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Health inequalities exist across countries and populations, but little is known about their long-term trends and even less about factors shaping the trends. We examined the magnitude of absolute and relative educational inequalities in self-rated health over 36 years among Finnish adults, considering individual covariates and macro-economic fluctuations. Our data were derived from representative annual cross-sectional surveys in 1979–2014 conducted among adult men and women. Participants aged 25–64 were included and nine periods used (n = 8870–14235). Our health outcome was less-than-good self-rated health (SRH) and our socioeconomic indicator was completed years of education as a continuous variable. Educational inequalities in self-rated health were analysed using the relative index of inequality (RII) and the slope index of inequality (SII). Nine time-variant sociodemographic and health-related covariates were included in the analyses. Linear trends suggested stable or slightly curvilinear overall trends in both absolute and relative health equalities over 36 years. Among men, absolute and relative inequalities narrowed immediately after economic recession in Finland in 1993–1994. Among women, inequalities narrowed during financial crisis in 2008–2009. Adjusting for most covariates reduced the magnitude of inequalities throughout the nine periods, but affected little the temporal patterning of health inequalities. Educational inequalities in self-rated health remained during 36 years in Finland. While among men and women health inequalities narrowed during and after recessions, they widened soon back to the pre-recession level. The perseverance of the trends calls for novel and powerful measures to tackle health inequalities., Highlights • Inequalities in self-rated health covering many decades are poorly known. • Relative and absolute health inequalities persisted over 36 years among Finnish men and women. • The health inequalities narrowed transiently during economic recessions. • Health behaviours and employment status reduced the magnitude of inequalities.

Background Heavy physical effort at work has been linked with disability pension, but the contribution of other ergonomic job exposures is less studied. We studied the independent and joint contributions of long-term exposure to (i) rotation of the back and (ii) repetitive movements to disability pension, particularly due to musculoskeletal disorders. Methods Exposures were measured with the Helsinki Health Study Job Exposure Matrix during 1996–2005 and linked to register data on employees of the City of Helsinki, Finland (n = 18 585). Outcomes were followed up during 2006–2015. Competing risk survival analyses were performed and synergy indices computed, adjusting for sociodemographic factors. Results Long-term exposure to rotation of the back was associated with disability pension due to any cause [age and sex-adjusted subhazard ratio (SHR) 2.39, 95% confidence interval (CI) 1.73–3.30], and specifically disability pension due to musculoskeletal disorders (SHR = 3.39, 95% CI 1.52–7.56) when compared to employees exposed to neither of the two exposures. Repetitive movements alone did not increase the risk of disability pension (all-cause SHR = 1.08, 95% CI 0.84–1.38, musculoskeletal SHR = 1.65, 95% CI 0.91–2.97). Employees with exposure to both rotation of the back and repetitive movements had the highest risk of disability pension due to musculoskeletal disorders (SHR = 5.98, 95% CI 3.85–9.28), but the interaction between exposures was additive rather than synergistic. Adjustment for education diluted the associations by 42–108%. Conclusion Long-term exposure to awkward work postures increased the risk of disability pension. Educational inequalities largely account for differences in occupational exposures.

Introduction Depression is a highly prevalent condition with typical onset in early adulthood. Internet-delivered cognitive behavioural therapy (iCBT) is a promising cost-effective and more widely available alternative to face-to-face CBT. However, it is not known whether it can reduce sickness absence in employees showing depressive symptoms. The randomised controlled trial component of the DAQI (Depression and sickness absence in young adults: a quasi-experimental trial and web-based treatment intervention) project aims to investigate if iCBT is effective in reducing sickness absence compared with care as usual (CAU) among young employees with depressive symptoms in primary care provided in an occupational health setting. Methods and analysis This study will use a randomised controlled single-centre service-based trial of an existing iCBT programme (Mental Hub iCBT for Depression) to evaluate whether or not this treatment can reduce the number of sickness absence days in public sector employees aged 18–34 years who present at the occupational health service with mild depressive symptoms (score ≥9 on the Beck Depression Inventory-IA). Control participants will be offered CAU, with no constraints regarding the range of treatments. The active condition will consist of seven weekly modules of iCBT, with support from a web therapist. Primary outcome will be participants’ all-cause sickness absence as indicated in employer’s and national administrative records up to 6 months from study entry. Secondary outcomes relating to long-term sickness absence (over 11 calendar days) for mental and musculoskeletal disorders and psychotropic medication use will be obtained from the Finnish Social Insurance Institution’s administrative records; and short sickness absence spells (up to 11 calendar days) will be extracted from employer’s records. Analyses will be conducted on an intention-to-treat basis. Ethics and dissemination The Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa has approved the study (HUS/974/2019). The results will be published in peer-reviewed scientific journals and in publications for lay audience. Trial registration number NCT10877837

Background Prior analyses of class differences in health trajectories among employees have often omitted women and transitions to retirement. We examined social class trajectories in physical functioning among Finnish female employees from midlife to retirement age, and whether transitions to retirement modified these trajectories. Methods Data were derived from mail surveys at Phases 1–3 (2000–2012) among employees of the City of Helsinki, Finland, aged 40–60 at baseline (n = 8960, 80% women, response rates 69–83%). We included respondents to any of the Phases 1–3 aged 40–72 (n = 6976). We distinguished higher and lower social classes, and employment statuses, i.e. employed, mandatorily retired and disability-retired. Short Form 36 physical component summary was used to measure physical functioning. Mixed-effect growth curve models were used to assess the association of social class and employment status with functioning over age. Results For employed women, physical functioning deteriorated faster in the lower than in the higher class, with class trajectories widening in ages 40–65. After mandatory retirement, functioning deteriorated in both classes, whereas after disability retirement, functioning improved. Across employment statuses, functioning converged at older ages, and the disability-retired caught up with the better functioning of the employed and mandatorily retired. Employment status modified the trajectories, as among the continuously employed and mandatorily retired women functioning deteriorated, but among the disability-retired, trajectories improved and reached a similar level with employed and mandatorily retired women. Social class inequalities remained in all employment status groups. Conclusions Overall, our results suggest evidence for the cumulative disadvantage model, with accumulating work exposures among lower classes potentially contributing to their trajectories of ill health.

Background We determined whether favourable changes in physical workload and environmental factors reduce sickness absence (SA) days using observational cohort data as a pseudo-experiment. Methods The data from the Finnish Helsinki Health Study included three cohorts of employees of the City of Helsinki [2000/2002–07 (N = 2927), 2007–12 (N = 1686) and 2012–17 (N = 1118), altogether 5731 observations]. First, we estimated the propensity score of favourable changes (reduction in exposures) in physical workload and environmental factors during each 5-year follow-up period on the baseline survey characteristics using logistic regression. Second, we created and stabilized inverse probability of treatment weights for each participant using the propensity scores. Lastly, we used generalized linear model and fitted negative binomial regression models for over-dispersed count data to estimate whether the favourable changes decrease the risk of short-term (1–3 days), intermediate-term (4–14 days) and long-term (>14 days) SA using employer’s register data. Results During a 5-year follow-up, 11% of the participants had favourable changes in physical workload factors, 13% in environmental factors and 8% in both factors. The incidence of short-term, intermediate-term and long-term SA were lower in employees with favourable workplace changes compared with those without such changes. The reductions were largest for long-term SA. Reporting favourable changes in both workload and environmental factors reduced the number of SA days by 41% within 1 year after the changes and by 32% within 2 years after the changes. Conclusion This pseudo-experimental study suggests that improving physical working conditions reduces SA.

Publisher Copyright: © 2021 The Authors This study aimed to examine the associations of perceived physical and mental working conditions with subsequent antidepressant medication purchases among 18-39-year-old municipal employees. Survey data collected in 2017 among employees of the City of Helsinki (n=5897, response rate 51.5%) were linked to register data on psychotropic medication purchases (82% gave permission to register linkage). The analysis included 3570 women and 972 men. We used three single-item measures of working conditions: perceived mental and physical strenuousness of work, and time spent in physical work. Covariates included age, gender, marital status, employment status, body mass index, smoking, alcohol use and previous medication. Cox regression analysis was used to calculate hazard ratios (HR) for the first antidepressant medication (ATC class N06A) purchase during a one-year follow-up. Those with mentally strenuous work (HR 1.85) as well as those spending more than four hours in physical work per workday (HR 1.60) had an statistically significantly increased risk of antidepressant medication use when adjusting for age and gender. Further adjustments for covariates attenuated these associations, which however remained statistically significant. Improving working conditions to avoid excess mental and physical workload is likely to be beneficial for preventing mental health problems already among younger employees.

This study investigates to what extent pain in multiple sites and common risk factors related to work environment, occupational class and health behaviours are associated with cause-specific work disability (WD) development clusters. The study population was derived from the Finnish Helsinki Health Study (n = 2878). Sequence analysis created clusters of similar subsequent cause-specific WD development in an eight-year follow-up period. Cross-tabulations and multinomial logistic regression were used to analyze the extent to which baseline factors, including pain in multiple sites, were associated with the subsequent WD clusters. A solution with five distinct WD clusters was chosen: absence of any WD (40%), low and temporary WD due to various causes (46%), WD due to mental disorders (3%), WD due to musculoskeletal (8%) and WD due to other causes (4%). Half of the employees in the musculoskeletal WD cluster had pain in multiple locations. In the adjusted model the number of pain sites, low occupational class and physical working conditions were linked to the musculoskeletal WD. The identified characteristics of the different WD clusters may help target tailored work disability prevention measures for those at risk.

Evidence remains unclear on how intergenerational social mobility is associated with body mass index (BMI) and its long-term changes. Our study identified BMI trajectories from middle to older age by intergenerational social mobility groups and stratified the analyses by gender and two birth cohorts (birth years 1940‒1947 and 1950–1962). We used questionnaire-based cohort data that consists of four survey phases: 2000–2002, 2007, 2012, and 2017. In Phase 1, participants were 40–60-year-old employees of the City of Helsinki, Finland. Our analytical sample consisted of 6,971 women and 1,752 men. Intergenerational social mobility was constructed based on self-reported parental and own education—both divided into high and low—yielding four groups: stable high socioeconomic position (SEP) (high-high), upward social mobility (low-high), downward social mobility (high-low), and stable low SEP (low-low). BMI was calculated from self-reported height and weight from all four phases. Using mixed-effects linear regression, we found increasing BMI trajectories in all four social mobility groups until the age of 65. Women and men with stable high SEP had lower BMI trajectories compared to those with stable low SEP. In the younger birth cohort, women with upward social mobility had a lower BMI trajectory than women with stable low SEP. Additionally, women and men with downward social mobility had higher BMI trajectories than those with stable high SEP. In the older birth cohort, however, the BMI trajectories of upward and downward social mobility groups were somewhat similar and settled between the BMI trajectories of stable high and stable low SEP groups. Our results indicate that the associations between intergenerational social mobility and BMI may depend on gender and birth cohort. Nevertheless, to reduce socioeconomic inequalities in unhealthy weight gain, obesity prevention actions that focus on people who are likely to remain in low SEP might be worthwhile., Highlights • Few studies exist on social mobility and long-term body mass index (BMI) changes. • Rising BMI trajectories were found in all social mobility groups. • Stable low socioeconomic position (SEP) was related to higher BMI trajectories. • Stable high SEP and upward social mobility may protect from excessive weight gain. • Social mobility–BMI associations differed by gender and birth cohort.

Sleep and functioning are associated with a risk of early workforce exit. However, patterns of change in sleep and functioning through time have not been investigated using person-oriented approaches to show what features of sleep and functioning are associated with an early exit. We examined the pattern of interactions between sleep and health functioning characterizing homogenous subgroups of employees and their associations with premature work exit. An additional aim was to provide a tutorial providing detailed description on how to apply these models, compared to traditional variable based risk factors. We analyzed data from 5148 midlife employees of the City of Helsinki, Finland, surveyed over three phases (2000–02, 2007, and 2012). Using repeated measures latent class analyses (RMLCA) we classified people into groups based on their trajectories in sleep and functioning. We identified four longitudinal groups: (1) Stable good sleep and functioning (reference), (2) Persistent sleep problems and good or moderate functioning, (3) Poor functioning with good sleep, and (4) Problematic sleep and health functioning. Compared to group 1, elevated risk was found in all classes with group 4 being the worst. In conclusion, focusing on person-orientated patterns of interactions between sleep and functioning helped produce qualitatively different and quantitatively stronger predictions than using conventional risk factor methodology. Thus, longitudinal person-oriented approaches may be a more powerful method for quantifying the role of sleep and health functioning as risks for premature exit from work.

Työn fyysinen kuormittavuus on yhteydessä heikkoon fyysiseen toimintakykyyn keski-iän ylittäneillä työntekijöillä. Fyysisen toimintakyvyn ongelmia esiintyy myös nuoremmilla työntekijöillä, mutta heidän osaltaan työn fyysisen kuormittavuuden ja fyysisen toimintakyvyn yhteyttä ei ole tutkittu. Tässä tutkimuksessa selvitettiin, miten työn fyysinen kuormittavuus on yhteydessä fyysiseen toimintakykyyn 18–39-vuotiailla kunta-alan työntekijöillä. Tutkimusaineisto kerättiin syksyllä 2017 vuoden 1978 jälkeen syntyneiltä 18–39-vuotiailta Helsingin kaupungin työntekijöiltä (n=11 459). Tämän tutkimuksen aineisto koostui niistä työntekijöistä, jotka vastasivat kyselyyn sähköisesti tai paperilla (n=5 111), ja joilta oli lisäksi vastaukset kaikkiin tämän tutkimuksen aihepiiriin kuuluviin kysymyksiin (n=4584, 40 % kutsutuista). Fyysistä toimintakykyä selvitettiin SF-36-kyselyllä, ja fyysisesti heikentyneeksi toimintakyvyksi määritettiin fyysisen toimintakyky pisteytyksen (PCS 1–100) alin neljännes (PCS ≤ 48,80). Työn fyysistä kuormittavuutta selvitettiin moniosaisella kysymyksellä työhön ja työympäristöön liittyvien tekijöiden esiintyvyydestä ja niiden aiheuttaman koetun haitan määrästä. Kuormituspisteet jaettiin kolmanneksiin. Työn fyysisen kuormittavuuden ja fyysisen toimintakyvyn välistä yhteyttä tarkasteltiin logistisella regressioanalyysillä. Analyyseissä huomioitiin mahdollisina sekoittavina tekijöinä ikä, koulutustaso, siviilisääty, korkea painoindeksi, toistuvat uniongelmat, tupakkatuotteiden käyttäminen, humalahakuinen juominen, vapaa-ajan fyysinen aktiivisuus sekä hedelmien, marjojen ja vihannesten päivittäiskäyttö. Heikko fyysinen toimintakyky oli yleisempää niillä, joiden työ oli fyysisesti jonkin verran (OR 1,70, 95 % luottamusväli [1,43-2,00]) tai erittäin kuormittavaa (OR 3,56 [2,70-4,70]) verrattuna ei kovin kuormittavaan työhön. Muista tutkituista tekijöistä toistuvat uniongelmat (OR 1,90 [1,67-2,22]), lihavuus (OR 1,89 [1,56-2,30]) ja matala koulutustaso (OR 1,37 [1,10-1,71]) olivat yhteydessä heikkoon fyysiseen toimintakykyyn. Työn fyysisellä kuormittavuudella saattaa olla merkitystä fyysisen toimintakyvyn kannalta jo nuorella aikuisiällä. Syy-seuraussuhteen selvittämiseksi tarvitaan kuitenkin pitkittäistutkimuksia. Lisäksi interventiotutkimuksilla voitaisiin osoittaa, missä määrin fyysiseen toimintakykyyn voidaan vaikuttaa työn fyysistä kuormittavuutta muokkaamalla.

Objectives To examine the association between cognitively stimulating work and subsequent risk of dementia and to identify protein pathways for this association. Design Multicohort study with three sets of analyses. Setting United Kingdom, Europe, and the United States. Participants Three associations were examined: cognitive stimulation and dementia risk in 107 896 participants from seven population based prospective cohort studies from the IPD-Work consortium (individual participant data meta-analysis in working populations); cognitive stimulation and proteins in a random sample of 2261 participants from one cohort study; and proteins and dementia risk in 13 656 participants from two cohort studies. Main outcome measures Cognitive stimulation was measured at baseline using standard questionnaire instruments on active versus passive jobs and at baseline and over time using a job exposure matrix indicator. 4953 proteins in plasma samples were scanned. Follow-up of incident dementia varied between 13.7 to 30.1 years depending on the cohort. People with dementia were identified through linked electronic health records and repeated clinical examinations. Results During 1.8 million person years at risk, 1143 people with dementia were recorded. The risk of dementia was found to be lower for participants with high compared with low cognitive stimulation at work (crude incidence of dementia per 10 000 person years 4.8 in the high stimulation group and 7.3 in the low stimulation group, age and sex adjusted hazard ratio 0.77, 95% confidence interval 0.65 to 0.92, heterogeneity in cohort specific estimates I 2 =0%, P=0.99). This association was robust to additional adjustment for education, risk factors for dementia in adulthood (smoking, heavy alcohol consumption, physical inactivity, job strain, obesity, hypertension, and prevalent diabetes at baseline), and cardiometabolic diseases (diabetes, coronary heart disease, stroke) before dementia diagnosis (fully adjusted hazard ratio 0.82, 95% confidence interval 0.68 to 0.98). The risk of dementia was also observed during the first 10 years of follow-up (hazard ratio 0.60, 95% confidence interval 0.37 to 0.95) and from year 10 onwards (0.79, 0.66 to 0.95) and replicated using a repeated job exposure matrix indicator of cognitive stimulation (hazard ratio per 1 standard deviation increase 0.77, 95% confidence interval 0.69 to 0.86). In analysis controlling for multiple testing, higher cognitive stimulation at work was associated with lower levels of proteins that inhibit central nervous system axonogenesis and synaptogenesis: slit homologue 2 (SLIT2, fully adjusted β −0.34, P Conclusions The risk of dementia in old age was found to be lower in people with cognitively stimulating jobs than in those with non-stimulating jobs. The findings that cognitive stimulation is associated with lower levels of plasma proteins that potentially inhibit axonogenesis and synaptogenesis and increase the risk of dementia might provide clues to underlying biological mechanisms.

Objective To identify social and health-related predictors of the number of days lost due to sickness absence (SA) and disability pension (DP) among initially 55-year-old public-sector workers. Methods The data from the Finnish Helsinki Health Study included participants aged 55 years at the baseline (in 2000–2002, N = 1630, 81% women), and were enriched with register-based information on SA and DP. The cumulative number of calendar days lost due to SA ≥ 1 day or DP between ages 55 and 65 was calculated. Negative binomial regression model was used to identify the predictors of days lost. Results The average calendar days lost was 316 days (about 220 working days) during a 10-year follow-up, and 44% were due to SA and 56% due to DP. Smoking [incidence rate ratio (IRR) = 1.19, 95% CI 1.01–1.40 for past and IRR = 1.30, CI 1.07–1.58 for current], binge drinking (IRR = 1.22, CI 1.02–1.46), lifting or pulling/pushing heavy loads (IRR = 1.35, CI 1.10–1.65), awkward working positions (IRR = 1.24, CI 1.01–1.53), long-standing illness limiting work or daily activities (IRR = 2.32, CI 1.93–2.79), common mental disorder (IRR = 1.52, CI 1.30–1.79), and multisite pain (IRR = 1.50, CI 1.23–1.84) increased the number of days lost, while high level of education (IRR = 0.66, CI 0.52–0.82) and moderate level of leisure-time physical activity (IRR = 0.80, CI 0.67–0.94) reduced the number of days lost. Conclusions Modifiable lifestyle risk factors, workload factors, common mental disorder, and multisite pain substantially increase the number of days lost. However, the findings of this study could be generalized to female workers in the public sector. Future research should also consider shorter SA spells in estimating working years lost and working life expectancy.

Mental health problems are a major public health and work-life issue. We examined in a quasi-experimental design whether occupational health psychologist (OHP) appointment reduces subsequent sickness absence (SA) due to mental disorders among younger Finnish employees. The present study was conducted among 18–39-year-old employees of the City of Helsinki using register data from the City of Helsinki and the Social lnsurance Institution of Finland. We examined differences in SA days due to mental disorders (ICD-10, F-diagnosed sickness allowances) between those treated (at least one OHP appointment for work ability support) and the comparison group (no OHP appointment) during a one-year follow-up. The full sample (n = 2286, 84% women) consisted of employees with SA due to a diagnosed mental disorder during 2008–2017. To account for the systematic differences between the treatment and comparison groups, the included participants were matched according to age, sex, occupational class, education, previous SA, occupational health primary care visits and psychotropic medication. The weighted matched sample included 1351 participants. In the weighted matched sample, the mean of SA days due to mental disorders was 11.4 (95% CI, 6.4–16.5) for those treated (n = 238) and 20.2 (95% CI, 17.0–23.4) for the comparison group (p Mental health problems are a major public health and work-life issue. We examined in a quasi-experimental design whether occupational health psychologist (OHP) appointment reduces subsequent sickness absence (SA) due to mental disorders among younger Finnish employees. The present study was conducted among 18-39-year-old employees of the City of Helsinki using register data from the City of Helsinki and the Social lnsurance Institution of Finland. We examined differences in SA days due to mental disorders (ICD-10, F-diagnosed sickness allowances) between those treated (at least one OHP appointment for work ability support) and the comparison group (no OHP appointment) during a one-year follow-up. The full sample (n = 2286, 84% women) consisted of employees with SA due to a diagnosed mental disorder during 2008-2017. To account for the systematic differences between the treatment and comparison groups, the included participants were matched according to age, sex, occupational class, education, previous SA, occupational health primary care visits and psychotropic medication. The weighted matched sample included 1351 participants. In the weighted matched sample, the mean of SA days due to mental disorders was 11.4 (95% CI, 6.4-16.5) for those treated (n = 238) and 20.2 (95% CI, 17.0-23.4) for the comparison group (p < 0.01) during the follow-up year. The corresponding figures in the full sample were (11.1, 6.7-15.4) days for those treated (n = 288) and (18.9, 16.7-21.1) days for the comparison group (p < 0.01). This quasi-experimental study suggests that seeing an OHP to support work ability reduces SA due to mental disorders.

We studied whether implementing binding ergonomic shift‐scheduling rules change ageing (≥45 years) social and healthcare employees’ (mean age 52.5 years, 95% women) working‐hour characteristics (e.g. weekly working hours, number and length of night shifts, and short shift intervals) and sleep. We compared an intervention group (n = 253) to a control group (n = 1,234) by survey responses (baseline 2007/2008, follow‐up 2012) and objective working‐hour characteristics (intervention group n = 159, control group n = 379) from 91 days preceding the surveys. Changes in working‐hour characteristics were analysed with repeated measures general linear models. The fully adjusted model (sociodemographics and full‐/part‐time work) showed that proportion of short shift intervals (

Background: Musculoskeletal diseases and mental disorders are major causes of long-term sickness absence in Western countries. Although sickness absence is generally more common in lower occupational classes, little is known about class differences in diagnostic-specific absence over time. Focusing on Finland during 2005-2014, we therefore set out to examine the magnitude of and changes in absolute and relative occupational class differences in long-term sickness absence due to major diagnostic causes. Methods: A 70-per-cent random sample of Finns aged 25-64 linked to register data on medically certified sickness absence (of over 10 working days) in 2005-2014 was retrieved from the Social Insurance Institution of Finland. Information on occupational class was obtained from Statistics Finland and linked to the data. The study focused on female (n = 658,148-694,142) and male (n = 604,715-642,922) upper and lower non-manual employees and manual workers. The age-standardised prevalence, the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were calculated for each study year to facilitate examination of the class differences. Results: The prevalence of each diagnostic cause of sickness absence declined during the study period, the most common causes being musculoskeletal diseases, mental disorders and injuries. The prevalence of other causes under scrutiny was less than 1 % annually. By far the largest absolute and relative differences were in musculoskeletal diseases among both women and men. Moreover, the absolute differences in both genders (p

Background: Whether low occupational class amplifies the risk of disability retirement among employees with cardiovascular disease (CVD) is unknown. We examined this issue in two prospective cohort studies. Methods: In the Finnish Public Sector Study and the Helsinki Health Study (n = 50.799 employees), prevalent CVD (coronary heart disease or stroke, n= 1269) was ascertained using records from national health registers, self-reported doctor-diagnosed diseases, and Rose Angina Questionnaire. Data linkage to national pension registers allowed the follow up of disability retirement among the participants for a mean of six years. We analysed the associations of occupational class and CVD with disability retirement using Cox regression, tested interactions between occupational class and prevalent CVD in predicting disability retirement by calculating the Synergy Index, and pooled the results from the two studies using fixed-effect meta-analysis. Results: Compared with the participants from high occupational class and no CVD, the participants from the low occupational class without CVD had a 2.13-fold (95% CI 1.97-2.30), those with high occupational class and CVD a 2.18-fold (1.73-2.74); and those with both low occupational class and CVD a 4.49-fold (3.83-5.26) risk of disability retirement. A Synergy Index of 1.55 (1.16-2.06) suggested a greater than additive effect for low occupational class and CVD in combination. Conclusions: Individuals with both low occupational class and CVD are at a particularly high risk of premature exit from the labour market due to work disability. These findings suggest that better preventive strategies are needed to improve prognosis in this risk group. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Breast cancer is the most common cancer among women in Western countries with clear socioeconomic differences. Higher occupational class is associated with higher breast cancer incidence but with better survival from the disease, whereas lower occupational class is associated with higher risk of sickness absence. We are not aware of previous studies examining changes over time in occupational class differences in sickness absence due to breast cancer. This paper focuses on occupational class differences in the incidence and duration of sickness absence due to breast cancer over the period of 2005&ndash, 2013. Age-adjusted occupational class differences in the cumulative incidence and duration of sickness absence due to breast cancer were calculated utilising a nationally representative 70% random sample of employed Finnish women aged 35&ndash, 64 years (yearly N varying between 499,778 and 519,318). The results show that higher occupational class was associated with higher annual cumulative incidence of sickness absence due to breast cancer. Lower occupational class was associated with longer duration of absence. Occupational class differences in both cumulative incidence and duration of absence remained broadly stable. As a conclusion, these results suggest that measures should be targeted particularly to promotion of work capacity among employees with breast cancer in lower occupational classes.

Objective: Childhood disadvantage is associated with a higher risk of adult obesity, but little is known about its associations with body mass index (BMI) trajectories during adulthood. This study aimed first to identify adulthood BMI trajectories, and second to investigate how childhood disadvantage is associated with trajectory group membership. Methods: Data from the Helsinki Health Study, a longitudinal cohort study of initially 40- to 60-year-old employees of the City of Helsinki in Finland, were used. The baseline survey was conducted in 2000–2002, and similar follow-up surveys in 2007, 2012, and 2017. Based on self-reported BMI, participants’ (n =5,266; 83% women) BMI trajectories, including their retrospectively reported BMI at the age of 25 years, were examined. Data on childhood disadvantage, including parental education and 7 types of childhood adversity (their own serious illness; parental divorce, death, mental disorder, or alcohol problems; economic difficulties at home; and peer group bullying) before the age of 16 years, were obtained from the baseline survey. Group-based trajectory modeling was used to identify BMI trajectories, and multinomial logistic regression to analyze the odds for trajectory group membership for the disadvantage variables. Results: Four ascending BMI trajectories in women and men were found: persistent normal weight (trajectory 1; women 35% and men 25%), normal weight to overweight (trajectory 2; women 41% and men 48%), normal weight to class I obesity (trajectory 3; women 19% and men 23%) and overweight to class II obesity (trajectory 4; women 5% and men 4%). Compared to trajectory 1, women with multiple adversities and repetitive peer bullying in childhood had greater odds of belonging to trajectories 3 and 4, whereas men with parental alcohol problems had greater odds of belonging to trajectory 4. For women and men, a low level of parental education was associated with a higher-level BMI trajectory. Conclusions: Low parental education for both genders, multiple adversities and repetitive peer bullying in childhood among women, and parental alcohol problems among men increased the odds of developing obesity during adulthood. Further studies are needed to clarify how gender differences modify the effects of childhood disadvantage on adult BMI trajectories. Objective: Childhood disadvantage is associated with a higher risk of adult obesity, but little is known about its associations with body mass index (BMI) trajectories during adulthood. This study aimed first to identify adulthood BMI trajectories, and second to investigate how childhood disadvantage is associated with trajectory group membership. Methods: Data from the Helsinki Health Study, a longitudinal cohort study of initially 40- to 60-year-old employees of the City of Helsinki in Finland, were used. The baseline survey was conducted in 2000–2002, and similar follow-up surveys in 2007, 2012, and 2017. Based on self-reported BMI, participants’ (n =5,266; 83% women) BMI trajectories, including their retrospectively reported BMI at the age of 25 years, were examined. Data on childhood disadvantage, including parental education and 7 types of childhood adversity (their own serious illness; parental divorce, death, mental disorder, or alcohol problems; economic difficulties at home; and peer group bullying) before the age of 16 years, were obtained from the baseline survey. Group-based trajectory modeling was used to identify BMI trajectories, and multinomial logistic regression to analyze the odds for trajectory group membership for the disadvantage variables. Results: Four ascending BMI trajectories in women and men were found: persistent normal weight (trajectory 1; women 35% and men 25%), normal weight to overweight (trajectory 2; women 41% and men 48%), normal weight to class I obesity (trajectory 3; women 19% and men 23%) and overweight to class II obesity (trajectory 4; women 5% and men 4%). Compared to trajectory 1, women with multiple adversities and repetitive peer bullying in childhood had greater odds of belonging to trajectories 3 and 4, whereas men with parental alcohol problems had greater odds of belonging to trajectory 4. For women and men, a low level of parental education was associated with a higher-level BMI trajectory. Conclusions: Low parental education for both genders, multiple adversities and repetitive peer bullying in childhood among women, and parental alcohol problems among men increased the odds of developing obesity during adulthood. Further studies are needed to clarify how gender differences modify the effects of childhood disadvantage on adult BMI trajectories.

Background Alcohol consumption is a significant cause of disease, death and social harm, and it clusters with smoking tobacco and an unhealthy diet. Using automatically registered retail data for research purposes is a novel approach, which is not subject to underreporting bias. Based on loyalty card data (LoCard) obtained by a major Finnish retailer holding a market share of 47%, we examined alcohol expenditure and their associations with food and tobacco expenditures. Methods The data consisted of 1,527,217 shopping events in 2016 among 13,274 loyalty card holders from southern Finland. A K-means cluster analysis was applied to group the shopping baskets according to their content of alcoholic beverages. The differences in the absolute and relative means of food and tobacco between the clusters were tested by linear mixed models with the loyalty card holder as the random factor. Results By far, the most common basket type contained no alcoholic beverages, followed by baskets containing a small number of beers or ciders. The expenditure on food increased along with the expenditure on alcoholic beverages. The foods most consistently associated with alcohol purchases were sausages, soft drinks and snacks. The expenditure on cigarettes relative to total basket price peaked in the mid-price alcohol baskets. Conclusion Clustering of unhealthy choices occurred on the level of individual shopping events. People who bought many alcoholic beverages did not trim their food budget. Automatically registered purchase data provide valuable insight into the health behaviours of individuals and the population. Electronic supplementary material The online version of this article (10.1186/s12889-019-7096-3) contains supplementary material, which is available to authorized users.

Purpose Physical work exposures and common mental disorders (CMD) have been linked to increased risk of work disability, but their joint associations with disability retirement due to any cause, mental disorders or musculoskeletal diseases have not been examined. Methods The data for exposures and covariates were from the Finnish Helsinki Health Study occupational cohort surveys in 2000–2002, 2007 and 2012. We used 12,458 observations from 6159 employees, who were 40–60 years old at baseline. CMD were measured by the General Health Questionnaire (GHQ-12, cut-off point 3+). Four self-reported work exposures (hazardous exposures, physical workload, computer and shift work) were combined with CMD and categorized as “neither”, “work exposure only”, “CMD only”, and “both”. Associations with register-based disability retirement were assessed with Cox proportional hazards models for sample survey data adjusting for confounders over 5-year follow-up. Additionally, synergy indices were calculated for the combined effects. Results Those reporting CMD and high physical workload had a greater risk of disability retirement due to any cause (HR 4.26, 95% CI 3.60–5.03), mental disorders (HR 5.41, 95% CI 3.87–7.56), and musculoskeletal diseases (HR 4.46, 95% CI 3.49–5.71) when compared to those with neither. Synergy indices indicated that these associations were synergistic. Similar associations were observed for CMD and hazardous exposures, but not for combined exposures to CMD and computer or shift work. Conclusions Identification of mental health problems among employees in physically demanding jobs is important to support work ability and reduce the risk of premature exit from work due to disability.

Purpose We developed a job exposure matrix (JEM) to study the association between long-term exposure to heavy physical effort or heavy lifting and carrying at work with disability pension due to musculoskeletal disorders and premature all-cause mortality. Methods Exposure to heavy physical effort at work during 1996–2005 was estimated with JEM developed for this study population, where the exposure was based on occupational titles of the participants. We included all employees of the City of Helsinki, Finland, who had annual data of exposure for 8–10 years (1996–2005, n = 18387). The outcome variables were register-based, and the follow-up was from 2006 until 2015. The risk estimates were evaluated using competing risk survival analysis. Results There were 530 (3%) disability pension events due to musculoskeletal disorders during the 10-year follow-up. After adjustment for sex, age, education and chronic diseases, employees in the second (SHR = 1.46, 95% CI 1.05–2.05), third (SHR = 2.73, 95% CI 2.00–2.29), and the highest exposure quartile (SHR = 2.56, 95% CI 1.88–3.50) had a higher risk of musculoskeletal disability pension than employees in the lowest quartile. A total of 110 (4%) men and 266 (2%) women died during the follow-up. Men in the third quartile (SHR = 2.29, 95% CI 1.23–4.24), and women in the highest exposure quartile (SHR = 1.54, 95% CI 0.99–2.41) had a higher risk of premature mortality than those in the lowest quartile. Conclusions Eight to ten years of exposure to heavy physical effort at work is strongly associated with disability pension due to musculoskeletal disorders. This exposure also increases the risk of premature mortality, particularly among men. Electronic supplementary material The online version of this article (10.1007/s00420-018-1393-5) contains supplementary material, which is available to authorized users.

ObjectivesPain is linked to an increased risk of sickness absence (SA); however, the extent to which unmeasured time-invariant differences explain this association is yet unknown. Therefore, we determined the within-individual associations between pain and short-term (in the survey year) and long-term (2 years following the survey years) SA risk in high and low occupational classes while controlling for the potential bias due to unobservable time-invariant characteristics.MethodsThe Helsinki Health Study data consisting of midlife public sector employees with mailed surveys from up to four time points, and SA record linkage were used (3983 persons). The within-individual estimates were calculated using hybrid negative binomial regression models.ResultsAcute/subacute pain was associated with a 13% increase in the rate of short-term SA days (incidence rate ratio 1.13 [95% CI 1.01 to 1.27]), while the association was somewhat stronger for chronic pain (1.32 [1.19–1.47]). For the employees in the low occupational class, these associations were robust (1.29 [1.10–1.50] for acute/subacute and 1.43 [1.23–1.66] for chronic pain), whereas only chronic pain was associated with SA among those in the high occupational class (1.25 [1.08–1.46]). Chronic pain was also associated with SA days in the long term without occupational class differences. Similar results were obtained for multisite pain (pain in several locations).ConclusionsThese results indicate that particularly chronic and multisite pain have a within-individual link to SA but ignoring unobservable differences between those reporting pain and those not might yield overstated effect sizes. Pain might have a different relation to SA in low and high occupational classes.

Objective We examined trajectories of work disability, indicated by sickness absence and disability retirement, among midlife public sector employees with and without common mental disorders (CMD) at baseline. We also examined adverse childhood events, occupational class, long-standing illness and health behaviour as determinants of the trajectories. Methods A sample from the Helsinki Health Study was extracted comprising 2350 employees. Baseline characteristics were obtained from mail surveys conducted in 2000–2 and 2007. CMD were measured by the General Health Questionnaire. Participants were followed between the ages of 50–59. Work disability trajectories were modelled by the annual number of work disability months in group-based trajectory analysis. Multinomial regression was used to predict trajectory group memberships. Results Three trajectories were identified: no work disability (consisting 59% of the all employees), stable/low (31%) and high/increasing disability (10%). Employees with CMD were more likely to belong to the stable/low (odds ratio 1.73 [95% confidence interval 1.37–2.18]), and the high/increasing (2.55 [1.81–3.59]) trajectories. Stratified models showed that the determinants of the trajectories were largely similar for those with CMD compared to those without CMD except that obesity was a somewhat stronger predictor of the high/increasing trajectory among employees with CMD. Limitations The focus on midlife public sector employees limits the generalisability to other employment sectors and younger employees. Conclusions CMD were strongly associated with a trajectory leading to early exit from employment and a stable/low work disability trajectory. These findings have implications for interventions promoting work ability of employees with mental ill-health.

Background Socioeconomic differences in smoking and other tobacco use are prevalent in adolescents. Less is known about the association between intergenerational social mobility and tobacco use. Methods Five waves of national cross-sectional School Health Promotion Study during 2008–2017 in Finland were used, including non-academically and academically oriented adolescents (15–21 years, N = 384,379). The adolescents' educational orientation was compared with the educational track of the parents as a proxy for intergenerational social mobility, which was used as the independent variable in regression models to examine the differences in daily smoking and daily snus use. Results Smoking declined in all mobility groups over time, but remained more prevalent among non-academically oriented adolescents among boys and girls. Daily snus use among boys increased over time in all mobility groups. Multiple adjusted models showed that upward mobility and downward mobility are differently associated with tobacco use, the latter increasing the probability of tobacco use compared with the stable high group (boys: smoking: OR = 5.24, 95% CI 5.02–5.46; snus use: OR = 1.57, 95% CI 1.50–1.66). In smoking, absolute socioeconomic differences between the mobility groups decreased over time while relative differences increased. In snus use, both absolute and relative differences increased. Conclusions Adolescent smoking and snus use associate strongly with the adolescent's educational track, irrespective of the social mobility class. Non-academically oriented adolescents have an increased risk of tobacco use. The academic and non-academic orientation should already be taken into account in tobacco use prevention in basic education.

Background The impact of retirement on health-related functioning, an important indicator of individual´s ability to function in everyday life, is poorly understood. Thus the aim of this study was to examine the association between transition to retirement, and changes in physical and mental health functioning among Finnish municipal employees. Methods Follow-upsurvey data were collected among ageing employees of the City of Helsinki, Finland, at three Phases: 1 (2000–2002), 2 (2007) and 3 (2012). Physical and mental health functioning were measured using the Short-Form 36 questionnaire at each Phase. Retirees between Phases 1 and 3 were identified from the national registers of the Finnish Centre for Pensions: Full-time statutory retirement (n=1464), part-time retirement not due to health reasons (n=404) and disability retirement due to health reasons (n=462). Generalised estimating equations were used to study the associations between transition to retirement and changes in health functioning. We also examined whether changes in functioning vary by gender, occupational status, or different health- and life-style factors. Results Statutory and part-time retirement were not associated with changes in physical health functioning during retirement transition process when adjusting for gender and age (β 0.1, 95% CI −0.3 to 0.5 and −1.0,–1.8 to 0.1, respectively), whereas clear decline was observed among disability retirees (−4.3,–5.4 to −3.2). Higher occupational class before retirement and sedentary lifestyle were associated with greater decline in physical health functioning. Mental health functioning improved during the retirement transition process among statutory and part-time retirees (1.9, 1.4 to 2.4 and 2.0, 1.0 to 3.0, respectively) while no association was observed among disability retirees (−0.3,–1.7 to 1.0). Conclusion Disability retirement was associated with decrease in physical health functioning, and statutory retirement with a slight improvement in mental health functioning. Evidence on changes in physical and mental functioning during retirement transition process may provide useful information for interventions to promote healthy ageing.

Background In January 2018, the legal limit for alcoholic beverages in grocery stores changed from 4.7 to 5.5 % alcohol. The increased availability of stronger beer, cider and ready-to-drink beverages was expected to increase the total amount of 100% alcohol bought. The study aimed to examine how the change in alcohol legislation affected the purchasing of 100% alcohol from grocery stores by comparing the years 2017 and 2018. Methods The study data consisted of 47,066 loyalty card holders of Finland's largest retail chain, who gave their consent and provided background information by an online questionnaire. The data contained the type, volume and alcoholic content of the purchases, from which we calculated the amount of 100% alcohol bought. The mean individual alcohol purchases in the years 2017 and 2018 were compared by age, gender, level of education and household income using repeated measurements ANOVA models. Results There was only a small, non-significant change in the total amount of 100% alcohol between 2017 and 2018 (mean 1.9 l and 2.0 l, respectively, p = 0.220). Lower income was associated with a decrease in total 100% alcohol purchased, whereas higher income groups showed an increase. Increase in 100% alcohol bought as ready-to-drink beverages was seen in all population groups. Conclusions The availability of stronger alcoholic beverages in grocery stores did not result in a notable overall increase in total purchases of 100% alcohol. The increased purchases of alcohol as ready-to-drink beverages were, on the average, compensated for by decreased purchases of alcohol as other beverages. The association of income with total alcohol purchases may indicate the effect of price in consumer behavior. Key messages The raise in the legal limit of alcohol content raised did not result in a significant increase in the total amount of 100% alcohol bought from grocery stores. Alcohol purchased as ready-to-drink beverages increased in all population groups.

Background Mental ill-health in young adults is a major public health and work-life problem. We examined in a quasi-experimental design whether occupational psychologist appointment can reduce subsequent sickness absence due to mental disorders among young Finnish employees. Methods The present study was conducted among 18-39-year-old employees of the City of Helsinki using register data from the City of Helsinki and the Social lnsurance Institution of Finland. We used Wald test to compare the differences in sickness absence days due to mental disorders (ICD-10, F-diagnosed) between those treated (occupational psychologist appointment for work ability support) and the non-treated (no psychologist appointment) during a one year follow-up. The full sample (n = 2156, 84% women) consisted of employees with mental disorder diagnosed sickness absence during 2009-2014. To account for the systematic differences between the treated and non-treated, the participants were matched according to their characteristics (age, sex, occupational class, education, previous sickness absence and psychotropic medication). The matched sample included 886 participants. We excluded those with treatment before the treatment screening time (± 3 months to the end of sickness absence period), non-treated with treatment during the follow-up and those that could not be matched (lack of common support). Results In the full sample, the mean of sickness absence days due to mental disorders was 17.7 (95% CI, 11.4, 24.1) days for those treated (n = 240) and 23.2 (95% CI, 20.5, 25.9) days for non-treated (n = 1916), difference being non-significant. The corresponding figures in the matched sample were (16.8, 95% CI, 9.5-24.1) for those treated (n = 195) and (27.8, 95% CI, 22.6-32.9) for non-treated (n = 691), difference being statistically significant (p = 0.02). Conclusions This quasi-experiment suggests that seeing an occupational psychologist to support work ability may be reduce mental health related sickness absence. Key messages We showed that supporting work ability at an early stage may prevent sickness absence due to mental disorders. More efforts to provide early stage support for maintaining work ability may prove useful in reducing sickness absence rates in younger employees.

ObjectivesThe determinants of poor functioning and subsequent early exit from work are well established but very little is known about the positive determinants of maintaining good functioning among the ageing workforce. We investigated modifiable determinants of maintaining good mental and physical health functioning.MethodsWe used prospective survey data collected across four waves among the midlife employees of the City of Helsinki, Finland, 2000–2017 (n=3342). Health functioning was repeatedly measured using the Short Form 36 (SF-36) inventory. Trajectories of mental and physical health functioning were separately examined using group-based trajectory analysis. Multinomial logistic regression models were fitted to examine determinants of each trajectory.ResultsFour trajectory solutions for the developmental patterns in health functioning during the follow-up period were selected, with a slightly different shape of the first trajectory for mental and physical functioning: (1) continuously low (mental), low and decreasing (physical), (2) increasing, (3) decreasing and (4) continuously high functioning. After adjustments, the employees in the continuously high mental health functioning group were more likely to have optimal job demands, high job control, no sleep problems and no binge drinking behaviour. Employees in the continuously high physical functioning group had more likely low levels of physically strenuous work and hazardous working environment and no sleep problems and normal weight.ConclusionHigh job control, good sleep and avoiding binge drinking may help maintain good mental health functioning. Low levels of physical or environmental work exposures, good sleep and recommended healthy weight may support maintenance of good physical health functioning among ageing employees.

Occupational health service (OHS) is the main provider of primary care services for the working population in Finland. We investigated whether socioeconomic differences in the utilization of OHS predict sickness absence (SA) due to mental disorders. We used register linkage data covering the employees of the City of Helsinki aged 18&ndash, 34 years (N = 6545) and 35&ndash, 54 years (N = 15,296) from 2009 to 2014. The outcome was medically certified long-term (over 11 days) SA due to mental disorders. Cox regression analyses were performed to obtain hazard ratios (HR) and their 95% confidence intervals (CIs). Employees with low socioeconomic position (SEP) used OHS more frequently. The number of OHS visits independently predicted SA due to mental disorders. HRs were 1.59 (95% CI 1.35, 1.86) for those with frequent visits and 1.73 (95% CI 1.30, 2.29) for those with a clustered visit pattern among 18&ndash, 34 year old employees, and 1.46 (95% CI 1.18, 1.81) and 1.41 (95% CI 1.14, 1.74) among 35&ndash, 54 year old employees, respectively. In both age groups, lower education and routine non-manual worker position indicated the highest probability of SA. Low SEP predicts both high OHS utilization and subsequent SA due to mental disorders. Medical records may be used to accurately predict future SA, and the results indicate that preventive measures should be targeted particularly to younger employees with lower SEP.

Sickness absence is associated with poor health outcomes, but little is known about its consequences for general mental health. This study examined the associations between diagnosis-specific sickness absence and subsequent common mental disorders (CMD). Register data on medically certified all-cause sickness absence and sickness absence due to mental disorders and musculoskeletal diseases from 2004&ndash, 2007 were linked to the Helsinki Health Study 2007 and 2012 survey data on City of Helsinki employees in Finland (N = 3560). Using logistic regression and multinomial logistic regression, we analysed the associations between the total number of reimbursed sickness absence days in 2004-7 and CMD General Health Questionnaire 12) in 2007 and 2012 and CMD changes. Sickness absence due to mental disorders (age- and sex-adjusted odds ratio (OR)range: 2.16 to 2.93), musculoskeletal diseases (OR range: 2.79 to 2.93) and all-cause sickness absence (OR range: 1.48 to 3.20) were associated with CMD in 2007. In 2012, associations with lower ORs were observed. Associations were also found with changing and especially repeated (OR range: 1.49 to 3.40) CMD. The associations remained after adjusting for work-related covariates and health behaviours. Diagnosis-specific sickness absence showed persistent associations with subsequent CMD and their changes. Attention should be paid to both the short- and long-term consequences of sickness absence for employee mental health.

This cohort study examines disease-free life-years in participants with varying combinations of lifestyle risk factors. Question Are different combinations of lifestyle factors associated with years lived without chronic diseases? Findings In a multicohort study of 116 & x202f;043 participants, a statistically significant association between overall healthy lifestyle score and an increased number of disease-free life-years was noted. Of 16 different lifestyle profiles studied, the 4 that were associated with the greatest disease-free life years included body mass index lower than 25 and at least 2 of 3 factors: never smoking, physical activity, and moderate alcohol consumption. Meaning Various healthy lifestyle profiles appear to be associated with extended gains in life lived without type 2 diabetes, cardiovascular and respiratory diseases, and cancer. Importance It is well established that selected lifestyle factors are individually associated with lower risk of chronic diseases, but how combinations of these factors are associated with disease-free life-years is unknown. Objective To estimate the association between healthy lifestyle and the number of disease-free life-years. Design, Setting, and Participants A prospective multicohort study, including 12 European studies as part of the Individual-Participant-Data Meta-analysis in Working Populations Consortium, was performed. Participants included 116 & x202f;043 people free of major noncommunicable disease at baseline from August 7, 1991, to May 31, 2006. Data analysis was conducted from May 22, 2018, to January 21, 2020. Exposures Four baseline lifestyle factors (smoking, body mass index, physical activity, and alcohol consumption) were each allocated a score based on risk status: optimal (2 points), intermediate (1 point), or poor (0 points) resulting in an aggregated lifestyle score ranging from 0 (worst) to 8 (best). Sixteen lifestyle profiles were constructed from combinations of these risk factors. Main Outcomes and Measures The number of years between ages 40 and 75 years without chronic disease, including type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease. Results Of the 116 & x202f;043 people included in the analysis, the mean (SD) age was 43.7 (10.1) years and 70 & x202f;911 were women (61.1%). During 1.45 million person-years at risk (mean follow-up, 12.5 years; range, 4.9-18.6 years), 17 & x202f;383 participants developed at least 1 chronic disease. There was a linear association between overall healthy lifestyle score and the number of disease-free years, such that a 1-point improvement in the score was associated with an increase of 0.96 (95% CI, 0.83-1.08) disease-free years in men and 0.89 (95% CI, 0.75-1.02) years in women. Comparing the best lifestyle score with the worst lifestyle score was associated with 9.9 (95% CI 6.7-13.1) additional years without chronic diseases in men and 9.4 (95% CI 5.4-13.3) additional years in women (P

Background Job strain is implicated in many atherosclerotic diseases, but its role in peripheral artery disease ( PAD ) is unclear. We investigated the association of job strain with hospital records of PAD , using individual‐level data from 11 prospective cohort studies from Finland, Sweden, Denmark, and the United Kingdom. Methods and Results Job strain (high demands and low control at work) was self‐reported at baseline (1985–2008). PAD records were ascertained from national hospitalization data. We used Cox regression to examine the associations of job strain with PAD in each study, and combined the study‐specific estimates in random effects meta‐analyses. We used τ 2 , I 2 , and subgroup analyses to examine heterogeneity. Of the 139 132 participants with no previous hospitalization with PAD , 32 489 (23.4%) reported job strain at baseline. During 1 718 132 person‐years at risk (mean follow‐up 12.8 years), 667 individuals had a hospital record of PAD (3.88 per 10 000 person‐years). Job strain was associated with a 1.41‐fold (95% CI, 1.11–1.80) increased average risk of hospitalization with PAD . The study‐specific estimates were moderately heterogeneous (τ 2 =0.0427, I 2 : 26.9%). Despite variation in their magnitude, the estimates were consistent in both sexes, across the socioeconomic hierarchy and by baseline smoking status. Additional adjustment for baseline diabetes mellitus did not change the direction or magnitude of the observed associations. Conclusions Job strain was associated with small but consistent increase in the risk of hospitalization with PAD , with the relative risks on par with those for coronary heart disease and ischemic stroke.

Background Alcohol use epidemiology is facing challenges as survey response rates decline. In addition, population surveys fail to capture a large proportion of alcohol consumed and are expensive to conduct. This study aims to aid in complementing traditional epidemiological methods by validate grocery purchase data in the research on population alcohol use. Methods The LoCard study subjects were loyalty card holders of a grocery retail co-operative, which possessed more than 45 % market share in Finland. One third of those who consented to the analyses of their grocery purchases were presented a questionnaire including a Food Frequency Questionnaire on the web; N = 11,818 responded. The relationship between beer purchase frequency and self-reported beer drinking frequency was studied for association and agreement in different subgroups using crosstabulations and Poisson regression modeling. Results The association between beer purchase frequency and self-reported beer drinking frequency was good (Gamma = .556). The agreement between beer purchase frequency and drinking frequency was only fair (Kappa = .189). Limiting the data to those single adult households that reported making at least 61 % of their grocery purchases from this grocery retailer and collapsing the frequency categories to three instead of six increased the agreement to good (Kappa = .463). Conclusions Information on beer purchase frequency from the loyalty card database can be used to rank people according to their drinking frequency and to estimate beer drinking frequency with fair to good accuracy, depending on what share of grocery purchases they make from the grocery retailer in question.

Introduction Chronic pain is common among employees. Childhood adversities are known determinants of adult health but their association with chronic pain in adulthood is largely unknown. We aimed to examine the associations between childhood adversities and chronic pain among midlife employees. Methods Data on seven childhood adversities and chronic pain (pain having lasted at least 3 months) were derived from the baseline survey of the Helsinki Health Study collected in 2000 to 2002 among 40 to 60-year-old employees of the City of Helsinki in Finland. The study included 8140 employees of whom 80% were women. The analyses were made by logistic regression and the results are presented as odds ratios (OR) and their 95% confidence intervals (CI). Age, gender, father’s education, own education, marital status, working conditions, sleep problems and common mental disorders were included as covariates. Results Economic difficulties in the childhood family (OR 1.60, 95% CI 1.41-1.81), childhood illness (1.74, 1.45-2.08), parental divorce (1.26, 1.07-1.48), parental alcohol problems (1.34, 1.18-1.52) and bullying in school or among peers (1.59, 1.37-1.89) were associated with an increased odds of chronic pain in midlife. Adjusting for father’s education, own education and marital status did not contribute to the associations. Working conditions, sleep problems and common mental disorders slightly attenuated the associations between childhood adversities and chronic pain. Conclusions Childhood adversities associate to chronic pain in midlife. The results suggest that promoting well-being among children might lead to less pain decades after childhood. Key messages Childhood adversities are associated with chronic pain in adulthood. Considering well-being among children might lead to less pain decades after childhood.

Background Receipt of sickness allowance (SA), which in the Finnish benefit system functions as compensation for loss of income due to over 10-days-long sickness absence, is more prevalent in lower socioeconomic groups. As SA is an earnings-related benefit and higher occupational classes have on average higher previous income, their share of SA expenditure must be higher than their share of SA days would suggest. However, the allocation of SA costs to different socioeconomic groups is not known. The aim of this study was to compare occupational classes in terms of their shares of total paid SA days and SA benefit costs. Methods We used register data covering the total working-age (16-64) employed population of Finland at the end of 2016 (N = 2.2 million), with linked data on paid sickness allowances during 2017. Yearly accumulated sickness allowance days and allowance costs, paid by the Social Insurance Institution of Finland, were calculated for upper and lower non-manual employees, manual workers and self-employed persons. Results Of the total yearly SA days of the employed population, 13% were paid to upper non-manual employees, 40% to lower non-manual employees, 37% to manual workers and 10% to the self-employed (the respective shares of these occupational classes of the employed population were 23%, 36%, 30% and 11 %). The average gross allowance was 77€ per day among upper non-manuals and between 54€ and 60€ in the other groups. Accordingly, upper non-manuals accounted for a larger share of the SA costs compared to their share of SA days: the proportions of costs were 16%, 39%, 36% and 9% in each occupational class, respectively. Conclusions The results show that as the average amount of daily sickness allowance is distributed in an opposite manner compared to the prevalence and length of sickness allowance spells, socioeconomic differences in sickness allowance costs are smaller than differences in the prevalence of sickness allowance. Key messages Upper non-manual employees have a lower prevalence of sickness absence and shorter spells than other occupational groups. Because of higher earnings-related sickness allowance among upper non-manual employees, their share of sickness allowance costs is higher than their share of sickness allowance days.

Background We examined the developmental trajectories of multisite musculoskeletal pain to acquire the developmental patterns of musculoskeletal pain among midlife municipal employees and whether pain trajectories associate with common mental disorders or behaviors. Methods Middle-aged (44 to 67 years) municipal employees from the city of Helsinki were studied. The baseline survey was conducted in 2000-02 (N = 8960) and two follow-up surveys in 2007 (N = 7332) and 2012 (N = 6809). Repeated measurement of musculoskeletal pain in four anatomical sites was obtained. Trajectories of number of pain sites (0-4) were modeled using latent class growth analysis (n = 6527). Common mental disorders were measured using the General Health Questionnaire 12-item version (GHQ-12). Information on behavior factors, morbidity, and the socioeconomic position was obtained from the questionnaire survey. Associations of baseline factors with pain trajectories were assessed by multinomial logistic regression. Results We found four distinct trajectories of the number of pain sites: high (15%), increasing (24%), decreasing (20%) and low (41%). In multivariable multinomial regression model high, increasing and decreasing trajectories were strongly associated with higher odds with both medium and high common mental disorders. However, the magnitude of the association was much higher for high vs. low trajectory group due to medium (OR 3.70, 95% CI 2.81-4.89) and high (OR 5.37, 95% 4.36-6.61) common mental disorders. Mean score of common mental disorders was also highest for high trajectory group. High, increasing and decreasing trajectory group were also associated with poor behavior, having one or more musculoskeletal comorbidities and low socioeconomic position. Conclusions Multisite musculoskeletal pain remain persistent among midlife employees and those high trajectories of musculoskeletal pain are associated with common mental disorders, behavior, and musculoskeletal comorbidities. Key messages Four distinct trajectories of number of pain sites was identified among midlife municipal employees. High common mental disorders and poor behavior, as well as low socioeconomic position and musculoskeletal comorbidities were strongly associated with pain trajectories.

Background Health inequalities across countries and populations are well established, but little is known about their long-term trends and even less about factors shaping the trends. We examined the magnitude of absolute and relative educational inequalities in self-rated health over 36 years among adult Finns, considering individual covariates and macro-economic fluctuations. Methods Data were derived from representative annual surveys in 1979-2014 among men and women and covered ages 25-64. Nine periods were used (n = 8870-14235). Our health outcome was less-than-good self-rated health and our socioeconomic indicator was completed years of education as a continuous variable. Nine time-variant sociodemographic and health-related covariates were included. Educational inequalities in self-rated health were examined by relative index of inequality (RII) and slope index of inequality (SII). Results Linear trends suggested stable overall development in both relative and absolute health equalities during 36 years. Period specific analyses showed that among men relative and absolute inequalities narrowed immediately after economic recession in Finland in 1993-94, and among women, inequalities narrowed during global financial crisis in 2008-09. Adjusting for covariates reduced the magnitude of inequalities throughout the nine periods, but affected little the period specific patterning of health inequalities. Conclusions Educational inequalities in self-rated health persisted during 36 years in Finland. While among men and women health inequalities narrowed during and after recessions, they widened soon back to the pre-recession level. The perseverance calls for powerful measures to tackle health inequalities, such as preventing unhealthy behaviours, obesity and unemployment in particular among the lower educated. Key messages Health inequalities have persisted in Finland over 36 years, with unhealthy behaviors and unemployment affecting their magnitude. Health inequalities narrowed during economic recessions, but widened soon back to pre-recession level.

Introduction Healthy behaviours are associated with better health in general but less is known about the combined associations of multiple healthy behaviours with mortality risk. We aimed to examine the associations of combined healthy behaviours with mortality risk over a 15-year follow-up among middle-aged employees. Methods Survey data, collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, was linked with complete register data on mortality from Statistics Finland (response rate 67%, written informed consent for register linkages 74%). Healthy behaviours included high leisure-time physical activity, non-smoking, no binge drinking and healthy food habits. Each healthy behaviour were dichotomized and assigned a value of one for healthy and zero for unhealthy. The number of healthy behaviours were summed together (score range 0-4). Cox regression models were fitted, and the follow-up continued until the end of 2015 (n = 6336). Confounders included age, sex, marital status, socioeconomic position and self-rated health. Results Of the respondents, 7% reported four healthy behaviours, 27% three, 34% two, 22% one and 9% no healthy behaviours. A total of 281 deaths occurred during the follow-up. Each healthy behaviour was individually associated with a reduced mortality risk, non-smoking having the strongest and healthy diet the weakest association. The combined association showed that those without any of the healthy behaviours (HR 2.8, 95% CI 1.51-5.29) and those with only one healthy behaviour (HR 1.89, 95% CI 1.04-3.43) had a higher mortality risk than those with four healthy behaviours. Instead, those with at least two healthy behaviours were not at an increased risk of mortality. Conclusions A low number of healthy behaviours predicted mortality among middle-aged employees. Efforts should be made to promote multiple healthy behaviours among the middle-aged to enhance health and prevent premature mortality. Key messages Almost one third of the respondents had no or only one healthy behaviour. A low number of healthy behaviours was associated with an increased risk of mortality.

Background Fruit and vegetable consumption (FVC) and leisure-time physical activity (LTPA) are associated with better health outcomes but less is known about their joint associations with the risk of mortality. We examined the joint associations of FVC and LTPA with premature mortality among midlife and ageing municipal employees, adjusting for key covariates. Methods Survey data collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, were linked with complete register data on mortality from Statistics Finland (4961 women, 1373 men; response rate 67%; written consent for register linkages 74%). FVC was dichotomised into daily or non-daily, and LTPA into high (>14 MET-hours/week including vigorous exercise) or low. Covariates included age, sex, marital status, socioeconomic position, binge drinking, smoking and self-rated health. Cox regression models were fitted. The follow-up continued until the event of death or the end of 2015. Results A total of 281 deaths occurred during the follow-up. The mortality rate was 7.1% in men and 3.7% in women. A gender interaction was found, showing differing associations for women and men. Men with both daily FVC and high LTPA had the lowest mortality risk (HR 0.19, 95% CI 0.06-0.63) after adjusting for covariates. Men with high LTPA and non-daily FVC also had a lower mortality risk (HR 0.51, 95% CI 0.29-0.90) compared to those with non-daily FVC and low LTPA. Women with daily FVC and high LTPA had a lower mortality risk initially, but after adjusting for covariates no statistically significant associations were observed. Conclusions The joint associations of FVC and LTPA with premature mortality differed between women and men. This could be related to gender differences in e.g. the causes of death, and further studies are needed to clarify this. Increasing FVC and LTPA might prevent premature mortality among men. Key messages Fruit and vegetable consumption jointly with physical activity decreased the risk of premature mortality among men only. Further studies are needed to clarify the gender difference which could be related to for example death causes.

Surprisingly little attention has been devoted to the theories, concepts and measurement of social class and socioeconomic position in social epidemiology. This is particularly surprising as the number studies on health inequalities has increased exponentially over the decades.1 Guidelines have though been proposed for the use of socioeconomic position in health research and we have learnt a lot about the nature, measurement and use of various socioeconomic indicators.2–4 However, the suggested socioeconomic classifications have often been pragmatic, based on occupation, education and income, grouped hierarchically following statistical authorities or ad hoc principles. So far, theoretical and conceptual issues and their integration to empirical analysis of health inequalities have remained largely a white spot. The theoretical work within the sociology of class has had almost non-existent consequences for research on health inequalities. Similarly, research on socioeconomic inequalities in health has seldom been considered in the sociology of class. Cross-fertilisation between theoretical and empirical work as well as between sociology of class and social epidemiology would deepen our understanding of social class and socioeconomic position in the production of health inequalities. The Marxian and the Weberian theories are the dominant social class traditions and these have influenced some subsequent class schemes and classifications. Wright’s neo-Marxian class theory draws on the Marxian tradition in its emphasis on people’s location in the occupational hierarchy based on production relations as well as power and control over access to economic and productive resources.5 Additionally, Wright’s theory draws on the Weberian tradition in its emphasis on skill and expertise, rendering the theory a …

Objective We examined the joint association of overweight and CMDs (common mental disorders) with diagnosis-specific disability retirement among midlife employees. Methods Baseline surveys (n = 8960, response rate 67%) were linked with registers of the Finnish Centre of Pensions. We calculated the hazard ratios (HRs) for disability retirement due to any, musculoskeletal, and mental diagnoses according to the International Classification of Diseases (ICD-10) with Cox regression analysis (mean follow-up 8.3 years) among normal-weight (body mass index 18.5 to 25 kg/m) and overweight (≥25 kg/m) participants with or without CMD (General Health Questionnaire-12 score ≥3). Results Overweight was associated with disability retirement due to any and musculoskeletal diagnoses and CMD with any and mental diagnoses. The risk for disability retirement was additively higher for those with both overweight and CMD. Conclusion Preventing overweight and CMD, and especially considering those with both conditions simultaneously, likely helps maintain work ability.

Objectives The aim this study was to examine the effect of changes in physical and psychosocial working conditions on physical health functioning among ageing municipal employees. Methods Follow-up survey data were collected from midlife employees of the City of Helsinki, Finland, at three time points: wave 1 (2000–2002), wave 2 (2007), and wave 3 (2012). Changes in physical and psychosocial working conditions were assessed between waves 1 and 2. Physical health functioning was measured by the physical component summary (PCS) of the Short-Form 36 questionnaire at each of the three waves. In total, 2784 respondents (83% women) who remained employed over the follow-up were available for the analyses. Linear mixed-effect models were used to assess the associations and adjust for key covariates (age, gender, obesity, chronic diseases, and health behaviors). Results Repeated and increased exposure to adverse physical working conditions was associated with greater decline in physical health functioning over time. In contrast, decrease in exposures reduced the decline. Of the psychosocial working conditions, changes in job demands had no effects on physical health functioning. However, decreased job control was associated with greater decline and repeated high or increased job control reduced the decline in physical health functioning over time. Conclusions Adverse changes in physical working conditions and job control were associated with greater decline in physical health functioning over time, whereas favorable changes in these exposures reduced the decline. Preventing deterioration and promoting improvement of working conditions are likely to help maintain better physical health functioning among ageing employees.

Aims: This study aimed to investigate whether hospitalisation is associated with increased risk of disability retirement differently across four occupational classes. Methods: 170,510 employees of the City of Helsinki, Finland were followed from 1990 to 2013 using national registers for hospitalisations and disability retirement. Increases in the risk of disability retirement after hospitalisation for any cause, cardiovascular diseases, musculoskeletal disorders, mental disorders, malignant neoplasms, respiratory diseases and injuries were assessed across four occupational classes: professional, semi-professional, routine non-manual and manual, using competing risks models. Results: In general, hospitalisation showed a slightly more increased risk of disability retirement in the lower ranking occupational classes. Hospitalisation among women for mental disorders showed a more increased risk in the professional class (hazard ratio 14.73, 95% confidence interval 12.67 to 17.12) compared to the routine manual class (hazard ratio 7.27, 95% confidence interval 6.60 to 8.02). Occupational class differences were similar for men and women. The risk of disability retirement among women increased most in the routine non-manual class after hospitalisation for musculoskeletal disorders and injuries, and most in the professional class after hospitalisation for cardiovascular diseases. The corresponding risks among men increased most in the two lowest ranking classes after hospitalisation for injuries. Conclusions: Ill-health as measured by hospitalisation affected disability retirement in four occupational classes differently, and the effects also varied by the diagnostic group of hospitalisation. Interventions that tackle work disability should consider the impact of ill-health on functioning while taking into account working conditions in each occupational class.

Previous studies have found that troubled childhood family conditions have long-term detrimental effects on a person’s economic situation in adulthood. However, the mechanisms behind these effects are unclear. The aim of this study was to examine the associations between poor adolescent family relationships and the economic adversity in mid-adulthood and whether different adversities in early adulthood mediate this association. Participants of a Finnish cohort study at 16 years in 1983 were followed up when aged 22, 32 and 42 (N = 1334). Family relationships were measured according to adolescents’ perceived lack of emotional parental support (e.g. My mother is close to me (reversed)), lack of parental support in the individuation process and poor atmosphere at home. We analysed the direct effects of poor family relationships at age 16 on the economic adversity at age 42 and also indirect effects via various adversities at ages 22 and 32. The examined adversities were poor somatic and mental health, lack of an intimate relationship, low education and heavy drinking. Poor adolescent family relationships were associated with economic adversity in mid-adulthood. For women, poor relationships were associated with their economic adversity (42y) through poor mental health and low education in early adulthood. For men, the effect was transmitted via low education, although this was not the case after adjusting for school achievement in adolescence. The quality of family relationships in adolescence is associated with an individual’s economic situation well into mid-adulthood in women. Moreover, this association was not explained by family structure and parental SEP in adolescence. Early promotion of parent-child interaction, as well as health and education of individuals from troubled family conditions, might reduce economic inequality in adulthood.

Objectives: Mental disorders are a key cause of sickness absence (SA) and challenge prolonging working careers. Thus, evidence on the development of SA trends is needed. In this study, educational differences in long SAs due to mental disorders were examined in two age groups among employees of the City of Helsinki from 2004 to 2013. Methods: All permanently and temporarily employed staff aged 18-34 and 35-49 were included in the analyses (n=~27800 per year). SA spells of ≥14 days due to mental disorders were examined annually. Education was classified to higher and lower levels. Joinpoint regression was used to identify major turning points in SA trends. Results: Joinpoint regression models showed that lower educated groups had more long SAs spells due to mental disorders than those groups with higher education. SA trends decreased during the study period in all studied age and educational groups. Lower educated age groups had similar SA trends. Younger employees with higher education had the fewest SAs. Conclusions: A clear educational gradient was found in long SAs due to mental disorders during the study period. SA trends decreased from 2004 to 2013.

OBJECTIVES: We aimed to examine the association between changes in psychosocial working conditions and major weight gain among midlife women and men. Furthermore, we examined the associations separately among normal- and overweight participants. METHODS: We used survey data among employees of the City of Helsinki, Finland, from 2000–2002 (phase 1, N=8960), 2007 (phase 2, N=7332), and 2012 (phase 3, N=6814), with a final study sample of 4369 participants. We examined changes in job strain, job demands, and job control from phase 1 to 2. We defined major weight gain as ≥10% weight gain between phases 1 and 3 based on self-reported weight (kg). We performed logistic regression analysis adjusting for baseline age, marital status, and occupational class, stratifying by gender and by baseline body mass index. RESULTS: Job demands among both genders and job strain among women was associated with major weight gain. Furthermore, increased job demands [odds ratio (OR) 1.52, 95% CI 1.05–2.20] or increased job strain (OR 1.53, 95% CI 1.11–2.11) was associated with major weight gain among overweight women. Normal-weight men reporting decreased job demands (OR 4.11, 95% CI 1.48–11.40) and overweight men reporting increasing job demands (OR 2.93, 95% CI 1.26–6.82) exhibited higher odds of major weight gain. CONCLUSIONS: Associations between working conditions and weight gain appeared primarily weak. Our study suggests that overweight individuals might be at a higher risk of weight gain when facing psychosocial strain in the workplace.

Background There is contradictory evidence on the association between health check-ups and future morbidity. Among the general population, those with high socioeconomic position participate more often in health check-ups. The main aims of this study were to analyse if attendance to health check-ups are socioeconomically patterned and affect sickness absence over a 10-year follow-up. Methods This register-based follow-up study included municipal employees of the City of Helsinki. 13 037 employees were invited to age-based health check-up during 2000–2002, with a 62% attendance rate. Education, occupational class and individual income were used to measure socioeconomic position. Medically certified sickness absence of 4 days or more was measured and controlled for at the baseline and used as an outcome over follow-up. The mean follow-up time was 7.5 years. Poisson regression was used. Results Men and employees with lower socioeconomic position participated more actively in health check-ups. Among women, non-attendance to health check-up predicted higher sickness absence during follow-up (relative risk =1.26, 95% CI 1.17 to 1.37) in the fully adjusted model. Health check-ups were not effective in reducing socioeconomic differences in sickness absence. Conclusions Age-based health check-ups reduced subsequent sickness absence and should be promoted. Attendance to health check-ups should be as high as possible. Contextual factors need to be taken into account when applying the results in interventions in other settings.

Background: Long-term sickness absence (LTSA; >10 days) creates huge economic burden for employers and societies. Lifestyle behaviours and quality of sleep may reduce the risk of LTSA, but the possible savings achieved through improving these risk factors have been poorly quantified. We aimed to provide monetary estimates for the association of risk factors with cost of LTSA. Methods: The Helsinki Health Study is a cohort of employees of the City of Helsinki, Finland (n=8960, response rate 67%). In 2007, the participants received a questionnaire that gathered information on their lifestyle and sleep. A sum of the risk factors was calculated: Participants received one point for being a smoker; heavy alcohol user (>7 portions/week for women and >14 portions/week for men); physically inactive (