class and income, are well-known determinants of health. However, previous studies have not paid attention to mutual interrelationships between these socio-economic position measures and medically confirmed sickness absence., Methods: The study is a register-based study. The participants were municipal employees of the City of Helsinki aged 25-59 years in 2003. There were 21,599 women and 5841 men participants. Three socio-economic position measures were used, namely three-level education, four-level occupational class and gross individual income quartiles. Main outcome measure was medically confirmed sickness absence spells of 4 days or longer. Inequality indices were calculated using Poisson regression analysis., Results: High education, occupational class and individual income were all consistently associated with lower sickness absence rates among both women and men. After mutual adjustment, education and occupational class remained independent determinants of sickness absence. The association of individual income with sickness absence was practically explained by temporally preceding education and occupational class., Conclusions: Our results indicate that education and occupational class-rather than income-are strong determinants of sickness absence. Education, occupational class and income are complementary socio-economic position measures. To better inform sickness absence policy, future studies should aim to establish whether the observed socio-economic differences reflect broader differences in ill-health, lifestyle and working conditions.

Background: Health behaviours are potential explanatory factors for socioeconomic differences in mortality. We examined the extent to which seven health behaviours covering dietary habits, smoking and physical activity, can account for relative differences in cardiovascular and all-cause mortality by educational level., Methods: Health behaviour data derived from nationwide Finnish health behaviour surveys from the years 1979 to 2001. These annually repeated cross-sectional surveys were linked to register-based information on educational level and subsequent mortality from the year of the survey until the end of 2001 (average follow-up time 11.9 years). The analyses included 29 065 men and 31 543 women of whom 4263 died. Cardiovascular disease (CVD), coronary heart disease (CHD), stroke and all-cause mortality was studied., Results: Educational level showed a graded association with all mortality outcomes. Health behaviours explained 54% of the relative difference between primary and higher educational level in CVD mortality among in men and 22% among in women. For all-cause mortality the corresponding figures were 45 and 38%. Smoking, vegetable use and physical activity were the most important health behaviours explaining educational level differences in all mortality outcomes, while the effects of type of fat used on bread, coffee drinking, relative weight and alcohol use were small., Conclusions: Smoking, low vegetable use and physical inactivity explained a substantial part of educational level differences in cardiovascular and all-cause mortality among men and women. Socioeconomic trends in these behaviours are of crucial importance in determining whether socioeconomic mortality differences will widen or narrow in the future.

Background and Aims: Socioeconomic differences in smoking have been well established. While previous studies have mostly relied on one socioeconomic indicator at a time, this study examined socioeconomic differences in smoking by using several indicators that reflect different dimensions of socioeconomic position., Data and Methods: Data derive from Helsinki Health Study baseline surveys conducted among the employees of the City of Helsinki in 2000 and 2001. The data include 6243 respondents aged 40-60 years (response rate 68%). Six socioeconomic indicators were used: education, occupational status, household income per consumption unit, housing tenure, economic difficulties and economic satisfaction. Their associations with current smoking were examined by fitting sequential logistic regression models., Results: All socioeconomic indicators were strongly associated with smoking among both men and women. When the indicators were examined simultaneously their associations with smoking attenuated, especially when education and occupational status were considered together, and when income and housing tenure were introduced into the models already containing education and occupational status. After mutual adjustment for all socioeconomic indicators, housing tenure and economic satisfaction remained associated with smoking in men. In women, all indicators except income and economic difficulties were inversely associated with smoking after adjustments., Conclusions: Smoking was associated with structural, material as well as perceived dimensions of socioeconomic disadvantage. Attempts to reduce smoking among the socioeconomically disadvantaged need to target several dimensions of socioeconomic position.